• Founded a consulting firm to oversee multimillion-dollar projects and advise executive teams on strategic initiatives from inception to execution, including technical integrations, web development, marketing materials creation, and regulatory compliance oversight.• Collaborates with C-suite leadership and cross-functional teams to identify process gaps and key integration points between teams with differing development and deployment methodologies and to develop hybrid processes (e.g.… Show more • Founded a consulting firm to oversee multimillion-dollar projects and advise executive teams on strategic initiatives from inception to execution, including technical integrations, web development, marketing materials creation, and regulatory compliance oversight.• Collaborates with C-suite leadership and cross-functional teams to identify process gaps and key integration points between teams with differing development and deployment methodologies and to develop hybrid processes (e.g., consults, vendors, and outsourced services, etc.).• Transforms Medicare Advantage D-SNP plans for clients, utilizing proprietary tools to conduct comprehensive reviews and analyses of existing capabilities, execute plans and overall strategy, and ensure compliance with contracts and regulatory standards.• Advises banking/finance clients on IT governance and application support, standardizing processes to ensure up-to-date documentation and evaluating for CMMI capability and maturity level. Show less

• Senior Advisor, reporting to the CEO of Medicare, to transform the current Medicaid only organization, products and services into a Medicare Advantage D-SNP plan• Conducted a review and analysis of current capabilities and third-party assessments of the KHS capabilities, to establish an overall strategy and plan• Responsible leader for the designing and implementing the Program Management Office, to support the development of a new Medicare Advantage D-SNP, targeted for go-live… Show more • Senior Advisor, reporting to the CEO of Medicare, to transform the current Medicaid only organization, products and services into a Medicare Advantage D-SNP plan• Conducted a review and analysis of current capabilities and third-party assessments of the KHS capabilities, to establish an overall strategy and plan• Responsible leader for the designing and implementing the Program Management Office, to support the development of a new Medicare Advantage D-SNP, targeted for go-live 1/1/2026• Established an end-to-end capabilities framework for mapping critical Medicare Advantage (MA), functionality as a tool for mapping functional gaps and required enhancements• Developed an architectural roadmap for sequencing and prioritization of projects across the program, to be managed over three years• Conducted Medicare market and competitor analytics to determine health plan start-up feasibility; Found market opportunities for KHS that would bring return on investment two years earlier than was predicted by the actuaries• Served as the subject matter expert to establish a governance structure, Software Development Lifecycle & Product Development Lifecycle to support the Centers for Medicare & Medicaid Services (CMS), Medicare Part C and Part D annual bid process Show less

• Led the design, development and launch of a program management infrastructure and governance model to support a $50M+ capital investment to transform a Medicaid health plan operating model to support Medicare D-SNP expansion strategy to enter six new geographies by 2024 and 2-3 new geographies per year thereafter• Led the strategy and work teams including 7 major work streams and 32 sub-functions through planning, design, and estimation for Medicare Advantage D-SNP operating model… Show more • Led the design, development and launch of a program management infrastructure and governance model to support a $50M+ capital investment to transform a Medicaid health plan operating model to support Medicare D-SNP expansion strategy to enter six new geographies by 2024 and 2-3 new geographies per year thereafter• Led the strategy and work teams including 7 major work streams and 32 sub-functions through planning, design, and estimation for Medicare Advantage D-SNP operating model enhancements to build the capability of pursuing $800M+ in revenue across 10+ new geographies over the next 5 years• Responsible for the oversight of overall regulatory compliance and contractual obligations to meet state Medicaid and CMS Medicare Advantage D-SNP compliance standards• Responsible for completing corporate strategic roadmap and portfolio management templates including business case assumptions and strategic spending of capabilities enhancements to support growth at a rate that is sustainable and profitable in the next 3-5 years• Oversaw, mentored and coach junior project management staff, subject matter experts and healthcare leaders through the annual Medicare Advantage D-SNP critical timelines and milestones Show less

