Rise

Randee Bowder CEO

myMTMcare

A pharmacy graduate from Ohio Northern University, Randee brings more than 26 years of pharmacy experience, including 13 in the MTM space. Recognizing the important role that medication therapy management (MTM) plays in preventing health care problems, Randee launched myMTMcare in 2013 to concoct exceptional pharmacists with high-risk MTM eligible patients.  

As CEO of myMTMcare, Randee is responsible for company strategy, business development, and service innovation in the MTM industry. Through her dedication to positively impacting the health of patients, creating a satisfying work environment for her employees, and sustaining value for her partners, Randee has established a highly competitive and successful MTM company that creates innovative and successful MTM programs for their health plan partners.  

Luis Cerda Star Ratings Consultant

Rex Wallace Consulting

Luis is Star Ratings Consultant for Rex Wallace Consulting, where he focuses on developing strategies to improve Part D performance, increase provider engagement, and dive into analytics. He has 10+ years of experience leading Star Ratings strategies. He previously worked for MCS, one of the main health plans in Puerto Rico, and later moved to Florida where he worked with Cigna leading strategies for all east coast markets. Luis has a master’s degree in economics from the University of Puerto Rico and enjoys cycling in his free time.

Omar Daoud Senior Director of Pharmacy

Community Health Plan of Washington

Omar joined Community Health Plan of Washington, CHPW, as the Director of Pharmacy in 2019 after sixteen years with Walgreens Co., where he led Specialty Pharmacy operations for the Pacific Northwest Region.  

Omar has extensive experience in Specialty Pharmacy, Managed Care including government programs, and Clinical Pharmacy quality initiatives. Omar’s current role is focused on PBM relationship oversight, clinical pharmacy integration, and utilization management of medical and prescription drug benefits.  

Omar received his Doctorate of Pharmacy Degree from the University of Washington in 2005 and continues to reside in the beautiful Pacific Northwest. 

Shannon Decker Principal

VBC One

Dr. Shannon Decker is principal at VBC One, a consulting firm assisting physician groups, health plans and vendors maximize the performance of their value based contracts and offerings.  Dr. Decker has more than 20 years experience in health care and most recently led teams in risk, quality, data and analytics, telehealth, COVID response and delegation compliance.  Of her more than 20 years of experience in healthcare--15 include working with risk adjustment, quality and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, dual MBA degrees--in Finance and in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is on the faculty at Arizona State University and is also an associate professor of Higher Education & Adult Learning (HEAL) and chief methodologist for Walden and Capella Universities where she chairs and oversees the dissertations of doctoral students. An author of two books and several peer-reviewed articles, and a prolific national public speaker, her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management. 

Joy Enright Director, Client Audit

CVS Health

Joy Enright has been with CVS Health more than 23 years with a current expertise focused on CMS Program audits. Her experience and expertise encompasses operational leadership for several BCBS health plan account management teams as well as successfully leading multiple health plan clients through the CMS Program audit experience. A recent accomplishment is being a leading participant in driving CVS Health’s success when a fully delegated client received a perfect overall audit score for two consecutive audits. This is an industry record marking the first time a plan sponsor was able to achieve a perfect overall audit score, back-to-back, in the Medicare space. Mrs. Enright aims to influence every CVS Health client to attain this same level of success by ensuring that all services delegated to CVS Health receive zero Conditions.  

After years of supporting these audits herself, Joy developed a ‘best in class’ audit support structure which included developing a team of high performing leaders who are dedicated to delivering a consultative approach as they work beside internal business partners and CVS Health clients. Joy Enright’s team travels onsite to various client locations across the country to lead and support clients during their CMS Program audits for all services delegated to CVS Health. This support strategy offers real-time, side-by side guidance throughout the audit  experience with a personalized and proactive approach that has earned her team’s support structure a reputation of being ‘best in class’.  

During her tenure, Joy Enright’s team has supported hundreds of CMS program and Compliance Oversight audits. She has a robust ability to lead and execute in a fast paced, constantly changing environment. Mrs. Enright has extensive experience working with health plan clients, consultant firms and CMS auditors to meet and exceed client goals and offer innovative solutions leading to positive audit outcomes.  

Collaborating with clients to mitigate potential audit risk and to deliver outstanding audit results is of the utmost importance to Joy Enright and her goal-focused and success driven leadership team! 

Casey Gardner Consulting Actuary

Wakely Consulting Group

Colleen Gianatasio Director, Clinical Documentation

CDPHP

Colleen Gianatasio CPC, CPCO, CRC, CDEO, CPC-P, CPMA, CPPM, CCS, CCDS-O, and AAPC Approved Instructor has over 20 years of experience in the health insurance field. She has experience in customer service, claims, quality, and coding. As Director, Clinical Documentation Integrity and Coding Compliance, Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding and reimbursement. Colleen specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation, and auditing classes. Colleen serves as President of the AAPC National Advisory Board. 

