As the Senior Pharmacy Manager of Utilization Management at Devoted Health, Adam Hoyesimek plays a pivotal role in shaping the clinical strategy and operational framework for pharmacy-related medical benefits. Since joining the organization in its inaugural year as a health plan in 2019, Adam has...
As the Senior Pharmacy Manager of Utilization Management at Devoted Health, Adam Hoyesimek plays a pivotal role in shaping the clinical strategy and operational framework for pharmacy-related medical benefits. Since joining the organization in its inaugural year as a health plan in 2019, Adam has leveraged his extensive background in ambulatory care to enhance the pharmacy department's capabilities and services. One of his notable achievements includes the development of the first iteration of the diabetes management program, which has become a cornerstone of the company’s commitment to improving patient outcomes.
In his current role, Adam serves as the clinical strategy lead and operations manager, overseeing the day-to-day activities of an offshore team in the Philippines. His responsibilities encompass managing appeals and audits for pharmacists and pharmacy technicians, ensuring compliance with regulatory standards while optimizing operational efficiency. Adam's expertise in systems thinking and business process management allows him to implement innovative solutions that streamline workflows and enhance service delivery.
Additionally, Adam is instrumental in the decision-making process for determining which Medicare Part B drugs necessitate prior authorization, a critical function that balances patient access to medications with cost management for the health plan. His proficiency in policy writing and conflict resolution further supports his efforts to navigate the complexities of utilization management. With a strong focus on digital therapeutics and customer service, Adam is dedicated to fostering a patient-centered approach that not only meets regulatory requirements but also enhances the overall health and well-being of members. Through his leadership, Devoted Health continues to set a high standard in the pharmacy sector, driving forward initiatives that prioritize effective medication management and chronic disease support.
