Douglas Mitchell Email & Phone Number

---Senior Executive Leadership Synopses:---Highly accomplished Quality Improvement (QI), Risk, Disease, Case Management & Clinical ---Compliance senior executive who excels at driving dynamic healthcare initiatives to align with the ----organizations’ mission, vision, and values while contributing to the organizations’ EBITDA.Key Executive Competencies:---Authored, Deployed, Evaluated and Presented to the Board the following functional elements (work plans, annual approvals, etc.) and recognized as the organizations’ subject matter expert (SME):– NCQA (CM, CR and UM), URAC, The Joint Commission (TJC), Det Norske Veritas (DNV), CMS (Federal), Departments of Insurance (DOI) and State DOI requirements– Lean / Six Sigma / ISO certification– UR Program(s)– Case and Disease Management Program(s)– Population Health Management Programs (s)– Compliance Program(s)– QI, Grievance, and Appeals(s)EBITDA Contributions:– Reduced the utilization review (UR) written notification compliance requirements to save $812,000.– Drove loss reduction 14% over 2 enrollment periods via use of Workers’ Compensation, PL and GL claims data.– Passed 100% of all delegated health plan audits and all NCQA and URAC surveys.– Created and deployed an NCQA CVO/CV compliant Delegated Credentialing Program generating an EBIDTA contribution of $400,000 over 3 years.Patient and Member Advocacy & Enrollment Contributions:– Aligned operational needs with clinical compliance requirements for all product lines including the CMS Innovation Center's value-based propositions for aligned enrollees. – Directed professional, general, D&O, etc. from insurance inception to claims management and all mediation, settlements and NPDB reporting for a multi-level health service management corporation. – Led 100% of PL claims where a provider in the health plan network was named as defendant. Reviewed new Professional Liability (PL) and General Liability (GL) claims for risk / loss exposure while developing health plan contracting & underwriting criteria for network providers.