Jul 2021 – Present · 4 yrs 9 mos

• Provides process, project, and change management methodology & consulting support to both local and company wide initiatives; Trusted expert advisor and provides strategic direction in large scale projects; Proactively identifies opportunities for improvement; Researches, develops, and implements related best practices; Identifies and develops plans to improve performance enterprise wide.

Jul 2019 – Jun 2022 · 2 yrs 11 mos

• Responsible for ensuring the overall success of all Prospective Revenue Management programs
• Manages the activities related to CMS Medicare Risk Adjustment and Provider Outreach and Education.
• Develop metrics, policies and procedures in support of required deliverables and validation of programs ROI while ensuring the programs are in compliance of CMS program requirements.
• Create and maintains databases to track business performance.
• Oversees and assists in data analysis, reporting, and formulating recommendations and providing guidance to other team members and providers.
• Develops and analyzes business performance reports (internal and external) and provides notations of performance deviations.
• Hires, trains, coaches, counsels and evaluates performance of direct reports.

Jul 2018 – Jul 2019 · 1 yr

• Relationship owner and point of contact for large Accountable Care Organizations (50,000 plus attribution each) participating with Value Based Care arrangements.
• Responsible for consulting with practice leadership to improve efficiencies of provider practices and clinical processes leading to shared savings ($2.7M payout to one ACO in 2018).
• 100% success rate in shared savings earning among 3 ACOs, member attribution 116,000.
• Leads face to face and virtual encounters with executive leadership teams.
• Obtains and analyzes organization specific cost utilization and quality data and reports for cost of care and quality opportunities.
• Assists practices to target elevated risk members and stratify gaps in care.
• Develop, maintain and strengthen relationships among payer and provider.
• Identifies action plans for providers to implement to improve cost, quality, and the patient experience.
• Creates and hosts tailored learning opportunities to support the deployment of program interventions.
• Collaborates with all program stake holders to meet organization service needs.
• Manage high-profile and sophisticated provider groups engaged in value-based payment model.
• Train, mentor, and coach Care Consultants (9) to ensure success and growth.
• Audit staff (9) on core competencies and programmatic elements.
• Develop and lead educational sessions internally and externally.
• Pilot new programmatic features and serve as a SME on population health strategies and transformation topics to internal and external stakeholders.
• Collaborate with CDT Manager to review market level performance data and identify outliers.

Mar 2016 – Jul 2018 · 2 yrs 4 mos

• Relationship owner and point of contact for large Accountable Care Organizations participating with Value Based Care arrangements.
• Responsible for consulting with practice leadership to improve efficiencies of provider practices and clinical processes.
• Promote efficiencies and identify actions to achieve shared savings (all assigned groups successful, 3 with total 116,000 member attribution).
• Obtains and analyzes organization specific cost utilization and quality data and reports for cost of care and quality opportunities.
• Assists practices to target elevated risk members and stratify gaps in care.
• Develop, maintain and strengthen relationships among payer and provider.
• Identifies action plans for providers to implement to improve cost, quality, and the patient experience.
• Creates and hosts tailored learning opportunities to support the deployment of program interventions.
• Collaborates with all program stake holders to meet organization service needs.

Feb 2013 – Mar 2016 · 3 yrs 1 mo

• Responsible for clinical operations across the care continuum.
• Oversee case management and utilization management duties, maintaining quality and reducing costs associated with complications.
• Lead role in setting direction and development of program which yields annual revenue of $8.9M.
• Coordinates and collaborates with others to gain efficiencies and enhancements within the program and organization.
• Identifies and corrects client and member issues to maintain membership and growth.
• Communicates interdepartmentally to gain resolution and satisfaction of member and client/customer needs.
• Implements new accounts and determines operational needs.
• Sets team direction, resolves problems, and prioritizes while managing a team of 25 Registered Nurses.
• Utilization of quality measurement tools such as HEDIS and STARS.
• Participation and preparation in client audits and accreditation audits such as NCQA, URAC and ISO.
• Implemental in department growth, team of 12 RN’s in 2013 to current number of 25. Membership 4M 2013 to 7.7M 2105. Growth forecast for 2016 is 8.6M.
• Interviews and hires to bring the best talent to the program.
• Reviews, audits and coaches nurses on performance and areas of improvement.
• Develops and edits policies and educational aids.

Jun 2012 – Feb 2013 · 8 mos

• Supports management team in daily operations of busy and growing program.
• Performs and trains team in case and utilization management.
• Reviews, audits and coaches nurses on performance and areas of improvement.
• Participation and preparation in client and accredidation audits such as URAC, NCQA and ISO.
• Develops and edits policies and educational aids.

Jun 2006 – Jun 2012 · 6 yrs

Sep 1997 – Jun 2006 · 8 yrs 9 mos · Albany County Department of Health

• Responsible for providing in home nursing care to a diverse population.
• Maternal-Child care specialist.
• In home assessments and education.
• Synagis prior authorization and administration to at-risk infants.
• Assess physical and psychosocial needs of clients, and perform nursing duties as needed.
• Teach and demonstrate healthcare techniques to clients and families.
• Coordinate community services to meet clients’ needs.
• Develop and present wellness programs in health, safety, asthma, and lead poisoning prevention.
• Serve as Nurse Liaison for Health Department at family practice clinic.

May 1993 – Nov 1997 · 4 yrs 6 mos · Niskayuna, New York

• Responsible for care of infants in a level III NICU.
• Served as Charge Nurse, overseeing staff of five to eight RN’s.
• Attended all high-risk deliveries and cesarean sections.
• Neonatal Resuscitation as needed.
• Lactation support.
• Served as preceptor for new employees and graduate nurses.
• Participated in QA/CQI programming.
• Audit preparation and participation (JCAHO).