• Assessed and developed the Medicare Advantage Health Plan Technology Platform Design & Project Plan- Conducted a comprehensive review of a commercial health plan to identify technology and business capability needs in order to successfully operate and manage a Medicare Advantage Plan. - Using proprietary tools built over 15+ years, conducted a review of 126 distinct business capabilities resulting in the conceptual architecture of a core platform integrating 55 vendor… Show more • Assessed and developed the Medicare Advantage Health Plan Technology Platform Design & Project Plan- Conducted a comprehensive review of a commercial health plan to identify technology and business capability needs in order to successfully operate and manage a Medicare Advantage Plan. - Using proprietary tools built over 15+ years, conducted a review of 126 distinct business capabilities resulting in the conceptual architecture of a core platform integrating 55 vendor partners/systems.- Developed an integrated work plan and traceability matrix to deliver (i.e., design, build, test and deploy) 8 major core system implementations, requiring a team of 48 business & technical skilled resources for a period of 32+ weeks• Project managed and led multiple projects to assist with the Medicare Advantage start-up including technical integrations, web development, marketing materials creation and regulatory compliance oversight Show less

• In the Program Management Office (PMO) Director role, acted as the key lead and Senior Advisor to the Executive Sponsors and reporting directly to the CIO for the relaunch of a $40+M program, which had been in flight for three years• In the Program Manager role, met daily with top management leaders to address program management issues and consult on the strategy and approach to formalizing project management processes, increasing rigor and reestablishing confidence in PMO… Show more • In the Program Management Office (PMO) Director role, acted as the key lead and Senior Advisor to the Executive Sponsors and reporting directly to the CIO for the relaunch of a $40+M program, which had been in flight for three years• In the Program Manager role, met daily with top management leaders to address program management issues and consult on the strategy and approach to formalizing project management processes, increasing rigor and reestablishing confidence in PMO capabilities• Developed a success roadmap and 30/60/90-day plan to completely reorganize and redeploy 100+ program resources, consultants and contractors• In collaboration with the executive team, designed and implemented an end-to-end PMO Plan and processes to manage the large complex program using combined PMBOK and Agile methodologies, which allowed the organization to make a difficult transition from “waterfall” to “iterative” development• Identified and documented key data metrics for program control, governance, reporting and risk management; Designed and implemented a weekly Program Dashboard and Executive Summary• Designed and implemented a governance structure and standardized meeting cadence to facilitate day to day communications of program progress as well as escalation of critical program data to the executive team• Conducted numerous “root cause analysis” and “impact analysis” to better prioritize program team activity and identify barriers/blockers proactively• Coached and mentored existing and incoming program/project managers to be more effective and established best practices for team management, communicating, reporting, meeting, problem resolution and team collaboration• Provided consultation and guidance to configuration Program Management Information Systems (PMIS) tools to administer the program/teams and resources Show less

About UsHealth Management Innovation Company (HMIC) was founded in 2016 to fill a void in professional management services in Mid-Michigan. HMIC is a minority, woman, veteran and family owned business. Its primary mission is to provide local area professionals with the administrative and management support necessary to practice their profession and deliver services to the communities they serve with the highest quality and integrity.

ABOUT IHEALTHiHealth is an integrated team of health professionals who provide a variety of services—from conventional to alternative—and make them readily available to the patient. We identify and support the treatment of the root cause of chronic conditions, utilizing effective testing and personalized plans. We specialize in:whole body healing through an integrative approach through nutrition, fitness, and bodywork fitted to individual needs, extensive health history examination… Show more ABOUT IHEALTHiHealth is an integrated team of health professionals who provide a variety of services—from conventional to alternative—and make them readily available to the patient. We identify and support the treatment of the root cause of chronic conditions, utilizing effective testing and personalized plans. We specialize in:whole body healing through an integrative approach through nutrition, fitness, and bodywork fitted to individual needs, extensive health history examination, detailed lab testing to determine supplemental therapy and specific order of dietary changes, leveraging other specialists and professionals, such as dentists, chiropractors, mental health therapists and osteopathic medicine physicians, health and healing educational and support programs stress-relief, balance, and support. Show less

• Assigned as the first Senior Program Manager to the “Transformation Office” of a large hospital owned health plan. Responsible for achieving business outcomes for the organizations top 10 strategic projects.• Served as Program Director of large scale BPO service company start-up in Medicare Advantage for a large hospital owned health plan in Michigan.• Developed and implemented Portfolio/Program Management tools and processes to manage a team of more than 100 resources with a… Show more • Assigned as the first Senior Program Manager to the “Transformation Office” of a large hospital owned health plan. Responsible for achieving business outcomes for the organizations top 10 strategic projects.• Served as Program Director of large scale BPO service company start-up in Medicare Advantage for a large hospital owned health plan in Michigan.• Developed and implemented Portfolio/Program Management tools and processes to manage a team of more than 100 resources with a projected total spend of $40M+.• Developed an integrated work plan and implemented a forecasting and estimation tool that reduced the program estimate/forecast by nearly $10M. The program combined IT delivery and business delivery through all phases of development using an Agile methodology.• Developed and implemented a Strategic Roadmap development process that allowed the organization to align market opportunities with internal business capabilities and determine business value by product.• Conducted an assessment of Technology and Program Management for a large hospital owned health plan. Reviewed and evaluated technology and program (people, process & technology), to determine viability and success as well as to identify immediate program improvement needs.• Developed and implemented a Business Capabilities Framework for a Medicare Advantage BPO service company. The framework became the foundation for all development activity and traceability for administrative functions (e.g. finance, product development, pricing, etc.) Show less

