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scott dunhamScott Dunham, Pharm.D

Senior Consultant

Scott is a clinical pharmacist and Senior Consultant with BluePeak Advisors (BPA) where he works with health plans and Pharmacy Benefit Management (PBM) companies on compliance and operational issues related Medicare Part D. His focus is on providing health plans with program support and vendor oversight for Coverage Determinations, Appeals and Grievances (CDAG), Formulary Administration (FA), Medication Therapy Management (MTM), Star Rating initiatives and Part D plan implementations. He spent the last twenty years in managed care, and the last ten years within Medicare.

Prior to joining BluePeak Advisors (BPA), Scott was Senior Director, Clinical Program Operations for one of the top 3 PBMs in the country. His team’s primary responsibilities were supporting the daily rejected claims review quality assurance program; development, implementation and maintenance of a CMS compliant Medicare Part D Transition Benefit program, including daily operational monitoring and audit support; and assisting in the design and development of Medicare Part D MTM program software as well as managing the MTM operational processes, HPMS reporting, and annual CMS submissions. He also oversaw the Concurrent Drug Utilization Review (cDUR) programs and retrospective Drug Utilization Review (rDUR) programs for Medication Adherence, Controlled Drug Over-utilization, Pharmacy Guideline Compliance, Retail to Mail, Mandatory Mail and Therapeutic Interchange/Generic Substitution programs. In addition, Scott has also developed medication adherence programs directly related to improvement in Medicare Part D star measures for health plans.

Scott has also worked for three other smaller PBMs in a variety of clinical and pharmacy administrative roles.

  • University of Arkansas for Medical Sciences, PharmD.
  • University of Pittsburgh, BSPharm.
  • Registered Pharmacist: Commonwealth of Pennsylvania, State of Georgia.

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Experienced Medicare staff: Ready when you are!

BluePeak knows how difficult it can be for Medicare Advantage plans and TPAs to find knowledgeable resources with experience in Medicare, especially when demands increase sharply given the Medicare annual cycle. BluePeak maintains a wide variety of experienced Medicare personnel to help you with seasonal projects, operational backlogs, compliance monitoring, remediation activities, and more.

Examples of projects that BluePeak has assisted plans in 2022 include:

  • Clinical chart review by licensed clinicians
  • Call center oversight, including listening to calls for accurate classification and calibration
  • Operational support to resolve grievance backlogs and provider directory compliance
  • Pharmacy support to resolve coverage determination backlogs
  • Program area specific operational and administrative responses to a corrective action (initiated internally or externally)
  • Compliance resources to support compliance program initiatives

Whether you need one resource or many, BluePeak can quickly staff any project, train resources, track results, and deliver success.

Contact us today!