Charity Rausch, PharmD
Experienced PBM Executive
Lithia, FL
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Summary
Summary of Qualifications
Pharmacy executive with over 21 years of experience in pharmacy benefit management, pharmacy consulting and managed care. Dedicated and nimble leader who is results-oriented and strategically focused with a proven track record of growing pharmacy business units, business development, operational and technology improvement, fostering high performance teams, and development of solutions-oriented programs that contribute to company’s revenue growth and reduce overall drug costs. Experienced in managing and mentoring clinical and non-clinical teams to promote and maintain successful client relationships.Core Competencies
- Pharmacy Benefit Management
- Managed Care
- Client Growth, Retention and Satisfaction
- Process and Quality Improvement
- Strategic and Product Development
- Sales and Business Development
- Financial/Budget Development
- Clinical Strategy and Development
- Vendor Contracting and Management
- Leadership, Coaching and Mentoring
- Data Integration and Analytics
- Project and Implementation Management
Selected Accomplishment
- Collaborated with internal stakeholders to enhance client implementation process and developed new tools to simplify the implementation process for clients and consultants to improve client implementation satisfaction to 80% or above.
- Successfully transitioned over 7 million lives to a new pharmacy adjudication platform.
- Developed an operational staffing and reporting model to drive ongoing monitoring of staffing needs and productivity, which included time studies of staff activities.
- Developed and designed client reporting to quantify the impact of clinical interventions, benefit changes and ongoing utilization trends.
- Increased client retention to more than 95% and implemented more than 60 new clients in 2 years.
- Designed and implemented a provider facing opioid score card for 28 government-sponsored managed care plans to utilize in monitoring opioid prescribing rates. Decreased opioid prescriptions by 18% and utilizers by 22% over an 18-month period.
- Participated and supported with the business development, finalist meetings and onboarding of new clients which equated to new PBM revenue over $175 million and 30% client growth.
- Established and rolled out a compound initiative to decrease the spending associated with compounds with savings around 50%. Saved over $1.5 million in three months for one particular client.
- Created new workflows and processes to improve efficiencies which led to an increased profit of 20%.
- Built a home health savings report for key clients, which led to an increase in utilization of organizational services by 25% while providing clients with savings. One client had an annual savings of $222,000.
- Renegotiated lab vendor contracts that resulted in 37% savings.
- Recognized by Senators of Puerto Rico with Congratulatory Proclamation for efforts to provide humanitarian assistance in the aftermath of hurricanes Irma and Maria by providing needed resources, such as food, water, first aid items and over the counter medications.
- Implemented Narrow Network strategy for health plans Medicaid line of business for retail and specialty resulting in over $21M in savings
Experience
2020
Mar
-
Present
Sr Pharmacy Consultant
PricewaterhouseCoopers
- Develop and perform clinical vendors RFIs/RFPs for health plans and PBMs.
- Develop clinical program offerings for payors.
- Develop implementation project plans, educational materials, reporting, training and marketing materials to support new clinical program offerings.
- Analyze and provide guidance on specialty, PBM and pharmacy network contracts.
- Develop performance guarantees for PBM and vendor contracts.
- Develop communication strategies to ensure internal stakeholders have a full understanding of new clinical program offerings, provider contracts and vendor partnerships.
- Provide payors’ guidance on clinical operations efficiencies.
- Negotiate PBM and vendor contracts/pricing for payors
2019
Oct
-
Present
Chief Pharmacy Officer
Quest Analytics Group
- Provide guidance to consultants, brokers and clients (employers and health plans) regarding pharmacy and medical benefits.
- Provide strategic planning and consulting advice to clients including overseeing efforts in the production of Requests for Proposal (RFP), coordination of vendor responses, analysis and comparison of RFP responses, and preparation of a client report with recommendations.
- Provide evaluation of performance with medical and pharmacy benefit management vendors.
- Perform evaluation of current contract with medical and pharmacy benefit management vendors.
- Provide recommendations for improving pharmacy and medical plan performance.
- Provide guidance on clinical and pharmacy program management strategy.
- Assist in review and accuracy of vendor agreements.
- Assist in sales opportunities with prospective clients.
- Develop company sales collateral and presentations.
- Perform competitive analyses to support business growth and product development.
2019
Jul
-
Present
Owner, Senior Pharmacy Consultant
Achieve Pharmaceutical Strategies / Lithia, FL
- Provide guidance to consultants, brokers and clients (employers and health plans) regarding pharmacy and medical benefits.Provide evaluation of performance with medical and pharmacy benefit management vendors.
- Assist with RFP delivery and evaluation.
- Perform evaluation of current contract with medical and pharmacy benefit management vendors.
- Provide recommendations for improving pharmacy and medical plan performance.
- Provide guidance on clinical and pharmacy program management strategy.
