SUMMARY

• An experienced Executive, Servant Leader, Analyst, and Strategist with extensive experience in health plan operations and analytics. Over 15 years in healthcare leadership roles. Able to move enterprise level initiatives and teams from strategy / concept to production quickly and effectively. Objective and data - driven leadership style with focus on actionable analysis, accountability, and critical path goal achievement.

PROFESSIONAL EXPERIENCE

Confidential

Director, Reporting and Business Analytics

Responsibilities:

• Led startup, implementation, stabilization functions for analytics at the health plan and corporate level; change leader.
• Developed and executed data/analytics related aspects of partnership arrangements with external partners: Population Health, Value Based Purchasing, Competitor transition of care, Social Determinants of Health, MLR/HBR interventions
• Drove evidence based support for innovation, enterprise strategic planning, new product implementation
• Integrated state & national data into plan decision making solutions including Evidence Based Medicine, SDOH, others.
• Lead staff development to include: analytic staff training, management enablement, executive evangelism
• Advised health plan leaders on intricacies of New Mexico nuances, general Medicaid Managed Care, local and national trends related to government sponsored health care finance, Best practices, Operational alignment
• Guide state government Human Services Department with input and national experience regarding policymaking; inform state legislators via expert support for lobbying team at both state and national levels. Served on state Advisory boards support development of state Value Based Contract development, innovation, and implementation.
• Direct support for CEO, CFO, CMO, COO day to day insights and strategic target management
• Led analytic development for sensitive and otherwise non-public projects. M&A, legal / criminal, and IP protection.

Confidential

Director, Health Plan Informatics

Responsibilities:

• Executive leadership all Managed Care Org. analytics, co-owner BI stack, co-led Integrated Hospital/IPA analytics
• Identified potential new revenue sources >$20MM, creation of new business ventures & multi-state expansion
• Reduced Medicaid encounter based rejection risk of >$15MM and successfully passed multiple state and federal Encounter Data Validation (EDV) audits.
• Simplified and consolidated BI tools to eliminate >$1MM in annual licensing fees and more than tripled team efficiency with new tools / processes and a business need / ROI focused approach.
• Optimized team operational improvements from a 450+project backlog / 200+ day average turn around time to <70 open projects and <3 day TAT for emergent projects in under 18 months.
• Lead a team of 30+ analysts and consultants in all aspects of Managed Care and health plan analytics for the largest integrated health plan in New Mexico partnering with Hospitals and Physicians nationally.
• Lead development of analytics divisions & capabilities in multiple state expansion efforts.
• Developed and lead analytics in areas focusing on Clinical Operations / Population Health, Finance / Actuary, Business Operations and development, and Regulatory Operations.
• Communicated and adapted to regular discussions with Plan CEO, System CEO, and other C-Suite and VP level leaders in highly matrixed environment. Led Integrated analytics efforts with Hospital/IPA system managing $2B shared risk.
• Oversaw the RFP response, readiness review, and implementation of the analytic component of State of New Mexico Managed Medicaid (Centennial Care) 2017-18 with a potential multi-billion dollar impact. Wrote the only section of RFP for any health plan in the state to receive a perfect score by state assigned RFP Manager (Mercer).
• Managed contractual responsibilities related to analytic insights for key employer group customers and Provider at-risk entities. Led Broker/Employer user group analytic workgroup and implemented innovations as proposed.

Confidential, Brea, California

Director, Clinical & Operational Analytics

Responsibilities:

• Managed all Operations and Payor Solutions analytics including non-claims finance, clinical operations, compliance, pricing, leakage, and analytic automation.
• Owned / Architected the Business Intelligence Stack, including all data warehousing and BI toolsets as well as organizational data governance.
• Lead, in conjunction with the Chief Medical Officer, clients as a partner in development of IT and reporting solutions the meets industry clinical requirements.
• Managed ~$12MM per year of Quality Improvement Program risk fund, analysis, and outcomes oversight.
• Lead external client needs identification, analysis, and relationship support via direct contact with current and potential clients.
• Managed Population Health and clinical analytics to support Oncology and Cardiology benefit management for 4 Fortune top 100 Managed Care Organizations covering >5 MM lives and >10,000 Physicians.

Confidential, St. Louis, Missouri

Manager, Data Analytics & Lead Data Analyst

Responsibilities:

• Managed a multidisciplinary team charged with sensitive / time compressed / strategically critical analyses to Centene Corporate and Plan clients as well as staff development, internal consulting, systems development & prototyping, and outcomes audits.
• Developed and managed Inpatient admission management and costing predictive model serving >100K admissions annually in multiple states with an average accuracy within 3% of total spend over 4 years.
• Developed and managed multiple data marts and relevant analytic output.
• Lead projects including ad-hoc smaller scale production management, ongoing consulting, and long term research efforts with the ultimate goal of producing actionable information for senior leadership as well as evidence based strategic guidance.
• Administered long-arc efforts focused on project development and ownership to the point of full production.
• Lead communications and analysis for C-Suite executives, Physician leadership, externally facing compliance and ratesetting entities, investor relations, and Board of Directors in multi-state matrixed leadership roles.
• Provided strategic insights for multiple state health plans in support of monthly financial close including experience analytics, financial variance, and trending/forecasting.

Confidential, St. Louis, MO

Technical Analyst & Project Manager, Analytics/Care Management

Responsibilities:

• Developed enterprise analytics tools & reports with specific focus on Care Management, Pay for Performance, Performance Improvement, and Quality Improvement programs.
• Managed multiple open projects simultaneously for Clinical support, HEDIS, and Quality Improvement teams and manage team members to meet service level agreements
• Reported on broad datasets using SQL (TOAD, SQL Developer, and MS Enterprise Management Express), Crystal Reports, Business Objects, Web Intelligence, Xcelsius Engage, Access, and Excel.
• Created end-to-end analysis including initial needs investigations through release of production reports, analysis, tools, and subsequent support.
• Engaged in regular communication with physicians, hospital discharge coordinators, and social services to evaluate the recommend proper patient placement and service initiation.
• Coordinated insurance processing including benefit verification, referral/authorization, and care coordination.