Ashley Poloski Email & Phone Number

Grosse Pointe, Mi, Us

Detroit, Michigan, United States

Promoted to expanded scope, co-leading 8 large-scale matrixed teams in operational strategy, utilization roadmaps, and large-scale integrations. Manage compliance, quality affordability initiatives, performance enhancements, and contracts and internal service level agreement (SLA) deployment. Steer performance management KPIs, and staff training, synthesizing metrics to fuel key decision-making by senior leadership, as well as ensure top ratings with National Association of Quality Assurance (NCQA) audits. • Spearheaded numerous large-scale platform migrations to convert systems and processes to Centene platforms post-acquisition, including training, system setup, policies, and communication strategies.• Led team to earn top score for NCQA to utilization management audit universe category, as well as 4-star “commendable” rating for health plan.

Selected to manage team in rapid launch, execution, and executive-level reporting of quality utilization projects in Illinois and Michigan Medicaid markets. Instituted new company-wide, value-based quality processes with complex cross-functional collaboration and tracking functions, focusing on operations, payment, logic, and monitoring.• Rebuilt quality program, setting up value-based agreements with risk and reward components for healthcare quality metrics, including review process to reduce hospital readmission rates. • Drove double-digit, multimillion-dollar enterprise cost savings through implementation of utilization management initiatives, comprising 41% of company forecast and 2% of company revenue in 2019.

Promoted to lead strategic direction of 80+ member nonclinical workforce in daily workflows for utilization management division in fast-paced, time-sensitive environment. Set up thousands of streamlined processes, lean operations, and controls for authorization intake infrastructure, meeting financial targets as well as compliance with CMS, NCQA, Utilization Review Accreditation Commission (URAC), and state regulatory guidelines. Developed reporting insights for market leadership, identified performance gaps, and made enhancement recommendations. • Selected from emerging leadership program by senior management as part of organization’s diversified leader initiative to rebuild and enhance nonclinical quality audit program.• Streamlined intake process, achieving 98% plan to goal in turnaround compliance and 98% plan to goal for QA.

Established, managed, and grew new customer contact center with national lines of business to drive outstanding quality experiences for members and providers. Trained and upskilled 80 employees in multidisciplinary job functions through identification of strengths and weaknesses to drive productivity and performance excellence. Ensured adherence to SLA, state, and business requirements. • Spearheaded onsite launch of large-scale call center in Chicago, including employee hiring and training, technical setup, software implementations, and daily management. • Transitioned antiquated manual data processes into modernized Cisco call system to scale capabilities for higher call volume and larger workforce.

Rapidly promoted to lead care coordination operations. Served as subject matter expert (SME) in integrated care population product. Hired and led performance management of 20+ member team. • Exceeded quality plan to goal to reach 98% for SLAs for 10 out of 12 months; exceeded production plan to goal at 90% for SLAs for 9 out of 12 months with 4–6% YOY increase. • Recognized for best practices leadership due to consistent surpassing of production and quality objectives, averaging 99.5% for 98% quality plan goal and 95% for 90% production plan goal.

Fraser, Michigan, United States

Earned permanent role at nonprofit serving populations affected by substance use, due to early demonstrated dedication and leadership. Spearheaded writing and application process to win state grant for fetal alcohol program, and launched and scaled program as case manager.