- Produce content for business development, company collateral, case studies and company websites
2015
Nov
-
2019
Jul
Vice President, Account Management
Envolve Pharmacy Solutions / Orlando, FL
- Provided performance expectations, business goals and oversight to Directors, Account Executives, Account Managers and Clinical Account Managers.
- Provided oversight and drug management to over 10 million lives comprised of small and larger employers, TPAs, discount card, coalitions, Medicaid, Medicare, Exchange, union groups and workers’ compensation.
- Oversight of more than $10 billion in pharmacy spend.
- Developed enhanced formulary analysis tool with analytics and underwriting departments to assist clients with understanding the impact to formulary changes.
- Organized and moderates annual all account management conference to provide education, enhanced skills training, promote staff collaboration and introduce new client offerings.
- Organized and moderated annual health plan summit to provide pharmacy health plan leaders education, trend forecasting and strategic solutions to assist in the management of drug spend and utilization.
- Collaborated with senior leadership to develop enhanced clinical program offerings to be competitive in the marketplace.
- Drove strategy for client retention and contract renewals by working with account management team members, underwriting and finance.
- Established strong relationship with consultants, brokers and clients to retain and grow external business.
- Participated in various company committees to drive product development, strategize clinical and quality initiatives, established business goals, evaluated ongoing changes in state and operational compliance requirements and employee engagement. (Employee Engagement Committee, Quality Improvement and Utilization Management Committee, Compliance Committee, Employee Recognition Committee, Clinical and Product Development Committee, Strategic Development Committee and RFP Evaluation Team and Underwriting and Reporting Committee).
- Participated in presentations to employers, brokers, consultants, TPAs and other potential prospects to educate all participants on the pharmacy management value Envolve Pharmacy Solutions could provide.
- Assisted in the development of finalist presentations and collateral pieces.
- Collaborated and communicated effectively with internal business partners to drive client satisfaction and prompt resolution on client matters.
- Maintained knowledge of marketplace and industry trends.
- Responsible for all areas of client satisfaction throughout the life of the contract.
- Responsible for recruiting and hiring high performers to manage client needs and expectations.
- Assisted in the development and distribution of annual client satisfaction surveys to establish ongoing process improvement.
- Reviewed and approved drug recalls that are distributed to clients.
- Established and maintained staffing model to monitor department needs.
- Oversight of department budget and business plan.
- Assisted pharmacy health plan leadership on communication and responses to state entities inquiries.
- Developed and enhanced client standard reporting package to assist with the monitoring of performance guarantees, financials, operational, clinical and strategic initiatives.
- Collaborated with sales and marketing on RFP content to enhance responses to be competitive in marketplace.
- Maintained relationship and monitored performance of external vendors.
2013
Oct
-
2015
Nov
Head of Clinical Services
Helios / Tampa,
- Served as the leader of the clinical operations business unit and clinical account management team to provide appropriate clinical offerings to enhance Company’s positioning in the marketplace and develop new market segments.
- Developed and implemented clinical department’s infrastructure – governance, on-boarding, training guides, policies and procedures. Managed a budget of exceeding $8M.
- Developed and implemented a clinical triage program which lead to an increase of clinical services referrals by 33%.
- Developed a Continued Quality Improvement strategy to oversee with quality of all reviews performed by clinical pharmacists and peer vendors.
- Developed and implemented a cost-effective drug testing network which provided savings of over 60% to key customers.
- Grew a clinical team of driven and collaborative professionals from 30 to 60 employees over an 18 month period.
- Facilitated partnership opportunities with Helios’ National Account team to provide clinical support for clients at the national level.
- Provided clinical direction and oversight to the Company’s Response for Proposals responses by working with the Chief Sales Officer and Vice President of Marketing.
- Led the development of Company’s nationally certified continuing education programs, which support clients and associates.
- Directed the experiential training of Doctor of Pharmacy intern rotations to foster relationships with the Florida Colleges of Pharmacy and facilitate recruitment of qualified graduates.
- Conducted and developed clinical research effort and clinical thought leadership activities in the form of original publications and industry-specific speaking opportunities.
- Overseen strategy of formulary management for the Company and its customers.
- Chairman of Clinical Oversight Committee, which communicated clinical changes to internal stakeholders.
- Managed the nursing team providing clinical home health and DME reviews.
- Collaborated with IT to leverage new technologies to improve the clinical processes and offerings.
- Assisted Government Affairs and Compliance with the interpretation of state regulations and guidelines.
- Collaborated with Finance to determine the rebate impact of formulary changes.
- Managed clinical vendor relationships, including peer, lab, clinical program and drug information vendors.
2013
May
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2013
Oct
Senior Clinical Liaison Manager
Helios / Tampa, FL
- Provided clinical leadership and direction to the clinical account team to support client clinical strategy.
