Responsible for driving a cultural shift towards making health care safer and more affordable. - Oversees and leads the Cost of Care (CoC) team devoted to cost of care strategies, ensuring medical cost affordability initiatives are measured, monitored, and executed in alignment with organizational goals/budgets. This includes monitoring of year over year trend issues, industry benchmarks, and identification of gaps in care and development of strategies to close gaps. - Oversees and leads the Project Management Office (PMO) that manages project business requirements, priorities, execution, and post-implementation validation/lessons learned. - Oversees and leads the Vendor Management Organization (VMO) that maintains the vendor RFP process, contracting, performance management, valuation and ongoing relationship management.

Built a Cost of Care team to identify, steer and direct all medical cost saving activities for all health plans operating under Sentara Health Plans, Inc. (Optima Health and Virginia Premier). Adopted a best-practice approach to medical cost planning which will include:• Ensure there is a perpetual pipeline of new medical cost saving initiatives being funneled into process for review and oversight • Partner with business owners to identify, develop and support all cost saving initiatives• Prioritize cost saving initiatives utilizing Weighted Shortest Job First (WSJF) methodology• Have in-depth reporting for use by Finance and Actuary rate setting• Facilitate ideation sessions to identify potential new cost saving initiatives• Provide planning and oversight of medical cost budgeting

This role is focused on transforming business processes with the objective of delivering exceptional customer experience and employee engagement while improving overall efficiency using iterative, design thinking processes. • One of four leaders selected across the organization to drive strategic growth for the health plan.• Focused on all health plans under Sentara Health Plans, Inc. currently including Optima Health and Virginia Premier.• Lead business stakeholders through Customer Journey Maps and Process Journey Maps to guide the business toward better customer experience, enhanced efficiencies, and scalability.• Work with both Health Plan and Sentara stakeholders to prepare for and implement price transparency in a machine readable format and made fully available to the public. • Supported the Claims department toward increasing claims auto-adjudication through evaluation of current claim pends and in the implementation of Machine Learning technology.• Worked with a vendor to develop a business plan for a Vendor Management Office (VMO) function at Sentara Health Plans and implemented that plan.• Worked with a vendor to review our analytics organizational and functional capability and prepare a road map to be a best in class analytics organization.

Medical Economics Functions:Managed a team of 10 Medical Economic staff ranging from a Manager to entry level Healthcare Economic analysts. Functions included all aspects of medical data analysis including running data from a SQL server, review of data integrity, analysis of data, reporting of data, and assisting in any operational capacity as data is utilized by customers. Worked closely with all other departments in review of data and development of operational projects to effect positive change within our organization.• Supported Network Management department with fee schedule creation and maintenance, data analysis during contract negotiations including financial impacts, market intelligence, and peer comparisons.• Maintained medical expense reporting of all services and products, for cost and utilization, from high level trend reports to case mix adjusted peer comparisons and down to detailed category comparisons (such as CT or MRI).• Supported Sales team with competitive discount information customized to meet each RFP.• Assisted in the coordination and running of Optima’s Medical Expense Committee that reviews various medical expense reports and reviews projects and recommendations to control cost and utilization.Data Warehouse Functions:Acted as the business owner of the Optima SQL server data warehouse and managed a team of 3 Data Analysts. In 2018 completed an overhaul of data warehouse tables and structure to make it more efficient for data analytics use. Had oversight of data quality, content, and accessibility.• Created and Chaired the Optima Data Governance Committee from 2014-2017.• Created the Data User Group Committee in 2012 to share data knowledge and ensure the integrity of data reports are dependable and consistent throughout Optima.• Managed data requirements for all data feeds to and from vendors.

- In addition to being Director of Medical Economics as listed above, I was also the Director of the Special Investigation Unit (SIU) at Optima Health for 5+ years.Special Investigation Unit (SIU) Functions:Managed a team of 5 SIU Investigators charged with finding potential fraud, waste or abuse through data analysis and vendor partnerships.• Chaired Optima’s Fraud, Waste and Abuse committee that includes staff from Clinical, Pharmaceutical, Claims, IT, Underwriting and Governmental Relations.• Maintained appropriate inter-departmental relations.• Oversight of all investigations and cases.• Participated in quarterly DMAS Program Integrity meetings with all Virginia insurance companies.• Consolidated 7 vendor partners down to 3 high functioning vendor partnerships.

Managed team of 4 analysts to create fee schedules, provide contract negotiation support, set unit cost budgets, gather market intelligence, analyze medical expenses and compare to industry benchmarks.

Created Medical Economics department to create fee schedules, provide contract negotiation support, set unit cost budgets, gather market intelligence, analyze medical expenses and compare to industry benchmarks.

Appointed by the Virginia Commissioner of Health. Assist in the formation and operation of the Virginia APCD. Make recommendations on specificity of data and standardized reports. Participated on the RFP team to select a vendor for partnership. Participate on the APCD Data Review Committee to review requests for data and/or reports from the APCD.