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Work Background
Molina HealthcareAssociate Vice President, Integration Office
Jul. 2022 - May. 2024TelecommuterCo-led the Indiana Medicaid new business launch and supported various projects within the Integration Office. Reviewed and updated implementation tools and templates to incorporate best practices and lessons learned. KEY FUNCTIONS & SKILLS: project management, process improvement, strategic planning, team collaboration, compliance management, business integration, project management, SWOT analysis, RFP response, team collaboration SELECT ACHIEVEMENTS: * Implemented best practices from previous projects to enhance integration processes.
* Redesigned and streamlined the Integration Office Teams site, improving team efficiency.
* Conducted a SWOT analysis with the NY health plan, consolidating five separate work plans into a single work plan, reducing meetings, and eliminating duplicative efforts.
* Developed and presented an updated Requirements Traceability Matrix template, subsequently adopted as the standard for future implementations.
OptumVice President, Optum Behavioral Health Value Creation
Feb. 2021 - Jul. 2022TelecommuteLed a team to identify and implement quality and affordability opportunities in behavioral health. Focused on identifying opportunities to reduce medical spending in the behavioral health sector. Managed three direct reports. KEY FUNCTIONS & SKILLS: leadership, data analysis, behavioral health operations, process improvement and implementation, cross-functional collaboration, quality and affordability initiatives, data analysis, team leadership SELECT ACHIEVEMENTS
* Led initiatives that improved behavioral health outcomes and operational efficiency.
* Built consistent delivery processes and tracking tools to ensure proficient execution and improved outcomes.
* Identified and implemented process improvement initiatives that significantly enhanced efficiency and member outcomes.
* Developed and implemented a process for identifying medical cost savings opportunities for behavioral health.
WellCare Health PlansVice President, Strategic Initiatives
Aug. 2018 - Feb. 2021TelecommuteDesigned and launched the enterprise-wide medical cost savings program. Led the team responsible for implementing all new and expansion business. Built relationships with internal teams to ensure compliance and operational efficiency. Managed 25 direct reports and a $1-3M budget.
KEY FUNCTIONS & SKILLS: strategic planning, cost savings, program implementation, team management, cross-functional collaboration, medical cost-saving program development and implementation SELECT ACHIEVEMENTS
* Designed and implemented the medical cost savings process, surpassing the first-year savings target of $484.5M by 50%.
* Played an integral role in expansion into Florida market and shared services delivery on product launch. Worked with market and shared services to remove barriers to success and execute deliverables.
* Nominated for CEO Challenge from the Leadership Academy; completed challenge offered by the Wharton School of Business in 2018.
WellCare Health PlansSenior Director, Behavioral Health
Mar. 2017 - Aug. 2018TelecommuteDesigned and managed the process for WellCare’s mental health parity compliance. Oversaw behavioral health integration into the medical management process. Managed relationships between the behavioral health team and claims, benefit configuration, provider data loading, and other internal teams to ensure accurate claims processing rules and compliance with government programs. KEY FUNCTIONS & SKILLS: mental health parity compliance, program implementation, cross-functional teams SELECT ACHIEVEMENTS
* Orchestrated strategy for integrating behavioral health as part of WellCare’s medical management process.
* Identified and implemented Appeals & Grievance process improvements, reducing backlog and improving resolution times.
*Developed a streamlined process to provide the company’s CMS-approved template to states struggling with compliance approval formats.
*Ensured enterprise compliance with mental health parity regulations.
Aetna, a CVS Health CompanyVice President, Operations, MHNet Behavioral Health
Jun. 2008 - Mar. 2017TelecommuteManaged non-clinical operations and supervised new client implementations. Led the MHNet team during system conversions. Reduced call center team size while maintaining performance metrics. Developed and launched employee training programs and resolved a significant claims backlog. KEY FUNCTIONS & SKILLS: operations management, system implementation, training program development, claims management, process improvement SELECT ACHIEVEMENTS
* Cleared a 100K-claim backlog within six months, reducing provider complaints, appeals, and regulatory issues while maintaining compliant claims processing turn-around times.
* Transitioned 12 health plan markets to MHNet's behavioral health management within five years, strengthening customer relationships and upselling additional employee assistant program (EAP) products.
* Established comprehensive employee training curriculum and team, improving service consistency and reducing member and provider complaints by 15-20%.
* Restructured customer service to centralize operations, improve call metrics, and enhance satisfaction, reducing team size by one-third and increasing compliance.
* Revamped provider onboarding and training, significantly decreasing claims issues and improving provider satisfaction and call volumes.
* Implemented 83 regulatory-compliant explanation of benefits (EOB) templates, reducing the risk of regulatory fines, potentially saving up to $1M year over year for a single market.
* Launched an online authorization system, increasing provider acceptance from 5% to 55%, freeing up clinician time, and improving provider satisfaction and claim auto-adjudication.
OptumSr. Director
Jan. 2000 - May. 2008Telecommute• Implemented 25 behavioral health carve-out programs with 100% client retention.
• Developed repeatable processes for implementing behavioral health programs.
• Managed successful transitions and built strong client relationships. • Led implementation teams for both the client and Optum, building client relationships quickly and efficiently. Managed a team of Account Directors for ongoing client management once programs launched.
• Executed 25 individual plans in six years, managing six plans concurrently for six months.
John DeereManager, Contract Services - John Deere Health Plan
Dec. 1986 - Jan. 2000Moline, Illinois, United States• Negotiated and implemented national vendor contracts, enhancing service offerings.
• Managed a team of facility and ancillary contract analysts, ensuring compliance and efficiency.
• Developed a comprehensive vendor management strategy.
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