Jim Krocak
Associate Principal
Health Management Associates
St. Paul, MN
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Jim Krocak is a healthcare operations leader with more than 20 years of experience across Medicare, commercial, group, and pharmacy benefit management. He advises organizations ranging from start-ups to Fortune 20 companies on operational strategy, vendor implementation, regulatory compliance, and program integrity. By aligning strategy, financial performance, and stakeholder needs, Jim helps clients strengthen readiness, mitigate risk, improve service delivery, and achieve sustainable results.
Before joining Health Management Associates, Jim was an independent consultant, guiding managed care operations strategy, third-party administrator (TPA) configuration, and the development of a supplemental benefits flex benefit card. He partnered with a client to launch group and Affordable Care Act (ACA) insurance plans, focusing on benefit configuration and training of member and provider services teams. He also oversaw the pharmacy benefits and ensured effective pharmacy benefit manager (PBM) accountability and service levels.
Prior to his personal consulting work, he served as Bright HealthCare’s senior director of pharmacy operations for the ACA and Medicare business. Jim delivered $41 million in cost savings by leading four subsequent PBM transitions as they expanded into new markets and refining operational processes. He developed the organization’s pharmacy governance and compliance structure, ensuring successful Centers for Medicare and Medicaid Services (CMS) audit readiness and smooth transition from one plan year to the next.
Jim has a strong record of driving health plan operational efficiency. At Prime Therapeutics, he engineered a 60% reduction in new health plan setup time by streamlining workflows and centralizing benefit submissions. At Optum/UnitedHealth Group, he improved Stars quality performance by implementing adherence initiatives for diabetes and other chronic conditions. He also stood up the Medicare Pharmacy Readiness plan which led to leading the overall Medicare readiness program, connecting many teams and individuals into one central forum.
Jim began his career as an accountant and subsequently spent six years as a financial operations consultant focused on internal controls, program integrity, and risk mitigation. He earned a Bachelor of Science degree in accounting, with a minor in Spanish, from the University of Minnesota.