Nury Toledo-Núñez
Guaynabo
Summary
Pragmatic professional with solid experience in leadership roles. Adept at implementing strategic business plans, driving growth and improving operations. Skilled in financial management and stakeholder relations. Collaborative and dedicated to building and leading talented and motivated individuals.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Executive Vice President
PharmPix Corp
05.2022 - Current
- As the lead of PBM Services, I oversee the key operational areas of Benefits and Implementations, Network, Clinical, Call Center, Trend/Strategy and Account Management
- Aligned organizational objectives with company mission to increase business growth and integrate work strategies.
- I foster a culture of innovation and change within the organization by generating and implementing creative ideas and solutions, encouraging others to take calculated risks, and motivating others to embrace change
- I collaborate with the executives to achieve the operating plan: the growth objectives including revenue, profit and return on investment for all the channels/categories of business and/or key customers.
VP of Clinic Operations
MMM Holdings LLC
05.2018 - 05.2022
- As partner of Senior Management, play key role in ensuring smooth and effective functioning of Interdisciplinary and Multi-Specialty provider operations
- Collaborate with various stakeholders to design and implement business processes that optimize operational efficiency, revenue, and quality of service
- Monitor and evaluate performance of these processes and provide feedback and recommendations for improvement.
- Hired, trained and supervised employees to maintain team of high performers.
- Leveraged patient feedback and performed continuous process improvements to streamline day-to-day business operations and patient satisfaction.
- Developed marketing strategies to increase visibility and patient base.
- Created and implemented policies to improve operational efficiency and patient care quality.
- Maintained P&L and shouldered corporate fiscal responsibility.
Vice President of Pharmacy
MMM Holdings LLC
02.2015 - 05.2018
- Responsible for leadership and management of Medicare Part D pharmacy program
- Responsible for development and implementation of clinical pharmacy plan which includes and is not limited to clinical initiatives that impact drug utilization, clinical education, staff development, management of appropriate drug utilization, drug spend analysis, and CMS and NCQA quality improvement activities
- Hired and managed employees to maximize productivity while training staff on best practices and protocols.
- Collaborated with senior management to develop strategic initiatives and long term goals.
- Led recruitment and development of strategic alliances to maximize utilization of existing talent and capabilities. Example: "PAM", Pharmacy Adherence Program Alliance with Community Pharmacies.
- Monitored industry trends, keeping current on latest changes and competition in industry.
- Provided technical and leadership skills that ensure successful Part D pharmacy operations and program compliance within pharmacy department and CMS regulations
- Created succession plans to provide continuity of operations during leadership transitions.
- Maintained P&L and shouldered corporate fiscal responsibility.
Assitant Vice President of Pharmacy Operations
MMM Holdings LLC
03.2013 - 01.2015
- Responsible for leadership and management of Medicare Part D pharmacy program
- Providing technical and leadership skills that ensure successful Part D pharmacy operations and program compliance within pharmacy department and CMS regulations
- Responsible for development and implementation of clinical pharmacy plan which includes and is not limited to clinical initiatives that impact drug utilization, clinical education, staff development, management of appropriate drug utilization, drug spend analysis, and CMS and NCQA quality improvement activities
- Demonstrated proficient leadership skills to motivate employees and build competent teams.
- Clarified roles, responsibilities and expectations of staff.
- Collaborated with senior management to develop strategic initiatives and long term goals.
- Identified and resolved issues between employees, promoting better collaboration and mutual respect.
Sr Manager Formulary Management, Medicare Services
Catamaran
12.2007 - 02.2013
- Manage the staff and daily operations of the Medicare Formulary Operations Department, which includes: - Management all of Catalyst-maintained Medicare Part D formularies files (internal and external) to ensure submission files meet requirements set forth by CMS
- Provide clinical and operational direction for planning, creating, maintaining and implementing
- Medicare Part D Formularies (Puerto Rico, and Nationwide); CY Monthly formulary updates; and next
- CY Formulary creation, submission and review
- Develops and Maintains Marketing Materials - Develop and Review the Company’s Medicare formulary and inclusion/exclusion drug lists - Provides support to other areas: Plan finder NDC List Updates & Clinical support for PDE issues - Serve as Subject Matter expert in CMS Audit
- Serve as Subject matter expert in Claims adjudication research and resolution ( both in Medi-Span and FDB claims processing databases)
- Managed large-scale projects and introduced new systems, tools, and processes to achieve challenging objectives.
