Gorman Health Group | Wayne Miller, MBA, BSP, RPh - Gorman Health Group
19882
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Wayne Miller, MBA, BSP, RPh

Senior Director, Pharmacy Solutions



Wayne Miller is Senior Director of Pharmacy Solutions at Gorman Health Group (GHG). In this role, he is responsible for supporting the Senior Vice President of Pharmacy Solutions in the oversight and development of projects and services in Medicare Part D, Medicaid, and industry relations. In addition, he manages a variety of client projects in compliance, Centers for Medicare & Medicaid Services (CMS) audit support and remediation, Pharmacy Benefit Manager (PBM) audits and Requests for Information (RFIs). Wayne brings GHG clients 28 years of experience in the health care industry, with broad Medicare and Medicaid pharmacy operations leadership experience in multiple practice settings.

 

Wayne has led many initiatives including the development of operational improvement for new and expanding Medicare Advantage Prescription Drug plans (MA-PD), Special Needs Plans and dual eligible programs. In addition, he has been involved in healthcare informatics and prescription drug event (PDE) reconciliation, compliance and auditing, pharmacy and therapeutics (P&T) committees, delegated function oversight and provider communication, and mock audits and audit preparation teams for MA-PDs and Prescription Drug Plans. Furthermore, Wayne has led PBM implementation, compliance oversight, and auditing.

 

Wayne’s specialization in Part D elements, including CMS Star Ratings, formulary management, and regulatory oversight, have made him an invaluable member of the GHG Pharmacy team. Wayne has served in multiple interim management roles as Director of Pharmacy and Vice President of Medicare Part D Operations.

 

Over the past 28 years, Wayne has worked as a hospital pharmacy director, as president of pharmacy retail and long-term care enterprise, and in the managed care industry where responsibilities included management of MA-PD Star Ratings development, formulary development, Part D benefit design and implementation, clinical utilization management, regulatory compliance, internal auditing, and financial performance of Medicare Part D.

 

Wayne has served as past President of Central Pennsylvania Pharmacists Association and has served on various councils, commissions, and committees for state and national pharmacy organizations. Wayne has also presented at conferences on a state and national level on pharmacy operations quality improvement, automation, and CMS Star Ratings.

 

In addition to being a pharmacist, Wayne has earned his Master of Business Administration in Healthcare Management and a Master’s Certification in Healthcare Informatics.