Ana Handshuh Principal

Cat5 Strategies

Ana Handshuh, Principal at CAT5 Strategies, is a government programs executive with expertise in creating and implementing corporate programs for the healthcare industry. Her background includes Quality, Core Measures, Care Management, Benefit Design and Bid Submission, Accreditation, Regulatory Compliance, Revenue Management, Communications, Community-based Care Management Programs and Technology Integration. Ms. Handshuh currently serves on the Board of the Resource Initiative and Society for Education (RISE), the preeminent national professional association dedicated to managed and accountable care financing and delivery. She is a sought after speaker on the national healthcare circuit in the areas of Quality, Star Ratings, Care Management, Member and Provider Engagement, and Revenue Management. Her recent consultancy roles have included assisting organizations create programs to address the unmet care management needs in the highest risk strata of membership, document their processes and procedures, achieve accreditation status, design and submit government program bids, institute corporate-wide programs and create communications strategies and materials. She possesses sophisticated business acumen with the ability to build consensus with cross-functional groups to accomplish corporate goals. Ms. Handshuh served as the Vice President of Managed Care Services at Central Florida Inpatient Medicine (CFIM). In this role, she provided leadership and strategy on CFIM projects and collaborations with physicians, risk entities, hospital health care systems, and health plans. CFIM is the largest Hospitalist group in Central Florida, with 70 providers discharging over 50,000 patients annually from multiple hospitals across two health care delivery systems and 24 skilled nursing facilities. At CFIM Ms. Handshuh previously served as the Vice President of Operations. Prior to those assignments, she worked with Precision Healthcare Systems as their Vice President of Quality Improvement. In that capacity, she led the IPA’s Quality efforts and collaborated with payers on implementing programs to move the needle on Quality and Star Rating initiatives. Ms. Handshuh also served as the Director of Corporate Program Development at Physicians United Plan. In this role, she led the Quality Management and Corporate Communications departments and spearheaded the development of innovative integrated technology solutions to drive business excellence and Star Rating achievement initiatives. For the past fifteen years Ms. Handshuh has taken an active role in redefining and implementing changes that have led to improvements and greater efficiency within Government programs and healthcare delivery. Prior to joining Physicians United Plan Ms. Handshuh was the founder of I-Six Creative. Under Ms. Handshuh’s vision and leadership, I-Six Creative provided expertise in the areas of managed Medicare benefit design, MSO/IPA operations, provider network strategy, new market launches, technology integration, corporate communications and quality improvement.   

Justin Harris Senior Actuarial Manager, FSA, MAAA

Milliman

Justin Harris is a senior actuarial manager with the Milwaukee office of Milliman. He joined the firm in 2010. Justin has more than 10 years of health actuarial experience in pricing, financial reporting, strategic analysis, and regulatory analysis. His areas of expertise include Medicare Advantage, especially Part D plans, pharmacy, and general prescription drug market analytics.

Matthew Hayes Principal and Consulting Actuary

Milliman

Matthew Hayes FSA, MAAA, is a Principal & Consulting Actuary with Milliman, Inc. Matthew’s experience includes nearly 20 years in the actuarial field working in both the health and life sectors. Matthew’s expertise lies in all areas of the pharmaceutical space including formulary and rebate analysis, competitive analytics, network analysis, policy research, PBM analysis, benefit design, and Part D pricing. Matthew has helped numerous Part D plans and PBMs on Part D strategy to drive savings and create membership growth. Matthew also advises Pharmaceutical Manufacturers on pricing, reimbursement, and market access. Matthew also has extensive experience in Medicare Advantage pricing, research, experience analysis, and regulatory and compliance review. 

Prior to joining Milliman, Matthew spent seven years at a large national insurer, helping to double PDP membership during that time while honing his leadership, management, and technical actuarial skills. 

Ranarda Jones CEO

PSyn Inc.

Ranarda Jones is a true entrepreneur with having over eight established businesses under her belt. She looks to find a need and then a solution that is implemented with consistency and exemplary customer service. Currently she is the Founder and CEO of the managed care consulting company, Pharmacy Synergistics dba PSyn, Inc. Dr. Jones has over two decades of pharmacy practice experience and is an expert in Medicare operations, compliance, and quality ratings. She graduated from the University of South Carolina earning a Doctor of Pharmacy degree in December 2003 and later pursued an MBA in Healthcare Administration from South University in 2008. Ranarda is proud of being the 2021 NASPA Excellence in Innovation Award recipient nominated through the SC Pharmacy Association and sponsored by Upsher-Smith Laboratories. She is also the 2024 University of South Carolina College of Pharmacy Outstanding Young Alumni Award. Ranarda is most proud of the work she does with mentoring pharmacy students and entrepreneurs. Dr. Jones has become a certified 10X business coach under Grant Cardone to help others scale and grow their business.  

