St. Louis, MO
OBJECTIVE
Results-oriented health care professional with 21 years of diversified experience and proven track record. Brings a broad and successful background in health care management, case management, and call center management. Experience with Medicare/Medicaid population. Possesses highly developed and interpersonal leadership skills.
* Health Plan Experience
* Case Management
* Disease Management
* Utilization Review
* Hospital Nursing
* Call Center Operations
* Experience with Medicaid and Medicare population
WORK HISTORY
Mar 2003
to
Oct 2011
Executive Director
Healthways
St. Louis, MO
Overall responsibilities for all call center operations six days per week with 175- 250 employees.
Management of $30 million budget.
Leader of teams of Directors of Clinical/ Account management, Dialer Management, Human Resources, Sales and Business Technology.
Contract oversight for quality, operational performance and analysis of health plan contracts. Clinical Liaison between the Account Management team and its health plan customers.
* Developed the Standard Operating Guideline Committee for the enterprise.
* Obtained statistically significant improvement in dilated retinal examinations I HEDIS
* Lead Manager of the Standard Operating Guide Core Committee.
* Oversight of all health plan operations/tours in the St. Louis Center for 18 Health Plans.
* Leader of 5 managers who supported 50 colleagues
* Provided an integral role in the development and implementation of policies and procedures
* Contract oversight for quality, operational performance and analysis of health plan contracts.
* Responsible for a variety of personnel issues including employment, termination, performance reviews, salary reviews, and disciplinary actions.
Jan 2000
to
Mar 2003
Health Services Manager
CIGNA HealthCare
St. Louis, MO
Oversight for a team to manage daily operations of Health Services/Utilization.
Directed prior authorization, concurrent review, and case management activities. Identified program participants and managed resources in 4 disease management programs to improve clinical outcomes, provide quality care, and decrease medical costs.
* Developed an integration strategy between case management and disease management achieving a $3.50 PMPM savings.
* Consolidated St. Louis and Kansas/Missouri prior authorization and pre-certification phone queues with 150K in savings within first year
Feb 1996
to
Jan 2000
Home Care Consultant/Patient Care Supervisor
BJC Home Care Services
St. Louis, MO
Provided Sales of Home Infusion, Durable Medical Equipment, Intermittent H...
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