Paul Chamlies

About Paul Chamlies

As a seasoned pharmacist and business professional with experience in retail and hospital…

Experience

1. Pharmacy Benefits Consultant - Government Affairs

   Kaiser Permanente

   Apr 2010 — Present · Portland, OR, US

   Work with regional and National Pharmacy contacts to implement and maintain pharmacy benefits for Medicare, Commercial and Self-Funded lines of business• Partner with Pharmacy Benefit Managers (PBMs) to manage plan builds, design rules, benefit testing, pharmacy networks and formulary and drug list maintenance to ensure appropriate electronic adjudication of pharmacy claims • Maintain multiple regional formularies at PBM and member-level interface based on Pharmacy and Therapeutics Committee decisions and other state/federal regulatory requirements• Review Medicare Part D, federal, state and regulatory requirements to ensure compliance and appropriate implementation• Respond to regional Medicare audits as well as internal Compliance audits as Pharmacy Benefits SME• Coordinate and support regional efforts to achieve and maintain Medicare 5 Star rating• Collaborate with Pharmacy Leadership Team, Pharmacy and Therapeutics Committee and other key stakeholders to monitor drug utilization and costs• Communicate, educate and train internal staff and external customers regarding new or modified pharmacy benefits• Coordinate with Pharmacy Services help desk, Membership Services, Member Relations, Patient Financial Services, Sales and Account Management, Claims and other departments for benefit interpretation and customer resolutions • Work in conjunction with Senior Pharmacy Product Administrator to collaborate with and support Health Plan Product Development and Marketing in design, development and implementation of new pharmacy benefits and modification of current benefits • Make benefit change recommendations to Health Plan for Regional Benefits Committee review and approval

Education

• Auburn University

  Bachelor of Science, Pharmacy

  1993 — 1998

• Georgia State University - J. Mack Robinson College of Business

  Master of Business Administration

  2004 — 2006

• Georgia State University - J. Mack Robinson College of Business

  Master of Health Administration

  2004 — 2007

Skills

• Pbm
• Medicare Part D
• Pharmaceuticals
• Health Insurance
• Disease Management
• Compliance
• Account Management
• Healthcare Consulting
• Pharmacists
• Pharmaceutical Industry
• Clinical Pharmacy
• Medicare
• Utilization Management
• Pharmacy Benefit Management
• Healthcare Industry
• Medication Therapy Management
• Managed Care
• Pharmacy Automation
• Hipaa
• Healthcare
• Employee Benefits
• Medicaid
• Pharmacy
• Pharmacy Operations
• Health Policy