Sheena Cruz

Serve as the lead point of contact for clients and vendors, ensuring effective issue resolution, and strong relationships.

Collaborate with internal teams to meet client performance objectives, and ensure successful project implementations.

Manage ongoing account activities, and track progress on project status.

Lead client meetings, including progress updates, kick-offs, and annual reviews.

Resolve escalated customer service issues, and assist with high-severity requests.

Contribute to programs that reduce inventory and receivables losses.

Analyze key account metrics, and work with sales teams to grow opportunities within the territory.

Develop client operations plans aligned with company goals, and track performance.

Collect and analyze client data to identify trends and drive improvements.

Ensure customer satisfaction through surveys and continued service expansion.

Support a positive work environment, and assist in training new employees.

The role is divided into responsibilities for the Clinical Pharmacy Services Team for the Pharmacy Call Center.

Clinical outreach support and utilization management support.

Responsibilities vary based on business needs.

Serve as a direct member, pharmacy, and/or provider contact for pharmacy benefit information, clinical determinations program information.

Function as a liaison and subject matter expert related to client PBM systems and processes, specifically related to drug utilization management.

Support Medication Therapy Management, pharmacy outreach programs, refill reminders, and adherence calls.

Aid clinical pharmacy programs, including the collection of medication history data and pharmacy care plan initiation, under the guidance and direction of Clinical Pharmacists.

Managed over 40 customer calls and prior authorizations per day.

• Account managed contract pharmacy clients and prescribers, handling outstanding invoices, adjudication claims, reporting, and exceptions
• Oversaw the 340B drug purchasing program's operation and negotiated contracts between contract pharmacies and covered entities
• Managed pharmacy support calls, providing customer support, troubleshooting, and support ticket follow-up
• Closed at least ten new 340B agreements between hospital clients and pharmacy partners each quarter, exceeding quarterly goals
• Completed four hours of 340B Prime Vendor Program via Apexus 340B University OnDemand training

• Led patient navigator team, overseeing day-to-day tasks, and providing mentoring and training
• Obtained patient information to process prescriptions and refills and approval information to activate co-pay cards based on eligibility and prescriptions
• Assisted customers with accessing benefits and applying charges against co-pay cards
• Managed the financial assistance process for patients in need and facilitated appeals between patients, physicians, and insurance companies
• Gathered prior authorizations for oncology patients and liaised between insurance carriers and patients
• Coordinated prescription transfers between patients and pharmacies and followed-up to confirm receipt
• Completed over 65 prior authorizations on a weekly basis by training team best practices for closing between 50-75 authorizations a day
• Met revenue and customer satisfaction goals by educating patients on Medicare D drug coverage and options for both patient assistance programs and nonprofit programs for copay relief