David J. Rosa Email & Phone Number

Louisville, Ky, Us

Responsible for day-to-day provider network operations for the TriHealth Population Health Organization, a clinically integrated network serving 290,000 value based patients in the Cincinnati, Ohio region. Key functions include:o Ensuring network access and adequacy to deliver on value-based contracts.o Contracting with independent primary care and specialist physician groups.o Credentialing and participation standards.o Provider data management both in-house and externally with value-based payors.Assigned the task to restructure and develop the TPHO Network Operations Department with the aim to design efficient, standardized processes to support intricate value-based arrangements. Responsible for provider incentive metric development and executing funds distribution to Primary Care network based on their performance against the metrics.Supports growth strategy related to network access and patient attribution through national and regional value-based payers.Supporting TriHealth and Lumeris executive leaders in their mission to enhance the care continuum for TriHealth patients.

Louisville, Kentucky, United States

Partnered with our Market Chief Operations Officer and Market President to identify and execute on opportunities to enhance our member and provider experience, implement new programs, increase operational efficiencies, and build strategic community partnerships.Responsible as a key driver and business lead for all aspects of market operations, including: •Technology Enhancements•Clinical Model of Care Support•Operating Model and Staffing •Provider Network Development•State Specific Process Development•State Readiness Review•Compliance and Reporting•Comprehensive Communications Planning•Issue Resolution and Gap RemediationExecuted new UM integration partnerships to ensure members receive appropriate levels of care while creating a 4:1 ROI. Oversight of the integration of a state mandated Pharmacy Benefits Manager, limiting member and provider abrasion to ensure continuity of care and services.Oversight of the Value Added Service offering, delivering on innovative programs like Doula services, haircuts for school-age children, and home delivered fresh fruits and vegetables.Created a market PMO, and managed a team of associates who specialize in project management, process design and improvement, and issue resolution.

Louisville, Kentucky

Responsible for program level leadership and oversight of the implementation of Medicaid state contracts, including Virginia MLTSS and Kentucky MMC.Leader responsible for the 1/1/2021 Kentucky MMC contract implementation for Humana. Provides oversight and solutions to fulfill new contract requirements and to execute on commitments that make Humana Healthy Horizons in Kentucky a leader in the Commonwealth.Medicaid Corporate integration leader for the transition of the Kentucky Medicaid Managed Care contract administration from a delegated partner to Humana on 1/1/20. Transitioning 140,000 enrollees to Humana’s integrated Care Model will ultimately improve the long term health outcomes for our members, improve the provider experience of our network, and has already created job growth within the Commonwealth.Responsible for the implementation of an enhanced care management program as well as a non-emergent transportation provider, both designed to support our most vulnerable members while reducing long-term care costs in our Illinois market.Provided project oversight of an insourcing effort to integrate a delegated vendor's clinical and call operations into Humana, ensuring operational continuity and creating a seamless transition for our Medicaid members and providers in North Florida.Responsible for additional enterprise-wide enhancements and organizational roll-outs to reduce overall costs and improve member and provider experiences in both Florida and Virginia markets.

Louisville, Kentucky, United States

Partnered with cross functional leaders on the strategy, design, incubation, and operational implementation of new programs and technologies to deliver new revenue streams for our Employer Group segment. Created a consulting arm within the organization, focused on process improvement opportunities, implementation of new market initiatives, or technology solutions to increase efficiency, increase output, and reduce costs.Led a team accountable to drive issue resolution and liaison with IT partners on systemic incidents which are considered critical business priority.Identified key processes to analyze efficiency, drive improvement, and reduce waste for our Commercial Life/Disability business.Consulted with executive leadership to understand strategic goals and operational needs to deliver a solution with greatest impact per dollar spent on the private exchange business, including the implementation of Humana Intellichoice.

Louisville, Kentucky, United States

Led large cross-functional teams to implement and service complex benefit administration programs in the Large Group Commercial Segment.Managed a portfolio of business that included high profile and strategically important clients, such as PGA Tour and PGA Players.Chosen to engineer and lead pilot programs on numerous new market initiatives, including self-funded HumanaVitality, Non-Integrated HumanaVitality, Rx Only, and Life/Disability products.

Chicago, Illinois, United States

Managed daily operations and staff resources for the Conflicts of Interest Department. Led various Department and Enterprise-wide projects, including the automation of new business workflow, designed to reduce overhead and improve the end customer experience.

Chicago, Illinois, United States

Hired to build and scale the Conflicts of Interest Department for an expanding mid-size Firm.Partnered with executive leadership to design enterprise processes, business rules, and technologies related to workflow management, records retention, and department input/output.

Chicago, Illinois, United States

Responsible leader for the Conflicts of Interest Department, Washington D.C. office of Winston & Strawn.

Master Of Science (M.S.) In Business Communication, Organizational Leadership

Bachelor Of Arts (B.A.), Political Science; Economics; Minor - History

Activities and Societies: Tau Kappa Epsilon, IFC, Student Senate, Football, Lacrosse