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Summary
This Health Plan Operations expert has led many initiatives achieving transformational changes that positively impacted the quality and cost of health care for people in multiple settings- nursing home, health plan, hospital, clinic, community. They effectively designed and operated successful clinical and business programs/processes within health systems, health plans or other privately funded healthcare organizations for the most vulnerable populations. Their relationships within the industry across the country and market research she is well versed on the latest CMS, ACA and other significant changes that impact payers, providers and beneficiaries. Whether healthcare affordability, healthcare delivery or clinical IT platform design and implementation, they provide guidance and operating discipline ensuring strategic goals and targets are met.
Highlights
- 30+ years healthcare industry expertise
- Healthcare business solutions design, implementation
- Quality Program and Contract Compliance
- Utilization, Care and Disease Management
- Health plan operations and process improvement
- Clinical workforce leadership/development
- IT platform business requirements and end user design
- Vendor/provider contract development and negotiation
- Government program healthcare services proposal writing
- Government program sales and marketing
Relevant Accomplishments
- Built and launched first CHF business/clinical model that reduced $5 million loss for Medicare patients within a health system to $10 million contribution margin
- Designed and implemented first Medicare Risk adjustment program launched in Florida that yielded a 12.1 ROI
- Expanded retail clinic footprint from 350 to 500 clinics within 14 months
- Successful retail clinic M and A operational alignment
- Successfully planned and submitted CMMI Dual-eligible Model of Care to CMS that yielded 5 state contracts
- Designed and successfully implemented new line of business for chronically ill members that yielded a positive ROI by year two
- Increased chronic care program sales by 50% in one year
- Successfully achieved managed care health plan turnarounds in 3 states financially and contractually
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Click “request expert” for a free initial screening call with this expert or a similar expert regarding your expert consulting needs
