• Develop and execute the Digital Transition Market Engagement Strategy. This strategy engages health care quality stakeholders to learn from their peers and engage with each other as they advance their digital quality strategies. Utilizes market feedback in strategic plans.• Represent NCQA’s Digital Transition within the marketplace and use opportunities to gain market intelligence on the readiness and support for the Digital Transition. • Engage internal & external with focus groups, knowledge gathering, market reviews. Develop education & training strategy for the different external stakeholders in the Digital Quality Transition. • Develop KPIs for engagement and evaluate and report on success metrics. Create roadmaps, product requirements and timelines. • Architect the digital community and work with IT resources to build the digital community platform.• Develop content strategy and oversee the development of content, e.g., blogs, knowledge articles, multimedia and other forms. Work with internal and external partners to seed content and discussions to engage the market. • Partner with Product & Marketing teams on Digital Products development and go to market strategy.

• Responsible for Market Strategy for Interoperability business to include FHIR API Roadmap, code Developer Program, Health Information Exchange and Payer Strategy • Identify market tends and 'what's next' for Interoperability and the Quality Measures markets. • Engage with Interoperability and Open Platform markets though client surveys, internal delivery challenges, client workgroups and industry council calls. • Assess market penetration and product positioning in relationships to competitive advantage and revenue potential. • Conduct Market Research to determine current competitive view, regulatory and accreditation guidelines. Create financial and market requirements. Identify market & solution needs for enhancements, workflows and net new functionality. Responsible for management of Business Unit Idea Space and client feedback. • Discern market feedback and technical feasibility to obtain Business Committee Approval • Create Opportunity Assessment, Market Assessments and Business Cases to request investment for roadmap placement. Work across business units to coordinate resources & capacity to achieve development. • Partner with Product Management Client Delivery and Downstream Marketing on go to market activities and strategic requirements on Product (internal & external) roadmaps.

• Led NCQA HEDIS Certification Project. First time for Cerner and completed in CQL/FHIR for the first time. Included cross functional teams from all across the organization with net new functionality. • Responsible for Quality Reporting Strategy for Population Health Platform. Determine market needs to support Payer and Population Health Organization needs. Enhance current functionality and net new functionality to drive Quality Reporting. • Manage solution roadmap. Create business requirement, and business case for new and current enhancements. Develop user stories & personas to gain understanding of market needs. Drive new opportunities based on business goals, strategic direction and client feedback. Create Benefit Cost Analysis on new and current functionality.

• Develop and implement UM Reporting Plan for 5 LOB’s. Including operational, strategic, cost savings and MEI’s in plan. Specific focus on decreasing readmission rates, tracking ALOS, Admits/K and Days/K. • • Use data to recommend pilot cost savings initiatives to include: PT/OT Utilization, targeted rounding on specific inpatient populations, OP high-cost radiology and monthly LOB summaries based on Utilization data. • Manage auth/claim Suspended claims process based on UM Errors • Responsible for System configuration and updates for all UM Workflow systems to include production support and implementation on new UM Workflow systems. • Create, Develop and maintain clinical workflows, SOP’s and job aids. Conduct process improvement to recommend and implement streamlined processes.

• Provide data analysis and validation for ad hoc and scheduled reporting for Utilization Management (UM), Care Management (CM) Behavioral Health (BH) and Disease Management (DM) specific to individual Medicare, Medicaid and Exchange contracts. Data resulted presented in summary, presentation and analytical formats. • Manage Utilization Management (UM) Staffing model for new markets and current markets. Use model to make staffing recommendations and forecasts for existing and incoming markets.  Identify data trends in UM, BH and CM reporting. Partner with Clinical Business leaders on program development based on data trends. Facilitate ongoing meetings with clients to review reporting norms, development needs and identify department strategic goals. • Work with clinical departments to provide data analysis; validate data and expected outcome based on the business process and operational procedures. Document SOPs and workflows for all projects and reports. • Create robust reporting from multiple data sources, to include organized and unorganized sources. Able to merge manual and non-manual data sources in metrics. • Utilize Authorization and claims data to provider Medical Expense Initiatives recommendations, tracking and post implementation analysis. Strong understanding of different cost drives and environmental factors impacting MEI’s

• Provide reporting and data analysis to the Hawaii Market Health Services department, to include Case Management, Disease Management, Utilization Management and Behavioral Health Services. Partner with clinical business leaders reporting strategy and recommendations based on data analysis. Deliver Ad Hoc reports on request. Use data analysis, reporting and trend analysis to improve and build Health Services processes. • Ensure reporting and current processes meet state RFP requirements. Provide data analysis for State report requests. Compile and prepare Regulatory reports for Hawaii State Medicaid office and CMS. Deliver Ad Hoc report requests. Perform data validation to ensure accuracy prior to submission. Provide Quality metrics to support Quality WorkPlan, NCQA, HEDIS and CMS requirements.• Represent Health Services when working with corporate IT partners. Work with developers on automated report requirements and design. Provide end user support with internal & external solutions. Responsible for Health Services vendors to include Implementation and ongoing vendor management.

• Data analysis to include trend monitoring/reporting, and Ad Hoc reporting. Provide recommendations based on data and analysis. Provide data analytics to track and measure HEDIS (NCQA), URAC and QI progress. Utilize data analytics to develop, deliver and assess HEDIS activity. Support local QI program with process improvement and documentation.• Create and provide data analysis for monthly clinical and operational reports. Comprehensive reports include data analysis, narrative of timeframe activities, and trending from multiple sources. • Implement new polices as needed. Conduct on-going training for clinical and non-clinical staff. Topics to include Quality, and service requirements. Developed training materials and maintain official training documentation for staff. • Manage grievance & appeals and adverse incidents. Monthly file review. Conducts clinical file audits monthly and quarterly. Make recommendations to clinical team based on audit results.

• Provide Data analysis by developing internal Dashboard to track and report progress of Wellness programs based on data from internal and external sources Monitor program metrics, run data queries from vendor warehouses and prepare reports in Excel dashboards and PowerPoint presentations using statistics, graphs and illustrations while leading department health informatics initiatives. Vendor site administrator to maintain and update user site and data management in Oracle database for department operations including program eligibility, participation tracking and program evaluation. Work with internal IT team to maintain and resolve issues of data file feeds to external vendors• Conduct best practice research and serve as subject matter expert to support program strategy and new program development. Partner with the internal customers to understand their needs and worked with key stakeholders on tools to support health promotion and program strategy. • Managed over $100,00 of vendor contracts for wellness programs. As account manger for multiple vendors, worked to establish plans/relationships resolve daily issues, manage invoices, updated site content as needed, and ensure projects met deadlines. Managed $1.4 million dollar departmental budget.