Yyyyyy x. yyyyyy

Dynamic Clinical Manager who makes sound decisions to rexxxxxxect positively on specialty pharmacy field initiatives in alignment with a company s vision, value, and goals. Top Performer who offers a proven record of attaining a competitive advantage via solutions-centric critical thinking for insightful, change-driven results. Visionary Professional who rises above clinical challenges to improve the bottom line and achieve winning outcomes, including quickly adapting to evolving scenarios to reach high productivity levels, as well as independently resolving in-depth issues to boost success. Ambitious Self-Starter who exhibits up-to-date knowledge of national care management trends and statistics to support core objectives. Excellent Communicator who develops synergistic relationships with cross-geographical decision-makers, teams, and customers; who leads staff by example and with integrity; and who excels in fast-paced work environments.

Aetna Way Excellence Award Silver Award Winner (2015)

Developed new workxxxxxxows and expert clinical support for specialty drugs.

Aetna Way Excellence Award Silver Award Winner (2010)

Generated significant results by removing organizational barriers impacting cross-functional workxxxxxxow.

Aetna Spirit of Excellence Award Runner Up (2003)

Delivered excellence in customer service, including quickly responding to internal / external constituent needs.

Clinical Manager Specialty (2013 2017)

Capitalized on the opportunity to lead forward-thinking Specialty form management, criteria maintenance, and updates as Specialty Product Lead, including collaborating with technical product manager and pharmacists to provide ongoing support for implementation, management, and maintenance of Specialty Drug Programs. Developed and maintained Specialty precertification criteria for Aeta / CVS and Coventry / ESI, and oversaw criteria workgroup and ongoing enhancements and vendor management. Resourcefully communicated among clinicians, medical directors, NPL committee, and Medical Policy regarding NPL criteria development, maintenance, and revisions. Monitored prior authorization approval / denial rates. Personally handled development and / or writing of approval and denial letters, reasons, and system updates.

  Saved $16+ million via the seamless implementation of a comprehensive new review process.

  Managed Medical Pharmacy Denial Appeals trends for key improvement and ongoing growth.

  Contributed a focus on Precertification Clinical Support Programs implementation to the Specialty Precertification Operational Unit, including reviewing clinical policies and materials.

  Served as PA Specialty Product Clinical Lead tasked with collaborating with Specialty clinicians and CoverMyMeds to facilitate comprehensive criteria building for the efficient new ePA process.

  Collaborated with technical product manager on large transition project for pharmacy-covered drugs, including supporting all question sets, denial reasons, editing, training, and messaging.

  Served as Hepatitis C Specialty Review Process Co-Lead, including developing workxxxxxxow, policy, clinical assessments, reference, and training materials, as well as communicating updates and presentations for medical directors, Specialty Precertification, and Customer Care Units.

Yyyyyy x. yyyyyy ￨ Page Two ￨ (xxx-xxx-xxxx

Healthcare Manager Specialty Drug Precertification Operations (2009 2013)

Strategically steered Aetna Specialty Precertification initiatives, including mentoring and managing an 85-member team responsible for reviewing drugs on the National Precertification List, as well as those associated with customer service, nursing, inbound queue, care management, and UM nurse associates. Comprehensively presented overview of team to high-level leadership and CMS. Continually supported goals via process and program implementation, accurate budget administration, and proactive problem resolution.

  Collaborated with National Contracting on Dialysis Precertification.

  Ultimately obtained 2 large national contracts due to key project success.

  Partnered with employees to optimize workxxxxxxow processes and quality standards.

  Saved millions of dollars by implementing new precertification programs (20+ drugs to 150+).

Nurse Supervisor Specialty Pharmacy (2007 2009)

Led a patient-focused clinical staff (i.e. UMNAs, CMAs) in supporting Specialty Injectable Precertification programs, as well as managing nurses in completing clinical drug assessments. Taught specialty injectable drugs to members. Communicated program achievements, goals, and statistics to executive management.

  Conducted UAT for electronic clinical assessment tools prior to sign-off for release.

  Met Utilization Management goals by implementing new precertification initiatives.

  Interfaced with pharmaceutical manufacturing companies to meet contract requirements.