- Collaborated with National Account Managers/Directors to plan and execute strategies for relieving client clinical pain points and addressing clinical needs.
- Developed and implemented quality assurance measures for Clinical Liaison performance and built best practices for client support.
- Built relationships with client key clinical stakeholders in order to identify client clinical pain points and needs.
- Provided clinical direction and oversight to the Company’s Response for Proposals responses by working with the Chief Sales Officer and Vice President of Marketing.
- Managed clinical vendor relationships, including peer, lab, and drug information vendors.
- Collaborated with the Clinical Implementations and Analytics Liaison to ensure that all client clinical program implementations were executed flawlessly.
- Worked in partnership with the Clinical Implementations and Analytics Liaison to enhance and ensure the accuracy of clinical analytics reporting.
- Acted as a Subject Matter Expert (SME) regarding client-specific project requirements.
- Proposed, developed and implemented new clinical programs and client clinical solutions.
- Collaborated with the Clinical Team and SalesForce.com developers to improve and streamline clinical documentation and reporting capabilities in SalesForce.com.
2008
Feb
-
2013
May
Director of Analytics and Clinical Initiatives
Employer Health Purchasing Coalition / Dublin,OH
- Provided clinical support to internal stakeholders and over 150 clients (3 million lives) serviced by the organization.
- Assisted clients with changes in medical, pharmacy benefit and disease management plan design.
- Designed and implemented strategies to improve analytics capabilities to support clients.
- Collaborated with PBM account managers to coordinate employer prescription claims analyses.
- Provided RFP support via proposal design, vendor analytics and contract review for client renewals and prospectanalyses.
- Accredited physicians for diabetes recognition program through NCQA.
- Educated clients on drug trends, specialty management and disease management.
- Educated physicians on electronic prescribing.
- Worked with a data integration vendor to build a data repository tool to integrate medical and pharmacy data,monitored implementation of a new warehouse working with 24 medical and pharmacy vendors to pull in data for28 plan sponsors representing over 300,000 participant lives.
- Executed data and analytics to provide clinical insights to improve quality and efficiency.
- Assisted clients by creating their health management strategies and how incorporate value based benefit design principles.
- Developed metrics to measure clinical performance and outcomes for health management and pharmacy programs by creating dashboards and scorecards to be utilized by C-Suites to evaluate efficacy of various efforts.
2006
Jul
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2008
Feb
Clinical Account Manager
Affiliated Computer Services / Westerville, OH
- Provided clinical expertise and strategy to State of Ohio Medicaid pharmacy program to optimize therapeutic outcomes while maintaining economic efficiency in delivery of medication therapy.
- Performed clinical data and drug utilization analysis to identify quality improvement and cost containmentopportunities.
- Developed clinical criteria for prior authorization and prospective drug utilization reviews and oversight of Formulary Management and Drug Utilization Review (DUR) Committee for the State of Ohio Medicaid program.
- Oversight of Clinical Pharmacist Liaisons who educated pharmacists and providers on the Ohio Medicaid formulary and program offering
2004
Jul
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2006
Feb
Lead Clinical Pharmacist
Veteran Affairs / Fort Myers,FL
- Provided education and counseling to patients regarding the handling and pharmacological use of their medications.
- Reviewed medication orders and patient charts to determine appropriateness in drug and dosage selection.
- Provided consultation and drug information to physicians, nurses and other health professionals about drug therapy.
- Directed and provided oversight to the pharmacy technicians in dispensing prescriptions in accordance with accepted standards of the professional practice of pharmacy.
- Assisted with Coumadin and medication adherence clinics and new patient education.
- Assisted with the development of patient refill counseling and medication management program.
- Participated in Pharmacy and Therapeutic Committee.
- Reviewed new drug studies to provide education to pharmacy and physician staff.
- Engaged pharmaceutical companies on new drugs to the marketplace.
2000
Sep
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2003
Dec
Clinical Pharmacist
Medco Health / Dublin, OH
- Performed clinical prior authorizations for small and large plan sponsors.
- Worked closely with corporate P&T committee to review clinical information and appeals process.
- Performed formulary interchanges by educating providers and patients on preferred drug list requirements and drug benefit design.
- Provided disease management to patients on diabetes and cardiovascular diseases.
- Monitored the quality and efficiency of the prior authorization process: coverage criteria, denial language and communication with patients and providers.
- Provided recommendations on clinical content of new programs and maintenance of existing offerings.
- Provided implementation support to operational departments of various programs rollouts and daily support of patient quality of care.
- Assisted with patient and provider escalated calls.
- Assisted in the resolution of pharmacy related inquiries from patients, clients, providers and pharmacies.
Education
2008
-
2011
Ohio Northern University
Doctorate of Pharmacy / Pharmacy
1994
-
1999
Ohio Northern University
Bachelor in Pharmacy / Pharmacy
Skills
