Oct 2019 – Aug 2024 · 4 yrs 10 mos · Remote

• Led the implementation and served as strategic advisor and operational lead of risk adjustment, clinical, and quality programs across new markets.
• Bridged the gap between platform capabilities and market-specific needs, ensuring seamless integration and execution
• Collaborated with cross-functional teams - product, data, clinical, and market leadership - to align programs goals with physician workflows and engagement strategies
• Partnered with new market teams to define program goals and develop tactical plans to meet goals
• Applied in-depth expertise in risk adjustment program execution, particularly its dependence on accurate, timely data.
• Understood physician practice dynamics and office workflows to ensure effective operational and engagement strategies
• Championed continuous improvement initiatives based on market feedback, performance metrics, and changes in the CMS-HCC model from V24 to V28

Jul 2019 – Oct 2019 · 3 mos

Jun 2017 – Jun 2019 · 2 yrs

• As a key member of the Risk Adjustment and Quality Leadership team I am responsible for overseeing and directing all aspects of implementation and operations of Evolent’s core risk adjustment and quality solution. I provide strategic and operational leadership to ensure that our partners are successful and compliant in all risk adjustment and quality initiatives to ensure optimal revenue is achieved.

Jan 2015 – Jun 2017 · 2 yrs 5 mos

Jun 2006 – Dec 2014 · 8 yrs 6 mos · Detroit Metropolitan Area

• Responsible for clinical performance and managed care activities for a fully integrated delivery system that includes 1,200 employed and 800 private practice physicians, four hospitals, and 32 medical centers. Manage twenty direct reports that include informatics, certified professional coders, and population health managers. Matrix reporting relationship to the Henry Ford Medical Group Chief Operating Officer and Henry Ford Physician Network Chief Medical Officer.
• Implemented population risk management tool for 160,000 lives.
• Decreased inpatient admissions by 11%, emergency room visits by 11% and high-tech Imaging Requests by 16% through case management activities, nurse call program and policies for referral and utilization management.
• Increased ambulatory quality metrics for diabetes and preventive health care bundles by hiring and placing population health managers in primary care clinics to identify and outreach to patients with gaps in care.
• Developed clinical integration program by implementing a continuum of care tool, developing utilization and quality metrics, and physician engagement activities.
• Serve on Henry Ford Medical Group Senior Management Team, Primary Care Leadership Team, Clinical Integration Committee, Provider Network Committee and Efficiency Campaign Planning Committee.
• Maximized pay-for-performance incentives available through CMS’s PQRS/Meaningful Use, patient centered medical homes, and other payer supported incentive programs.
• Led initiative that led to 4.5 stars in the Medicare 5-Star program.
• Negotiated risk based contracts.
• Received system awards for employee engagement and revenue improvement activities.

Feb 2002 – May 2006 · 4 yrs 3 mos

• Northern California Management Accounting and Analysis
• Responsible for management of production, customer service, and auditing/cost analytics staff. Strategize and develop the departmental 5-year plan. Perform HR functions for interviewing, hiring, performance reviews and discipline. Provide support to 17 hospitals and 27 medical offices for their cost accounting and finance decision support needs. Manage the processing of 8 million utilization records, 2.5 million encounters, and $2 Billion per month. Review accuracy of unit costs, encounter costs, and departmental costs generated by the Eclipsys/SDSM System. Assure HIPAA compliance of all data analyses and customer service requests. Support projects and programs such as Product Line Analysis and Reporting; Centers for Medicare and Medicaid Services Bid; National Pricing Rate Setting; Community Benefit; and Transfer Pricing.
• Greatest Success: Developed team-oriented atmosphere, and improved overall organization. Under previous leadership, staff members operated independent of one another, and were specialized narrowly. Through cross training and team building, this atmosphere changed to one of interdependence and increased organization. The result was an improvement in morale and production processing.

Oct 1999 – Feb 2002 · 2 yrs 4 mos

• Metrics Department
• Responsible for analyses of workers compensation claims for large employer groups. Provided foundation and analyses for a business case to provide Pharmacy Benefits. Mentored and trained consultants and analysts within the department in the use of SAS.

Oct 1994 – Oct 1999 · 5 yrs

• Responsible for supporting three hospitals in their finance decision support needs using the Eclipsys/SDSM system and SAS reports. Developed a productivity system for the patient care departments that helped the system realize cost savings in labor and benefits. Developed reports using Solucient/HCIA data for benchmarking. Provided data for budget creation for all departments in the three supported hospitals.