- Implemented and developed operational standards, policies and procedures.
- Conducted performance evaluations, compensations and hiring to maintain appropriate staffing requirements.
- Developed proposals and presentations for internal and external audiences.
- Serve as Subject Matter expert in formulary related compliance inquiries.
Intern Pharmacist
Walgreens
06.2004 - 12.2007
- Followed department policies, procedures and best practices for pharmacy operations.
- Educated patients on possible drug interactions, potential side effects, and optimal methods of administration.
- Used pharmacy software to enter prescription and insurance information.
- Assisted pharmacist in final review of filled prescriptions.
- Monitored inventory levels and notified pharmacist of items requiring reorder.
- Evaluated patient histories to assess medication compliance and spot issues such as doctor shopping or excessive usage.
Education
Doctor of Pharmacy (Pharm.D) - Pharmacy
School of Pharmacy, Medical Sciences Campus
San Juan, Puerto Rico06.2007
Bachelor's degree - Natural Sciences
Universidad De Puerto Rico, Recinto De Rio Piedras
San Juan, Puerto Rico06.2003
Skills
- Pharmacy Benefit Management
- Medicare Part D
- Managed Care
- Healthcare Management
- People and Culture
- Budget Forecasting
- Improve Policies
- Strategic Planning
- Analytical and Critical Thinker
- Project Oversight
- Operations Oversight
Accomplishments
- Successfully managed the Medicare Part D formulary and clinical operations to achieve outstanding results in compliance audits, star rating results, and NCQA accreditation.
- Achieved transitioning and establishing a stand alone clinic model to support an interdisciplinary approach to a multi-specialty provider organization by managing its operations and supporting the clinical strategy.
Additional Information
- Honors & Awards , Patient Care Award - GlaxoSmithKline Jun 2007 Award in recognition of outstanding performance during pharmacy rotations in the 2006-2007 academic year. McKesson Medication Management Award - McKesson Jun 2007 In recognition of outstanding performance in hospital setting pharmacy rotations. Employee of the Year Award - MMM Holdings Dec 2015 Nury Toledo-Núñez, Pharm. D. - page 3
Affiliations
- CFPR -Colegio de Farmacéuticos de Puerto Rico, Member, December 2007-Present · 16 yrs
- AMCP- Academy of Managed Care Pharmacy, Member, 20011-Present · 12 yrs
- Asociación Puertorriqueña de Diabetes, Board Secretary, Jan 2023 - Present
- Club Cívico de Damas de Puerto Rico, Member, Mar 2023 - Present · 5 mos
Certification
- PR Pharmacy License: 5299
- Registry No. 126086, Office of regulations and Certifications of health Profesionals of PR, Issued Dec 2022 thru Dec 2025
- Pharmacy Based Immunization DeliveryPharmacy Based Immunization Delivery, APhA FoundationAPhA Foundation - Issued Apr 2021 thru Apr 2024
- Pharmacist Certificate Program in MTMPharmacist Certificate Program in MTM, Postgraduate Healthcare Education - PowerPakPostgraduate Healthcare Education - PowerPak, Issued Sep 2021
Languages
Spanish
Native language
English
Proficient
C2
Timeline
Executive Vice President
PharmPix Corp
05.2022 - Current
VP of Clinic Operations
MMM Holdings LLC
05.2018 - 05.2022
Vice President of Pharmacy
MMM Holdings LLC
02.2015 - 05.2018
Assitant Vice President of Pharmacy Operations
MMM Holdings LLC
03.2013 - 01.2015
Sr Manager Formulary Management, Medicare Services
Catamaran
12.2007 - 02.2013
Intern Pharmacist
Walgreens
06.2004 - 12.2007
Doctor of Pharmacy (Pharm.D) - Pharmacy
School of Pharmacy, Medical Sciences Campus
Bachelor's degree - Natural Sciences
Universidad De Puerto Rico, Recinto De Rio Piedras
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