Fred Davis Email & Phone Number

West Conshohocken, Pa, Us

Tampa, Fl, Us

Responsible for maximizing the value of the Care Management platform and ensuring that the platform is up to date and current with the latest compliance requirements. • Responsible for the implementation of one of the nations largest insurers, over 4 million members, across 13 states, from multiple existing platforms and systems to one unified platform for all of their care management needs.• Capture existing workflows and understand existing process in order to provide improvements and enhancements in order to streamline and implement efficiencies across the organization.• Document all requirements and understand all state and federal requirements and provide solutions for automation and tools to ensure compliance ,within the care management programs.• Designed, developed and implemented a full LTSS/LTC solution for 5 different states, which each have contrasting requirements including numerous state reporting needs.• A redesign of the platform’s existing model of care solution. Existing product did not include safeguards for compliance, automation, nor safeguards for ensuring timeliness and reporting requirements. • Coordination amongst various teams within an Agile organization to incorporate skills required to translate the language between the end user Business teams, the internal teams including configuration and development as well as the internal project teams. • Stragegic planning to determine where the greatest use of time and skills were needed throughout the project and the ability to swiftly move between roles as needed.• Administer years of technical expertise within the project teams in order to encourage idea generation and technical solutions to the opportunities presented.

Tampa, Fl, Us

Accountable for the day to day oversight of all non-clinical support staff in a 24/7 intake service center. Continuous process improvement and efficiency/productivity gains through active management tools and process improvement utilizing six sigma skills that focus on People, Process, Productivity and Platforms. Other non-clinical support areas include an outbound engagement team, fulfillment center and all non-clinical support associates for all clinical programs•Led a team of Directors, Sr. Managers, and Managers, responsible for 100+ associates through a transformation that established metrics, increased productivity and accuracy over a 6 month period•Implemented a daily operating report that was shared with all senior leadership within the organization. Targets were established based on key performance indicators and were measured by client as well as an aggregate view.•Worked with consultants from the performance improvement firm of Carpedia to identify end to end process gaps and implement enhancements that improved productivity.•Provide mentoring and training to direct reports, complete departmental and organizational projects, report on call trends/stats and metrics, overall case management; and oversee the interactions, resources and support between the staff, our inter-departmental service partners as well as teams supporting our clients. •Oversight of non-clinical support associates responsible for all administrative needs of the clinical teams including outbound calls for discharge follow up, census management, care coordination and Health Risk Assessment administration.•Combined resources for all program engagement activities previously handled by each individual program/department into one single team. •Responsible for all outbound fulfillment and mail campaigns. •Ensure departmental compliance with CMS, NCQA and URAC guidelines, rules and standards. Consistently received full accreditation from both NCQA and URAC for the past 8 years.

Tampa, Fl, Us

Oversight of all clinical care management programs including Case and Care Management, and Special Needs Programs including non-clinical program support.Total Care Management• Company expansion of services to include Total care management• Design and implement programs based off of the SNP Model of Care such as; o State specific Health Risk Assessments, transition of care, discharge planning, post discharge follow up, Care Plan generation and ongoing care management.o Referral program into other programs such as Health Homeso Stratification based on risk for other programs such as, Care Coordination, Case Management and Disease ManagementCare Management• Became a member of CMSA (Case Management Society of America), attended national conferences in order to provide ongoing education to the current Case Managers and to share best practices for enhanced program results. • Introduced Integrated Case Management to the organization utilizing many of the principles and measurements, revamping all care management assessments.• Streamlined assessments across all of our care management programs in order to provide a consistent message throughout the programs which provides an ease of transition for the members between the programs.• Wove a biopsychosocial thread through all of the programs by providing training from the founder of the organization on the benefits of applying this skill through all member interactions.• Reviewed and revised all policies and procedures in order to ensure program compliance and establish improved caseload requirements• Improved the cost structure and profit margins for the program by streamlining process and identifying all administrative tasks being conducted by the Certified Case Managers and moving these functions to non-clinical support associates.

Tampa, Fl, Us

• Moved program from a severe negative operating cost to a positive profit margin within 6 months through program re-design, separating complex case management from Care Coordination functions which allowed for less of a need for RN level licensure and increase the use of LPN level licensed professionals and identifying all administrative tasks and utilizing non clinical support associates for this level of work. • 100% program and department restructure and design from the ground up. SNP is a highly regulated and controlled program offered through CMS and monitored and regulated through NCQA. • Designed the program to be sold in tiers based on a clients desired results from minimally compliant to a high ROI. • Segmented the program to allow sales to offer services to support individual aspects of the program, such as Health Risk Assessment management only, initial care plan generation, transitions of care, post discharge follow up or end to end program delivery.• Worked directly with industry leaders including the Gorman Health Group, CMS and NCQA consultants to build a compliant program. • Provided consultative services to clients and potential clients for review and writing of their Model of Care submissions and re-submissions as well as provided support and consultation for CMS/NCQA mock and actual audits.• Conducted national webinars on Model of Care requirements and best practices. Attendees included C-suite professionals from most of the leading health care organizations. These webinars consistently achieved the highest rate of attendance and provided the greatest amount of follow up requests.• Gathered requirements, designed, tested and implemented a platform specifically designed for optimal SNP service delivery including capturing all required reporting requirements. Platform was licensed and sold as a service to other clients.