Disability Manager (2002 2007)

Led targeted decision-making among a Dedicated Disability Unit of 20+ Inbound Queue Associates and Disability Nurse Case Managers, including continually focusing on employee development, coaching / mentoring, and retention. Ensured call center phone service levels were met. Directed a high-volume caseload while monitoring quality audits. Participated in customer site visits and offsite sponsor training.

  Coordinated and led a reward program for Disability Services prior to AWEA program.

  Served as Tampa office lead to coordinate and manage the Spirit of Excellence program.

  Liaised among senior management to develop budgets and organize program for 2 years.

  Served as the Integrated Health & Disability (IHD) Champion for the Tampa Service Center.

  Prepared Tampa s 01/01/07 Readiness Project Plan, including collaborating with Aetna Medical Implementation teams and group insurance, as well as key account management staff.

Disability Nurse Case Manager (1998 2002)

Demonstrated experience in managing disability claims for large-scale national accounts, including actively collaborating among disability service representatives to obtain appropriate information from employee and employer. Led information retrieval from physicians to identify medical necessity for the employee s absence.

  Seamlessly piloted a newly developed medical documentation system.

  Supported staff training during the successful rollout of the system in 1999.

Progressive Cardiac Unit

Played a vital role in delivering excellence in care within a 28-bed Critical Care Unit, including providing care for telemetry patients after Coronary Artery Bypass Graft (CABG) Surgery, Myocardial Infarction with Cardiac Stent, and Angioplasty Placement. Skillfully monitored patients to maintain hemodynamic stability.

  Selected among peers to successfully open the Post Stent Unit in 1996.

  Promoted to Charge Nurse due to leadership and dedication to quality patient care.

Bachelor of Science in Nursing Coe College, Cedar Rapids, IA

Registered Nurse (Current) State of Xxxxxx

Yyyyyy x. yyyyyy

Date

Hiring Agent Name

Company Name

Address

City/State/Zip Code

Dear__________________:

I am exploring a new career opportunity within a challenging [ Insert Job Title ] role, and I believe that I can make a positive contribution to your success.

To acquaint you with my background, I offer proven experience with Clinical Assessments / Management, Specialty Medications, Specialty Drug Education, Disease State Management, Injection Training, Market Health Programs, Precertification Clinical Support Programs, and Trends Tracking. I am also highly skilled in Team Building / Training, Process Optimization, Case Management, Medicare Guidelines, and Regulatory Compliance, and have served as a Hepatitis C SME, Electronic Prior Authorization Clinician Lead, and Multi-Project Lead Clinician.

Recently, as a Clinical Manager Specialty for Aetna Life Insurance Company, I served as a Specialty Product Lead driving Specialty form management, criteria maintenance, and updates while collaborating with technical product manager and pharmacists to provide ongoing support for the implementation, management, and maintenance of Specialty Drug Programs. Within this role, I developed and maintained Specialty precertification criteria for Aeta / CVS and Coventry / ESI, and oversaw criteria workgroup and ongoing enhancements and vendor management. I also communicated among clinicians, medical directors, NPL committee, and Medical Policy regarding NPL criteria development, maintenance, and revisions.

A sample of my accomplishments included:

  Saving $16+ million via the seamless implementation of a comprehensive new review process.

  Managing Medical Pharmacy Denial Appeals trends for key improvement and ongoing growth.

  Serving as PA Specialty Product Clinical Lead tasked with collaborating with Specialty clinicians and CoverMyMeds to facilitate comprehensive criteria-building for an efficient new ePA process.

  Serving as Hepatitis C Specialty Review Process Co-Lead, including developing workxxxxxxow, policy, clinical assessments, reference, and training materials, as well as communicating updates and presentations for medical directors, Specialty Precertification, and Customer Care Units.

Note that I earned a Bachelor of Science in Nursing from Coe College and am currently a Registered Nurse in the State of Xxxxxx.

As this is just an example of my abilities, please refer to my enclosed resume for additional specialty drug precertification, specialty pharmacy, disability nurse supervisor, and case management experience.

I am eager to discuss how my qualifications uniquely match your current and future needs, and look forward to interviewing with you soon.

Sincerely,

Yyyyyy x. yyyyyy