Arlene Scott Email & Phone Number

Orland Park, Illinois, United States

Orland Park, Illinois, United States

Naperville, Illinois, United States

Homer Glen, Illinois, United States

Greater Chicago Area

Greater Chicago Area

• Created, built, and led overall integration of business strategies across all plans and business segments (group, government, and retail). Directed activities and deliverables of cross-functional teams, including.
• Endorsed and socialized Provider Experience Framework and Insights Toolkit with cross-divisional teams responsible for provider enablement delivery imperatives to gain interest for partnered execution.
• Led implementation of outpatient utilization management partnership project with eviCore healthcare. o Delegated management of prior authorization for outpatient services, such as radiation therapy, genetic testing.
• Spearheaded and served as point person for provider contract with Alacura Air Ambulance. o Ensured use of proper mode of transport based on health plan medical policy, resulting in significant reduction in medical.

Greater Chicago Area

• Executed and managed day-to-day operations for Medicare Advantage HMO/PPO and Medicare-Medicaid Alignment Initiative- based contracts, including root cause analysis and resolution of eligibility/claims issues as well.
• Bridged relationships as liaison between high-profile medical groups, hospital systems, and payer.
• Nurtured inter-departmental relationships, executed monthly strategic meetings with government program’s leadership teams, and presented education and reporting needs in parallel to developing provider agendas for.

Greater Chicago Area

• Developed and implemented clinical, non-clinical, and system training policies and procedures for execution of Intensive Medical Home (IMH) value-based care delivery model. Managed and facilitated operations of.
• Drove success of value-based care initiative by building and maintaining respected relationships with provider community (specifically with nurse care managers).
• Trained and developed care managers to create care plans in partnership with attributed members, resulting in closure of several care gaps, as identified by goal setting.

Greater Chicago Area

• Managed daily operations for Commercial and Medicare Advantage HMO provider contracts affiliated with high-profile Independent Provider Association (IPA): Silver Cross Managed Care Organization. Oversaw all elements of.
• Built relationships with executive leaders, primary care, and specialty providers/staff.
• Led efforts to transition providers from manual to electronic claim submission and claim payment process.
• Named NAMM's first-ever Employee of the Year in 2010.