HDMS is the premier provider of healthcare decision support solutions and empowers employers and health plans to maximize the value of their healthcare data through powerful, specialized and customized, web-based reporting and analysis tools in a payor-agnostic framework.In the role, I direct a team of Product Managers to create an industry-leading healthcare analytics platform. Responsible for fostering client relationships for optimal product design and feedback. Plan strategic roadmaps for multiple value streams using a disciplined Scaled Agile/Pragmatic Marketing approach.

As a Senior Product Manager, my principal focus includes working with clients, Product, and Engineering teams to strategize new products and services offering healthcare solutions using a disciplined Scaled Agile/Pragmatic Marketing approach.

Led the reporting team on business process consulting for a national scope of over 16 million members. Instituted new technical processes and workflow streams to improve efficiency and accuracy of business reporting, which included six clinical programs (Utilization Management, Precertification, Clinical Claim Review, National Clinical Appeals Unit, External Review Unit). Consulted on Case Management and Disease Management reporting needs. Developed department standards and best practices for optimal efficiency.

Led reporting projects for Case Management and Utilization Management operations. Developed business requirements for new SDLC projects to deliver operational and plan sponsor reporting.

Led the service related administration of the Quality Management program for two health plans within the Capitol region, earning Full and Excellent NCQA Accreditation designations for reviews that took place six weeks apart. Served as project leader for Member Satisfaction Surveys, Physician Satisfaction Surveys, Credentialing, and Customer Service/Claims Performance. Directly managed a team of Quality Consultants. Assisted with HEDIS preparation and review. Implemented and chaired Network Management Workgroup devoted to supporting all Network Management/Provider Relations activities with regard to the Quality Management Program. Developed mechanisms for reporting quality measurements to workgroups and oversight committees. Represented the company to state regulators and accreditation auditors.

Managed the Complaints and Appeals department and established policies and process workflows to reduce a 3-month backlog to manageable Work on Hand metrics. Supervised a team in day-to-day operations. Responded to external and internal constituents for deadline-driven deliverables, including Medicare and Medicaid products. Increased department staff four-fold to reduce a backlog of over 1200 appeals within the first three months of holding the position. Implemented an automated database and reporting mechanism for day-to-day management of appeals volumes and workflow. Represented the health plan in a successful NCQA survey accreditation within first two months.

Developed reporting packages and workflow tools for a 60-member Medical Management department. Developed an automated database in collaboration with all functional areas of the department to track compliance of Precertification and Concurrent Review daily workflow. Initiated and maintained the reporting tool for all utilization data, call center statistics, and other workflow processes for weekly reporting to Senior Plan Management.