Michelle Juhanson Director, Government Programs

PSGConsults

Michelle has received industry recognition for helping plans and PBMs build exceptional Medicare reputations. She applies regulatory knowledge, innovation, and strategic thinking to every project. Michelle most recently served as Vice President and Chief of Staff II, Government Programs at Prime Therapeutics and Magellan Rx Management. She led Magellan Health, Inc. to one of only three “perfect” CMS Program Audits in 2021.[1]

Michelle is a breast cancer survivor, polyglot, and public speaker. She is certified in Health Care Compliance and Health Care Privacy Compliance by the Health Care Compliance Association. With 15 + years Medicare and Medicaid compliance and quality experience, Michelle advises industry coalitions and councils on health equity (AHIP, PCMA), pharmacy quality (PQA), compliance (HCCA), and accreditation (NCQA). The National Academy of Social Insurance elected Michelle to membership in its 2024 cohort. She is serving a two-year term on the Pharmacy Quality Alliance Health Equity Technical Expert Panel. In 2022 Michelle was named a Health Care Businesswomen’s Association (HCBA) Luminary and is a member of the HCBA. 

Helen Liu Former Vice President of Pharmacy Operations

ATRIO Health Plans

Dr. Liu is the former Vice President of Pharmacy Operations for the ATRIO Health Plans, where she was responsible for the management and oversight of all Part D related operations. Dr Liu has an extensive background in clinical pharmacy, managed care operations, and data outcome analysis.  Prior to this role, she has developed and implemented the inpatient Drug Use Management program at Kaiser Permanente.

Rachel Madden Actuary, FSA, CERA, MAAA

Milliman

Rachel is a Health Actuary with Milliman, Inc., and focuses in the Medicare Part D space. Rachel supports a variety of both public and private sector clients. Her experience includes pricing health benefits, competitive market analysis, formulary and rebate analysis, and analytic and strategic support for Medicare Advantage organizations. Rachel also assists Medicare Part D plan sponsors with plan design, formulary design, and pricing of prescription drug benefits.

Gary Melis Clinical Pharmacist

Network Health

Clinical Pharmacist for the past twelve years at Network Health, a local health insurance provider in Northeast and Southeast Wisconsin. I am currently one of three pharmacists involved making MTM calls in-house. My responsibilities also involve NCQA, pharmacy appeals, P&T Committee, Member and Provider relations.

Gary’s also has experience as pharmacy manager for a national long term care company, pharmacy manager for retail pharmacy chain, and Pharmacy Director for a National Health Care provider. He has also been a pharmacy instructor at local medical college family practice clinic.

Melinda Nelhuebel Senior Director of Operations, Pharmacy

Blue Cross Blue Shield of Massachusetts

Roxanne Newland Vice President of Pharmacy Operations

Rebellis Group

Roxanne Newland is the Vice President of Pharmacy for Rebellis Group and is an accomplished pharmacist with over 25 years of experience in government programs and managed care. She brings to the table both clinical and regulatory experience and a successful leadership track record.   As a pharmacy consultant she has worked with various MA-PDs, PDPs and Medicaid programs across the nation, providing various levels of support including delegation oversight audits, operational assessments, pharmacy consulting including interim Part D Pharmacy Director staffing,  and benefit administration testing. As a member of both mock audit and CMS audit preparation teams for MA-PDs and PDPs, she specializes in the Part D elements of CDAG Clinical Decision Making (CDM), Grievances and Formulary Administration (FA).  

Prior to her work as an independent Medicare consultant, Roxanne was a Senior Consultant for Gorman Health Group (GHG) leading and working in all areas of Medicare Part D consulting as well as Medicaid.  

Roxanne was previously the Wyoming State Pharmacist, Wyoming Medicaid Pharmacy Director, and Deputy Medicaid Director, as well as an adjunct professor at the University of Wyoming School of Pharmacy. Roxanne received her Master of Science in Health Services Administration (MHSA) with a concentration in Health Economics and Outcomes through the University of Wyoming, School of Pharmacy. Roxanne also completed Advanced Leadership Training through the Regional Institute for Health & Environmental Leadership at the University of Colorado Health Sciences Center.  In addition, Roxanne is a graduate of Leadership Wyoming and received the 2000 Distinguished Young Pharmacist award from the WY Pharmacy Association 

Melissa Smith Founder

Newton Smith Group

For more than a decade, Melissa Smith has been at the forefront of leading Medicare Advantage and Star Ratings teams. As the founder of Newton Smith Group and a Senior Advisor to Oliver Wyman, Melissa is a widely recognized thought leader and healthcare strategist. Her proven track record of success lies in developing comprehensive enterprise-wide solutions that enhance Star Ratings, quality performance, health outcomes, and the overall member experience. 

Melissa excels in crafting strategic and tactical solutions to meet client needs, forging productive partnerships across internal teams and external vendors, and improving performance on various quality measures.  Her unique background in business, finance, regulatory compliance, and healthcare quality provides clients unparalleled access to healthcare strategy, quality performance, and revenue optimization. 

As the former Chief Consulting Officer at Healthmine and Senior Vice President at Gorman Health Group, Melissa's leadership spans across prestigious organizations like Cigna-HealthSpring and Vanderbilt University Medical Center. Graduating from Purdue University, Melissa began her career at KPMG, LLP and is a Certified Public Accountant.