• Served as project delivery lead for Tessellate to implement the company’s full suite of Medicare Advantage Quality and Risk Services to two Blue Cross health plans including encounters submission, Stars initiatives, HEDIS initiatives, Risk Management, RADV/Risk Mitigation and Retrospective Medical Review• Successfully implemented Tessellate’s proprietary Provider Engagement Coordinator (PEC) Program as a prospective Risk Management strategy for Health Care Services Corporation (HCSC) in… Show more • Served as project delivery lead for Tessellate to implement the company’s full suite of Medicare Advantage Quality and Risk Services to two Blue Cross health plans including encounters submission, Stars initiatives, HEDIS initiatives, Risk Management, RADV/Risk Mitigation and Retrospective Medical Review• Successfully implemented Tessellate’s proprietary Provider Engagement Coordinator (PEC) Program as a prospective Risk Management strategy for Health Care Services Corporation (HCSC) in two states and for a large regional Blue Cross plan on the west coast• Developed and executed an implementation plan to configure and implement the first new comprehensive client on their proprietary platform using EY’s Project Program Control software, Confluence and JIRA for Tessellate• Conducted an in-depth review of PMO operational and process challenges specific to new product implementations for Tessellate, a new “for profit” company owned by BCBSM; Developed a framework, strategy and approach to transforming Tessellate’s Client Implementation PMO to better accommodate emerging operational changes such as the implementation of Agile Methodology, KAN BAN, Confluence, JIRA as well as organizational changes to hierarchy, roles and responsibilities Show less

Enterprise Strategy1) Project Portfolio/IT Management Transformation (PMO and IT Program Management; MI Based Health Plan & PBM)Executed organization and information management change for single platform, enterprise-wide, proprietary system for multi-state health plan with multiple lines of business and subsidiariesExecuted enterprise strategy to expand existing products/services into multiple states and become a new entrant into the commercial market under the healthcare… Show more Enterprise Strategy1) Project Portfolio/IT Management Transformation (PMO and IT Program Management; MI Based Health Plan & PBM)Executed organization and information management change for single platform, enterprise-wide, proprietary system for multi-state health plan with multiple lines of business and subsidiariesExecuted enterprise strategy to expand existing products/services into multiple states and become a new entrant into the commercial market under the healthcare exchange2) Financial Transformation (Life Sciences; #2 Ranked Global Pharmaceutical)Developed and executed enterprise strategy to align financial data reporting globally across 42 facilitiesDeveloped project/program governance model to manage teams across Asia, Europe, Australia, Africa, North and South America3) Medicare Advantage Health Plan Technology Platform Using proprietary tools built over 15+ years, conducted a review of 126 distinct business capabilities resulting in the conceptual architecture and integrated plan to develop a core platform integrating 55 vendor partners/systems to deliver 8 major core system implementationsRegulatory/Business Readiness1) Medicare Sanctions Remediation (Part D Health Plan; 2nd Largest National Part D Plan)Led a team that provided audit readiness support for a large national Medicare Part D plan facing intermediate sanctions. The team was successful in assisting the client in obtaining release from sanctions through rigorous planning and preparation across four elements including interview preparation, universe creation, operational readiness and sanctions validation attestation.2) Medicaid Health Plan Start-up (Medicaid MCO, Joint Venture BCBS Conglomerates)Led a team to launch a new Medicaid health plan for joint venture between two large national health plan conglomerates. The team implemented new PBM operations for the Medicaid health plan from regulatory requirements gathering through state readiness. Show less

