Zhexin Zhang

Led the building of benefits and utilization management (UM) programs for new healthcare exchange book of business. Researched and identified unique business needs required by healthcare exchange and developed solutions to address those needs. Maintained and built benefits and programs for commercial clients. Worked closely with UM department, plan builders, benefits administrators, and quality assurance to ensure plans and benefits are built correctly . Helped develop new work flow process for distinguishing builds between exchange and commercial programs. Helped create a new tool for analyzing and comparing program builds to improve efficiency and accuracy. Assisted in leveraging new tools to improve work process efficiency.

Designed and developed programs to identify at risk members who should be enrolled in disease management programs and medication therapy management programs. Analyzed program performances and executed program improvements. Worked cross functionally to ensure developed programs are meeting client expectations.

Developed and modeled new strategies for formulary development. Reviewed new drugs to present at P&T Committee. Developed new utilization management programs and reviewed existing programs. Utilized analytics to validate various formulary strategies and clinical programs. Conducted outcomes research. Conducted appeals and coverage reviews. Developed business policies to streamline new drug review processes.

Performed inpatient filling duties. Assisted pharmacists with prescription final check duties.

Performed retail filling duties. Assisted pharmacists with final check duties. Provided customers with OTC education and recommendations, and prescription counseling.