Recent healthcare executive experience
WellPoint, Inc., Camarillo, California 2009-Present
Staff Vice President, Care Management , 2009 – Present
- Directed utilization management and post clinical claims review functions for the Medicaid and MediCare business units.
- Implemented an automated fax system, increasing throughput by 200%. Eliminated all paper handling in the department.
- Launched a 50 person outbound call program for the MediCare STARS program.
- Established a clinical compliance team for the MediCaid business.
- Managed Disease Management and Health Education member outreach functions.
- Responsible for 300 associate post clinical claims review function for the commercial lines of business.
- Standardized policies, processes, quality improvement and workflows across 5 claims systems.
- Change Management for 10 successful clinical operations outsourcing projects in 30 months.
- Achieved savings of 15% on a 37 million dollar annual budget in 2 years.
SecondWind Business systems design, Camarillo, California 2007-2009
- Consulted with executives in firms ranging from 3 person entrepreneurial company to Fortune 100 enterprises.
- Specialized in strategic planning, goal alignment, change management, and executive coaching.
- Consulted with Medicare Advantage Clinical Operations to turn around quality problems.
WellPoint, Inc., Camarillo, California 1997-2007
Staff Vice President, Operations Performance Department, 2001-2007
- Created new corporate department, introducing process analysis and performance improvement to five medical divisions.
- Developed strategy for department to meet business goals and support operation metrics.
- Managed team of 145 associates in 15 locations.
- Conducted performance analysis and consulting.
- Provided instructional design, training, quality monitoring, business process outsourcing, quality improvement, process analysis/improvement, change management, project management and executive consulting.
- Delivered Large Client Enrollment system on time and within budget; Recognized with innovation award.
- Analyzed staffing and technology requirements for facilitating 20% increase in membership. Developed web-based system for enrollment and trained temporary staff to manage business in time.
- Held responsibility for Western region, including California, Colorado and Nevada.
- Trained outsource vendors in Colorado, Georgia, Jamaica and the Philippines.
- Restructured priorities of shop, recruiting resources from operations, sales and information systems for key projects.
- Partnered with team to set parameters for project, including requirement for minimum training time of four hours.
- Served on steering committee tasked with managing Health Insurance Privacy and Portability Act (HIPPA) compliance and training.
WellPoint, Inc., Camarillo, California
Director of Customer Satisfaction, Newbury Park, California, 1997-2001
- Developed and implemented improvements to business operations.
- Managed training, performance consulting, quality monitoring, fulfillment and mail services.
- Designed and executed program management process to monitor ongoing projects as well as adjust priorities according to business requirements.
- Improved project completion rate from 55% to 75%, maintaining cancellation rate at 15% as well as off-track and over-budget rate at 5%.
- Created service transformation project, establishing new senior management sponsorship, management accountabilities and customer-focused metrics.
- Enhanced staff training and facilitated open dialogues among employees.
- Raised customer satisfaction scores by four points and decreased contract lapse rate by 6%. Received honor award.