Responsible for leading and managing client facing teams in a wide variety of health care strategy and operations projects ranging from regulatory change requirements to new business/product developmentDeveloped customized approach and solutions specific to client needs while managing to strategic vision, risk management, regulatory requirements and business/product phase of life cycle needsDeveloped health care advisory tools, solutions and accelerators specific to health plan… Show more Responsible for leading and managing client facing teams in a wide variety of health care strategy and operations projects ranging from regulatory change requirements to new business/product developmentDeveloped customized approach and solutions specific to client needs while managing to strategic vision, risk management, regulatory requirements and business/product phase of life cycle needsDeveloped health care advisory tools, solutions and accelerators specific to health plan business strategy to create a competitive advantage over competing consulting firmsNetwork with internal and external leaders/stakeholders to identify opportunities in new entrance marketsManaged project sales and pursuit teams including SOW management, invoicing, project budget and resource request fulfillment Show less

Work with health care and life science executives to design strategic development plans to increase health care value and lead innovation in the market. Develop tools and solutions derived from best practices across industries using core project management methods and processes.Pursued and managed client relationship at a large regional health in their health care center of excellenceDeveloped and implemented solutions to support health plan objectives to increase overall value… Show more Work with health care and life science executives to design strategic development plans to increase health care value and lead innovation in the market. Develop tools and solutions derived from best practices across industries using core project management methods and processes.Pursued and managed client relationship at a large regional health in their health care center of excellenceDeveloped and implemented solutions to support health plan objectives to increase overall value and quality of care to the member populationImplemented project governance and program management strategies to create repeatable implementation processes including business/product design, IT and business requirements gathering, system and process developmentDeveloped and implemented tools to track, monitor, report and forecast program strategies for executive level consumption and portfolio managementConducted detailed analysis of data gathering/reporting processes and develop tools, processes and controls for integrity and consistency across operations and leadership teamsDesigned and developed implementation playbook/instructional guide for external consumption with potential implementation partners Show less

Analyze, design and implement solutions for complex strategic healthcare initiatives and government sponsored healthcare operations. Manage information and regulatory risk at the enterprise level to achieve more efficient and effective project risk and program management of healthcare operations. Analyze, measure, track and monitor issues such as stakeholder risk, portfolio risk, knowledge management, change management, IT project risk, legal and regulatory compliance risk… Show more Analyze, design and implement solutions for complex strategic healthcare initiatives and government sponsored healthcare operations. Manage information and regulatory risk at the enterprise level to achieve more efficient and effective project risk and program management of healthcare operations. Analyze, measure, track and monitor issues such as stakeholder risk, portfolio risk, knowledge management, change management, IT project risk, legal and regulatory compliance risk management.Organize and lead cross-functional project teams across entities with integration of risk management, regulatory compliance and oversight controlsConduct risk assessments including but not limited to CMS compliance, CMS audit protocols, internal audit process review, controls testing/review and develop detailed reports including corrective actions and future state objectivesDevelop and deliver customized project governance infrastructure and tools capable of supporting 50-100 person project teams including communication, program reporting, issue/risk management and strategic alignmentLead internal practice development initiatives to create proprietary tools, solutions and methodologies specific to government health plan processes and program deliveryLead internal practice development teams to develop new service offerings and tools for emerging health care initiatives specific to Affordable Care Act legislation and CMS activitiesAuthored regulatory compliance publications and internal training materials for new hires and junior staff specific to Medicare and Medicaid health plansResponsible for mentoring and counseling junior staff in professional development, core consulting and health plans specific project/program managementResponsible for sales and managed revenue and have documented success in managing “Green Dot” projects (internal and external) between Advisory and Consulting divisionsAchieved #1 rating in the firm as a Sr. Consultant for exceeding firm metrics Show less

Responsible for enterprise wide coordination of operations and administrative projects for three subsidiary companies including two Medicaid health plans, one Medicare D-SNP as well as the PBM. Responsible for coordination of internal process improvement and change control processes for proprietary software as well as administrative and operational processes. Responsible for reporting to CEO, COO, CIO and CMO for overall progress of development and implementation… Show more Responsible for enterprise wide coordination of operations and administrative projects for three subsidiary companies including two Medicaid health plans, one Medicare D-SNP as well as the PBM. Responsible for coordination of internal process improvement and change control processes for proprietary software as well as administrative and operational processes. Responsible for reporting to CEO, COO, CIO and CMO for overall progress of development and implementation projects.Served as the champion for research, development and implementation of programs to support managed care businesses.Responsible for the design, development and implementation of enterprise wide documentation, training, change management processes and corporate style guides & templates. Responsible for coordination of corporate compliance initiatives for quality accreditation (NCQA and URAC) and government contracts including material submission as well as onsite visits, requests for proposal, auditing and monitoring programs.Designed and implemented complex project management process for identifying critical business needs and the appropriate front end data analysis to support long range project goals and performance metricsDesigned, developed and implemented corporate standards for process change control & management, proprietary software versioning, policies, procedures and training for all core business processesResponsible for application and implementation of a Medicare Advantage Prescription Drug Dual Eligible health plan in accordance with CMS and Michigan Department of Community Health (MDCH) guidelines Show less

