Requests
6
5
Keep in touch with meI'm using Intch to connect with new people. Use this link to open chat with me via Intch app
Work Background
Self-employedSenior Healthcare Consultant
May. 2023RemoteDynamic and strategic healthcare leader with over 20 years of experience at Express Scripts, providing a solid foundation for successes in quality assurance, clinical strategy development, and operational enhancement. Proven track record in managing healthcare projects, ensuring compliance with benefit designs, and optimizing patient care outcomes. Expert in prescription benefit design implementation, EHR system integration, and process improvement. Demonstrated ability to lead cross-functional teams, collaborate with stakeholders, and drive system enhancements. Adept at translating clinical requirements into technical specifications, fostering strong relationships with healthcare providers and vendors. Recognized for improving adjudication platform accuracy and aligning processes with CMS regulatory requirements. Skilled in leveraging clinical and operational expertise to enhance healthcare delivery across multiple settings.
Areas of Expertise
● Clinical & Operational Strategy ● Strategic Planning & Execution
● Team Leadership & Development ● Cross-Functional Collaboration
● Operational Product Owner ● Project Management ● System Enhancements ● Business Analysis
● Process Improvement ● Requirements Analysis
● Systems & Design Analysis ● Patient Care Optimization
● Stakeholder Engagement ● Relationship Management
● Healthcare Compliance
GalaxE.SolutionsSenior Director of Delivery
Sep. 2019 - May. 2023Somerset, New Jersey · RemoteDirected clinical and operational strategies to enhance patient outcomes and ensure accurate healthcare claim payments in alignment with benefit designs and contracts. Spearheaded the documentation of client communication methods and contact reasons, laying the groundwork for automated response systems. Collaborated closely with healthcare providers to confirm the accurate implementation of prescription benefit designs on the claims processing platform. Provided leadership and steering committees with comprehensive status reports and dashboards that detailed project timelines and adherence. Played a pivotal role in development of a patient portal, focusing on data relationship identification and use case development to improve member experiences.
● Transitioned prescription benefits between PBM's without disrupting patient services. ● Led the facilitation of clinical criteria requirements for the automation of key processes. ● Implemented new processes to align with CMS regulatory requirements. ● Engineered process improvements through meticulous documentation of current state operations. ● Fostered strong relationships with healthcare providers and vendors, streamlining service request resolutions.
Trinity Health (HQ Michigan)Clinical Transformation Specialist
Apr. 2012 - Sep. 2019Newtown Square, PaProvided clinical support within a 92-hospital system to enhance patient care through the integration of clinical processes and technology. Facilitated the collection of requirements and steered the development of clinical designs such as process flows, order sets, and documentation templates. Translated patient care and medication orders into standardized Order Sets aligned with clinical best practices. Managed the onboarding of new partner hospitals, ensuring adherence to purchasing contracts for cost-effective care. Championed transition to a new electronic health record system, employing agile methodologies for efficient project progression.
● Developed and implemented in-patient order sets, optimizing care delivery based on best clinical practices. ● Oversaw the development of medication orders, managing the full lifecycle from admission to discharge across Trinity hospitals. ● Ensured seamless integration of new partner hospitals into the health system, maintaining contract compliance. ● Played a pivotal role in the system-wide electronic health record transition, contributing to enhanced operational efficiency.
PharMericaGeneral Manager, Pharmacy Operartions
Nov. 2007 - May. 2011Plymouth Meeting, PaManages a Long Term Care Pharmacy that services 32 facilities, including Pharmacy Operations, Regulatory Compliance P & L, Inventory Management, Client Services, Customer Service. Facility annual revenue of $25M. Leadership of pharmacy staff of Pharmacists, Pharmacy Technicians, Medical Records, Consultant Pharmacists. Facilitates process improvement to ensure service levels required by customers.
Express ScriptsDirector, Program and Portfolio Management
Dec. 1986 - Mar. 2004
Intch is a Professional Networking App for the Future of WorkSee more people like Michelle on Intch
300k+ people
130+ countries
AI matching
Get Intch if you'd like to
538069 people
21
Education Consultant
15
Human Resources @ UB Greensfelder
15
Principal Consultant @ Marketing Endeavors Strategic Consulting
70309 people
15
Human Resources @ UB Greensfelder
42
Senior Mining Engineer @ Riot blockchain
62
CEO /Co-founder @ The James Ruff Group/ HardMoney Loans