Jamie Sexton

About Jamie Sexton

I’m a PharmD with 20+ years leading large teams in healthcare operations, clinical quality, and system design. I specialize in building processes that reduce chaos, strengthen compliance, and make care measurably better for both patients and the teams delivering it.*Senior Manager of Quality & Process Improvement at a Fortune 25 company by 35*99.99% retention over 15+ years; three direct reports promoted to Director roles*Rho Chi recipient; early Women in Science participant*Known for emotionally grounded, psychologically safe leadership & *Built and led QA programs across DUR, MTM, home delivery, REMS, and prior authorization workflows*Managed specialty call-center quality (PAH, oncology, MS, IVIG, RA, factor products)*Authored PA criteria and clinical policy for Medicaid, Medicare, and commercial lines*Hospice/palliative care experience under a collaborative practice agreement *Led successful audits for URAC, NCQA, CDAG, ODAG, DMHC, TX DOI, NY DOH, and MN Medicaid*Piloted MD Rx call-in workflows during TN’s technician-led order-entry expansion*Improved clinical decision workflows and audit readiness across multiple markets & *Created tools to flag Medicare Part D/MMP compliance risks (hospice, HRM, BEERS)*Designed adaptable workflows for evolving PBM oversight requirements*Built custom QA/production metrics in Kronos and Excel with auto-scoring and alerts*Identified a system workaround missed by engineering, saving led 3 formal events focused on reducing operational waste & Longtime pharmacy informatics advocate.*Programmed logic in Witness → 62% reduction in tech order-entry errors*Developed scripting that reduced AHT/AST and improved abandonment rates*Early programming background (TI code, Visual BASIC, DOS) used to design decision-support toolsI recently finished a memoir (Yet Another Survivors Story) and also am building a trauma-informed mental health app (Beyond the Spiral) focused on emotional pattern recognition, DBT-style reflection, and parts work.

Experience

1. Senior Manager, Medicare Part d Um

   Capital Rx

   Mar 2026 — Present

Education

• Arkansas State University

  Bachelor of Science (BS), Biology, General

  1999 — 2002

• UAMS - University of Arkansas for Medical Sciences

  Pharm.d., Pharmacy

  2002 — 2006

Skills

• Clinical Pharmacology
• Pharmacy Automation
• Community Pharmacy
• Patient Counseling
• Medicare Part D
• Certified Immunizer
• Medication Therapy Management
• Clinical Pharmacy
• Compounding
• Managed Care
• Pharmacy Benefit Management
• Disease Management
• Hospital Pharmacy
• Pharmacy
• Immunization
• Pharmacists
• Pharmacy Practice