Responsible for design, configuration and implementation of project management methodologies and systems necessary for managing enterprise wide coordination of operations and administrative projects for three subsidiary companies including two government healthcare products as well as a Pharmacy Benefit Management company. Responsible for coordination of internal process improvement and change control processes for proprietary software as well as administrative and operational processes… Show more Responsible for design, configuration and implementation of project management methodologies and systems necessary for managing enterprise wide coordination of operations and administrative projects for three subsidiary companies including two government healthcare products as well as a Pharmacy Benefit Management company. Responsible for coordination of internal process improvement and change control processes for proprietary software as well as administrative and operational processes. Medicare & Medicaid Compliance Experience Responsible for research, collection, interpretation, development and implementation of compliance requirements as set by the Code of Federal Regulations, Centers for Medicaid and Medicare Services, Office of the Inspector General and the Michigan Department of Community Health. David has served as the project leader for large scale compliance initiatives including state on-site readiness reviews, Part-D claims audits, FWA monitoring, contract compliance audits and insurance regulation audits.New Business Development Experience Served in delivery lead, project manager and team member capacity on various government RFPs including successful Medicaid rebids, various Medicaid HMO proposals and a Medicare Advantage Special Needs Population contract. Developed and implemented formal project plans and processes to facilitate the development of new business for a Managed Care Organization from front end analysis through operational go-live. Show less

Responsible for interpretation, development and implementation of compliance requirements as set by the Code of Federal Regulations, CMS, Office of the Inspector General and the MDCH for a large regional health plan acquisition of a commercial plan and it's subsidiary Medicaid health plan.Responsible for reporting compliance readiness and project status to COO and the Vice President of Corporate Administration for all compliance activities and day to day operations of state and federal… Show more Responsible for interpretation, development and implementation of compliance requirements as set by the Code of Federal Regulations, CMS, Office of the Inspector General and the MDCH for a large regional health plan acquisition of a commercial plan and it's subsidiary Medicaid health plan.Responsible for reporting compliance readiness and project status to COO and the Vice President of Corporate Administration for all compliance activities and day to day operations of state and federal contract requirements.Responsible for compliance oversight during the acquisition of a university owned health plan and it's subsidiary Medicaid health plan.Responsible for interpretation of a large regional health plan contract with the State of Michigan to determine critical gaps in corporate administrative and business management functions for operating a Medicaid Managed Care health plan.Drafted or revised corporate administrative and management policies and procedures to ensure compliance with state and federal regulations for Medicaid health plans.Developed compliance education and training for all employees, providers and contractors.Organized and submitted the MDCH annual audit readiness for regional Medicaid health plan.Responsible for direct reporting relationships with senior level management, area directors and principal attorneys, Managed Care Law.Developed and implemented a fraud, waste and abuse program for a large regional health plan.Drafted and revised the Corporate Ethics and Compliance Program and Policy to include Medicare and Medicaid specific policy language to ensure compliance with State and Federal regulations.Developed systems testing and training materials for a large regional health plan provider data management department.Designed and developed work flows, business process documentation and integrated them with custom built information sets and data processing systems for all provider typeshigan HMO’s. Show less

Responsible for research, collection, interpretation, development and implementation of compliance requirements as set by the Code of Federal Regulations, Centers for Medicaid and Medicare Services, Office of the Inspector General and the Michigan Department of Community Health for Blue Care Network of Michigan, Blue Care Network Medicare Advantage and BlueCaid of Michigan HMO’s. Responsible for reporting compliance readiness and project status to COO and the Vice President of Corporate… Show more Responsible for research, collection, interpretation, development and implementation of compliance requirements as set by the Code of Federal Regulations, Centers for Medicaid and Medicare Services, Office of the Inspector General and the Michigan Department of Community Health for Blue Care Network of Michigan, Blue Care Network Medicare Advantage and BlueCaid of Michigan HMO’s. Responsible for reporting compliance readiness and project status to COO and the Vice President of Corporate Administration for all compliance activities and day to day operations of state and federal contract requirements. Show less