Tampa, Fl, Us

Directs all aspects of non-clinical support for Medical and Behavioral Utilization and Case Management including inbound call center, operations coordinators, non telephonic support, and workforce management. • Reduced attrition from over 90% to 32% year to date.• Dramatically improved efficiency by implementing a capacity and staff plan as well as flexible schedules.• Created and implemented a call quality monitoring program• Introduced a performance management program which combines metrics, company values, individual and team goals• Effectively conducted several lean process strategies resulting in improved workflows and a new system platform.• Participated and led all aspects of design, build, testing and implementation of a new system for intake and utilization review.• Developed a new non clinical support triage department which coordinates support to the clinical team.• Partnered with the training department and developed new hire on-boarding practices and a structured training program.• Coordinated on going certification for URAC, HIPAA, Diversity, and Ethics compliance.

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Bellevue, Wa, Us

Served as primary leadership force in the resource planning division specifically for the financial care organization. Recruited, built and directed a talented team of resource planning professionals including 9 exempt level reports and 30 Service Level Coordinators in Tampa, Birmingham and Denver. Led the development and launch of successful strategic plans encompassing short and long term hiring plans and capacity plans targeting maximum efficiencies through extensive research and data mining of historical trends in consumer and employee behavior on a daily, weekly and monthly cycle. Restructured the business unit to optimize resources and provide excellent support service. Evaluated training initiatives and developed and launched a national training campaign Liaised with site leadership to build loyal and respected relationships across all department borders. Orchestrated a highly comprehensive business continuity plan which provided redundancy for a key operations facility.

Bellevue, Wa, Us

Leveraged best practices across departmental and site boundaries to enhance productivity and service level performance, sustained the effective and efficient utilization of resources through workforce management systems, process engineering, quality planning and management. Sustained positive leadership and high team morale through restructuring and cost constraint transitions. Championed a variety of incentive and recognition programs resulting in 87% favorable employee satisfaction results. Triggered a 30% improvement in service level results by identifying opportunities to decrease volume through the use of technology, improved process and communication.

Bellevue, Wa, Us

Realized an industry low attrition by implementing employee satisfying initiatives such as reduced and flexible schedules and by implementing a local hiring team consisting of key leadership within the organization that met weekly to calibrate hiring plans as well as retention plans for front line employees. Reduced and sustained a reduction in call handle time in excess of 200 seconds. Efficiency gained through an executive level campaign to reduce operating hours from 24/7 by leveraging a ‘follow the sun’ initiative utilizing centers across the 4 time zones to continue to provide extended hours to customers.Implemented a redundant Command Center which included all aspects of the national command center including the ability to load balance calls in and out of the organization and manage global service levels across all lines of business.

Bloomfield, Ct, Us

Promoted to this position based on tenure and historical results in prior business reengineering and optimization. This organization was comprised of medical personnel and was not structured as a call center. In order to gain efficiencies and improve productivity, studies were conducted and the following enhancements were implemented.• Implementation and execution of a National quality program for the Tampa Provider Service Dept. • Design and Implementation of Access and Excel databases for scheduling and QA purposes.• Implemented an on line reference system which included the necessary resources to handle incoming calls.• Integration of 2 phone units into one. Capitalizing on a larger queue for increased efficiency and occupancy.• Dramatically improved service levels from single digit results to the high 90’s.

Bloomfield, Ct, Us

Led and participated in a variety of special projects while working remote in the Hartford CT Corporate office. 100% travel required to provide expert subject matter detail for an organizational reengineering initiative for the customer service organization. • Reengineered all of the workflows, policies and procedures and built a new desktop tool for the Customer Service division.• Process modeled 100% customer service workflows utilizing Aris software.• Making process improvements recommendations.• Documented detailed Business Transaction Descriptions which were the basis for system design as well as training materials.• Designed screen mock ups for new desktop tool.• Certified in Siebel software.

Bloomfield, Ct, Us

Daily management of a team of CSA’s. Team size ranged from 15-20 full time employees. Provided daily, weekly and monthly feedback and coaching to each representative. Set realistic goals and followed up on their progress• Participated on the Volume reduction task force which identified numerous opportunities to make improvements to the IVR and billing statements which resulted in a significant reduction in call volume.• 10% increase in call handling efficiencies in the Memphis Claim office by implementing recommendations from the optimization review team. • Creation of agent schedules through IEX ensuring optimal efficiency. • Real time monitoring of CMS. • Administration of weekly schedules and time off requests. • Created and distributed phone reports to leadership along with analysis and identification of trends.

Jacksonville, Fl, Us

Jacksonville, Fl, Us

Bachelor Of Science (Bs), Operations Management And Supervision

Marketing Management

Business