Christopher Mora Email & Phone Number

Long Beach, Ca, Us

Orange County, California, United States

Oversee Everest medical management programs, program delivery, and product managementManage relationships between third party administrators, managed care partners, and claims operations Analyzes trends, costs, and operations to determine progress toward stated goals and objectivesOutline key performance metrics, determine reporting criteria, and develop monthly, quarterly, and yearly goals in line with overall organizational targetsMonitor current processes, systems, and… Show more Oversee Everest medical management programs, program delivery, and product managementManage relationships between third party administrators, managed care partners, and claims operations Analyzes trends, costs, and operations to determine progress toward stated goals and objectivesOutline key performance metrics, determine reporting criteria, and develop monthly, quarterly, and yearly goals in line with overall organizational targetsMonitor current processes, systems, and workflows to identify opportunities for improved program delivery and identify costs savings opportunitiesWork closely with key stakeholders in order to develop and implement managed care initiatives in line with organizational goals Oversee the Everest Medical Provider Network development, certification, and enhancements to maximize product utilization and increase medical costs savings. Show less

Long Beach, Ca, United States

Oversaw case management and delivery of workforce support service operations for veterans through a range of programs, community outreach, and workshops/trainingUtilized LEAN process mapping to identify four major bottlenecks and create a process improvement planDesigned and implemented virtual case assessment, management, and outreach workflow and processes as a response to the COVID-19 pandemicCultivated strategic partnerships with the agencies and organizations serving veteran… Show more Oversaw case management and delivery of workforce support service operations for veterans through a range of programs, community outreach, and workshops/trainingUtilized LEAN process mapping to identify four major bottlenecks and create a process improvement planDesigned and implemented virtual case assessment, management, and outreach workflow and processes as a response to the COVID-19 pandemicCultivated strategic partnerships with the agencies and organizations serving veteran communities Show less

Orange, Ca

Directed the operations of a $5M managed care division supervising 40 nurses/claims professionals and overseeing medical bill review, networks, nurse care management, utilization review, triage, and MPNIncreased efficiency allowing staff re-deployment to other areas of operations, saving $200K in operating costsDeveloped and implemented product and service plans that enhanced program delivery and outcomesOutlined budgetary and profitability goals; implemented a strategic vision to… Show more Directed the operations of a $5M managed care division supervising 40 nurses/claims professionals and overseeing medical bill review, networks, nurse care management, utilization review, triage, and MPNIncreased efficiency allowing staff re-deployment to other areas of operations, saving $200K in operating costsDeveloped and implemented product and service plans that enhanced program delivery and outcomesOutlined budgetary and profitability goals; implemented a strategic vision to obtain revenue targetsServed as the Subject Matter Expert supporting sales and account management staffManaged vendor relationships, created requests for proposals, and defined service performance metricsOrchestrated the implementation of a new medical bill review system Show less

Irvine, Ca

Managed all aspects of the national medical bill review and provider network program meeting key performance metrics, including profitability, operational efficiency, and service delivery goalsRedesigned the medical bill review workflow that resulted in an overall 25 % efficiency increase Established key performance metrics, outlined strategic goals, and negotiated terms with vendorsIncreased network utilization rate; secured $1M+ in operational cost savings Identified and… Show more Managed all aspects of the national medical bill review and provider network program meeting key performance metrics, including profitability, operational efficiency, and service delivery goalsRedesigned the medical bill review workflow that resulted in an overall 25 % efficiency increase Established key performance metrics, outlined strategic goals, and negotiated terms with vendorsIncreased network utilization rate; secured $1M+ in operational cost savings Identified and analyzed program issues to develop and initiate process improvement solutions Show less

Boston, Ma

Developed program plans, defined goals, and evaluated operational effectiveness to improve performanceLead project team that designed and implemented the medical marijuana policy and procedures nationwidePartnered with claims and medical bill review teams to streamline workflow, manage customer service metrics, and enforce quality standards increasing the overall workflow efficiency by 45%Overhauled medical treatment program that resulted in cost savings of approximately… Show more Developed program plans, defined goals, and evaluated operational effectiveness to improve performanceLead project team that designed and implemented the medical marijuana policy and procedures nationwidePartnered with claims and medical bill review teams to streamline workflow, manage customer service metrics, and enforce quality standards increasing the overall workflow efficiency by 45%Overhauled medical treatment program that resulted in cost savings of approximately $15MUtilized Agile in the development of system and workflow processes Show less

Greater San Diego Area

Led strategy development and oversaw managed care programs, networks, and medical bill review; successfully expanded product suite from two to eight product offersCollaborated with the operational teams to initiate medical bill review and provider networks improvement for increased efficiency and quality output boosting program utilization by 45%Managed all client and vendor relationships; ensured program effectiveness through key performance metricsEvaluated vendor performance and… Show more Led strategy development and oversaw managed care programs, networks, and medical bill review; successfully expanded product suite from two to eight product offersCollaborated with the operational teams to initiate medical bill review and provider networks improvement for increased efficiency and quality output boosting program utilization by 45%Managed all client and vendor relationships; ensured program effectiveness through key performance metricsEvaluated vendor performance and addressed performance gaps by identifying areas of improvementPartnered with executive leadership, operations, and account management teams on new product options Show less

Irvine, Ca

Oversaw the national medical cost containment program handling all aspects of operations, data capture, medical bill review process, customer service, and mailroom maintenanceDeveloped and managed performance dashboards for all operational services, vendors, and networksEstablished training and quality assurance metrics for medical bull review and customer service teams Prepared budgets and authorized expenditures for all workers’ compensation claimsMonitored the implementation… Show more Oversaw the national medical cost containment program handling all aspects of operations, data capture, medical bill review process, customer service, and mailroom maintenanceDeveloped and managed performance dashboards for all operational services, vendors, and networksEstablished training and quality assurance metrics for medical bull review and customer service teams Prepared budgets and authorized expenditures for all workers’ compensation claimsMonitored the implementation of outsourcing program for medical bill review and mailroom operations Show less

Greater San Diego Area

Led Medical Claim Department and provided guidance to over 250 employees covering three-shift operationsMonitored vendor performance to enhance productivity and improve quality assurance programsEstablished operational objectives and work plans consistently meeting/exceeding organizational goalsCoordinated all aspects of the transition of large-scale mailroom operations off-site

Long Beach, Ca

Spearheaded the regional medical cost containment program; streamlined medical bill review and customer service operations for 13 western regional statesServed as the Expert Witness for CA medical bill reviews and pricing disputes; worked with medical providers to negotiate settlements on outstanding medical claimsManaged and developed medical programs to reduce medical costs and resolve specific client issues

Bremerton, Wa

Shortly after graduating from high school, I entered the United States Navy. After 12 weeks of basic training and then an additional 1-year advance technical training I began my naval career. During my tenure, I earned citations for my work in logistics management, developing safety guidelines, and providing administrative support to operational leaders. In addition to my normal duties, I was also assigned to temporary duties within other departments, where I worked with national and… Show more Shortly after graduating from high school, I entered the United States Navy. After 12 weeks of basic training and then an additional 1-year advance technical training I began my naval career. During my tenure, I earned citations for my work in logistics management, developing safety guidelines, and providing administrative support to operational leaders. In addition to my normal duties, I was also assigned to temporary duties within other departments, where I worked with national and international vendors developing operational workflows. Show less

Master Of Business Administration - Mba, Finance

Bachelor Of Arts, English Language And Literature/Letters, Cum Laude

Master Of Library & Information Science - Mlis, Library And Information Science