Holly Kuhl

Experience

• 

  Schnuck Markets, Inc.

  May 2015 - Jan 2017

  Conduct Drug Utilization Review (DUR) to ensure prescription medications are appropriate, medically necessary, and not likely to result in adverse medical consequences Fill prescriptions in compliance with physician orders as well as state and federal laws, including verification of final products for accuracy and quality Provide patient counseling and medical advice for prescription and over the counter productsServe as the primary employee responsible for managing Outcomes™ Medication Therapy Management cases Assist with inventory management including product ordering and elimination of “dead” itemsSupervise and train pharmacy technicians and internsImplemented monthly patient education bulletin board. Past topics included: Safe Medication Disposal, Proper Measurement of Medications, Understanding Insurance for a New Year, Heart Health, and Smoking CessationServed as guest speaker for Essence diabetes management course for elderly patients Show less

  • Staff Pharmacist

    Jul 2015 - Jan 2017

  • Pharmacy Grad

    May 2015 - Jun 2015
• 

  Magellan Health

  Jan 2017 - Feb 2019

  • Manage daily pharmacist schedule for Medicare Part D prior authorization work queue• Manage Paid Time Off (PTO) scheduling for a team of 10 pharmacists• Conduct weekly and monthly Quality Assurance (QA) reviews for Medicare Part D CDAG• Conduct quality testing prior to implementation of new FirstTrax updates• Provide clinical updates and input to Medicare Part D “Comparable Formulary Alternatives List” • Provide clinical coverage determinations for Medicare Part D prior authorizations, exceptions, and Medicare B vs. D request using plan criteria and protocols • Developed SOP for new appeals process protocol and trained pharmacist and physician team on workflow• Conducted prospective reviews of pharmacist team coverage determinations during Clean Period CMS Audit• Worked with marketing department to facilitate translation of Medicare Part D denial letters to Spanish • Co-managed team of 10 pharmacists during interim period of 2 months Show less • Provide coverage determinations for Medicare Part D prior authorizations, exceptions, and Medicare B vs. D request using plan criteria and protocols within the designated CMS compliance timeo Outreach to providers for necessary clinical information via phone and faxo Research medically acceptable indications using MicroMedex and LexiComp AHFS-DI o Evaluate CMS approved Cancer Compendia as well as peer-reviewed journals for favorable citations of off-label chemotherapy use for exceptions under the CMS Medically Reasonable and Necessary Clause o Maintain compliant with CMS regulations • Evaluate prior authorization appeals prior to escalating for physician review • Provide excellent customer service to patients and providerso Resolve official grievances o Provide formulary and lower cost alternatives o Answer clinical questions• Exceeded team average of reviews per hour during all months of employment • Participate in team discussion with clinical pharmacists and physicians to interpret clinical data as well as CMS regulations • Assisted in new hire pharmacist training• Demonstrate commitment to prevention of fraud, waste, and abuse Show less

  • Senior Clinical Pharmacist

    May 2018 - Feb 2019

  • Clinical Pharmacist

    Jan 2017 - May 2018
• 

  Cigna

  Feb 2019 - Aug 2020

  Clinical Pharmacist/Lead Trainer

  • Provided ongoing and continuous improvement support for the Part D appeals clinical team by creating and updating job aids, sending information alerts, and presenting process change • Contributed to a decrease in clinical appeals pharmacist team errors by 39% (2019) and 79% (2020) • Exceeded company and industry averages on training related questions from the Cigna employee engagement survey: 93% of the clinical appeals team felt they were provided with the training needed to do their job (+23% from company average, +33% from industry average) and 100% of the team felt they had the resources and tools needed to do their job (+23% from company average, +31% from industry average)• Provided go-live support for coverage determination and redetermination clinical team during system integration • Played an integral role in the transition of Cigna clinical department from OnBase and Rx Claim to C360 and ESD including collaborating with ESI and Cigna leadership teams, process mapping, developing new training material, and training the Cigna pharmacists prior to go-live • Developed 61 new job aids for Cigna team related to Medicare guidance, use of the claims processing and review systems, and Texas Medicaid • Trained and evaluated 8 contract pharmacists on Medicare Part D regulations, OnBase/ Rx Claim, and the redetermination clinical review process for open enrollment and 1/1 production assistance • Developed a complete new library of job aids for the redetermination pharmacists team for the OnBase system • Developed e-learning modules for new and refresher material for the clinical coverage review teams • Received 7 Cigna Standout recognitions by managers and peers from January 2020-July 2020• Attended the following Cigna training sessions: C-KIT Author Training, Writing Effective Job Aids and Resources Workshop, Adjunct Facilitator Training, C360/ESD Train-the Trainer (Prior Authorization Representative, Primary Clinical, Appeals Clinical) Show less

• 

  CVS Health

  Nov 2020 - now

  Lead a team of three Clinical Operations Advisors and two offshore pharmacists in a client facing role for two strategic health plan clients (960,000 lives and 1.2 million lives). Developed process improvements and job aids to improve quality. Distributed and monitor team workload and turnaround times using Salesforce. Facilitated development of automation to improve efficiency and reduce human error. Lead Caremark Service Excellence (CSX) team calls to identify Root Cause by facilitating a 5Y process discussion. Delivered bi-weekly training sessions for direct reports to uptrain and expand team skillset. Implemented new third Exchange health plan account for 2023 plan year in addition to maintenance of two existing clients. Show less Collaborate with the account team in a client facing role to design the client formulary and utilization management programs. • Interpret the client’s clinical strategy and roadmap to create a clinical operations plan. • Facilitate the gathering formulary and utilization management requirements and designs the drug level set up for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines. • Complete clinical data analysis to at the request of the client and internal team members• Reviewing identified defects from testing and work to resolve these defects Show less

  • Senior Manager, Custom Formulary Consultants

    May 2023 - now

  • Senior Manager, Clinical Client Operations

    Oct 2022 - May 2023

  • Clinical Operations Advisor

    Nov 2020 - Oct 2022