Lyle Brauner, PharmD, MBA

Experience

• 

  Fry's Food and Drug

  Dec 1997 - Mar 2010

  • Pharmacy Manager/Pharmacist-In-Charge

    Jul 2005 - Mar 2010

  • Staff Pharmacist

    Jul 2003 - Jul 2005

  • Pharmacy Technician/Pharmacy Intern

    Dec 1997 - Jul 2003
• 

  CVS Health

  Mar 2010 - May 2011

  Supervisor - Clinical Services
• 

  Safeway

  May 2011 - Jul 2011

  Staff Pharmacist
• 

  Phoenix Children's

  Jul 2011 - Jul 2014

  Outpatient/Retail Pharmacy Manager/Pharmacist-In-Charge
• 

  Maxor National Pharmacy Services, LLC

  Jul 2011 - Jul 2014

  Pharmacy Manager/Pharmacist-In-Charge
• 

  Melrose Pharmacy

  Sept 2014 - Nov 2014

  Staff Pharmacist
• 

  Safeway

  Dec 2014 - Nov 2015

  Pharmacy Manager/Pharmacist-In-Charge
• 

  Health Choice

  Nov 2015 - Jun 2018

  Medicare Pharmacist

  In this role, I had several key responsibilities and accomplishments:1. Managed Medicare operational and clinical pharmacy processes for beneficiaries, with a focus on maintaining the Medicare formulary and pharmacy benefit.2. Developed and implemented operational procedures and policies specifically related to Medicare Part D.3. Created and maintained audit protocols to ensure compliance and accuracy in Part D functions.4. Collaborated with Pharmacy Benefit Manager (PBM) vendors regarding Part D pharmacy benefit operations.5. Responded promptly to requests for information and audits related to Medicare Part D.6. Maintained accurate records of Health Choice Generations prescription drug formulary and associated documents, as well as other Part D website materials.These responsibilities suggest a focus on ensuring the efficient and compliant operation of Medicare Part D benefits for beneficiaries. Show less

• 

  Magellan Health

  Jul 2018 - Jan 2022

  In this role, I had several key responsibilities and accomplishments:1. Oversaw Coverage Determinations, Appeals, and Related Policies: I was responsible for managing Coverage Determinations, Appeals, and related policies and procedures. This likely involved ensuring that the processes for handling coverage determinations and appeals were in line with Medicare Part D regulations.2. Participated in Client Implementations: I played a role in client implementations, which would involve helping new clients onboard onto the Medicare Part D program and ensuring that the necessary utilization management services were in place.3. Transitioned Prior Authorization (PA) Platform: I successfully co-led the transition of a home-grown Prior Authorization (PA) platform to a market-leading platform known for its compliance with CMS rules and regulations. This transition improved efficiency and compliance in the organization.4. Reduced Operational Errors: I achieved a significant reduction in operational errors by updating and implementing applicable Medicare Part D policies, procedures, and work instructions. This improvement was measured by increasing the pass rate from 80% to 95%. 5. Standardized Training Programs: I established standardized training programs for both new hires and existing staff, ensuring that all team members were well-equipped to perform their roles effectively.6. Participated in CMS Audits: I actively participated in various CMS audits, presenting clinical cases to the CMS auditor, CMS pharmacist, and CMS medical director. These audits are crucial for ensuring regulatory compliance and program integrity.Overall, my role involved a deep commitment to compliance, efficiency, and excellence in managing Medicare Part D programs and services, as well as actively engaging with CMS audits to maintain high standards and ensure adherence to regulations. Show less In this role, I had several key responsibilities and accomplishments:1. Management of Medicare Part D Prescription Drug Plan (PDP): I oversaw the day-to-day operations of the Medicare Part D Prescription Drug Plan and managed a team of 13 pharmacists. My team was responsible for performing clinical coverage reviews, coverage determination and appeal reviews, and monitoring adherence to established criteria.2. Data Analysis and Forecasting: I analyzed daily, weekly, and monthly statistical reports to make informed recommendations and forecasts regarding call volume and staff scheduling. Additionally, I provided input into the departmental budget.3. Project Management: I managed implementations, program additions, and new technical requests related to the Medicare Part D plan. I also oversaw quality assurance (QA) processes and inter-rater reliability testing for my staff.4. CMS Audits: I actively participated in CMS-required audits for the CDAG team, ensuring compliance with regulatory requirements. I also was instrumental in CMS-required audits for the Formulary Administration team, which included new member and cross-plan year transition fills, as well as claims processing.5. Career Advancement: My performance led to a promotion to the position of Director within just three months of being hired.Overall, my role involved significant responsibilities related to Medicare Part D plan management, data analysis, project oversight, regulatory compliance, and rapid career advancement. Show less

  • Director, Clinical Operations, Medicare Part D

    Oct 2018 - Jan 2022

  • Clinical Pharmacists Manager

    Jul 2018 - Oct 2018
• 

  CVS Health

  Jan 2022 - now

  As the leader of a team responsible for the development of short and long-term strategies at CVS Caremark, my primary focus is on maintaining the company's best-in-class performance in audits and quality assurance. My role involves overseeing a team of 145 colleagues. Here are some key accomplishments and responsibilities in my role:1. Audit Management: I manage all end-to-end Medicare-related audit activities, including those conducted by the Centers for Medicare & Medicaid Services (CMS), PDE Audits, Internal Audit activities, URAC/NCQA Accreditation activities, and health plan mock audits. This involves ensuring that our operations comply with regulatory requirements and industry standards.2. Relationship Building: I have successfully cultivated strong relationships with internal partners such as account teams, Medical Affairs, Regulatory Affairs, and Client Audit. This has allowed us to produce effective deliverables and solve problems more quickly through scheduled meetings, fostering collaboration and information sharing.3. Compliance and Change Management: Collaboration with change management, operations, regulatory and medical affairs teams is a crucial aspect of my role. I work to ensure that any modifications or changes in our processes or systems align with Federal, State, and client-specific compliance requirements. Subsequently, I improved the training programs to ensure that all cases were completed correctly and in compliance with regulatory standards.This helps in maintaining our reputation for quality and adherence to regulations.4. Reduced Attrition: One of my notable achievements has been reducing attrition rates from 6-8% down to 2-3%. This was achieved by working closely with various teams to streamline "Welcome Season," which included enhancing work instructions, improving training programs and Production Readiness Certification (PRC). This resulted in a smoother onboarding process and increased employee retention. Show less

  • Lead Director, Strategic Accounts EGWP

    Oct 2023 - now

  • Lead Director, Audits and Quality

    Jan 2022 - Oct 2023