Felix J. Bradbury, Rn, Scd, Fache Email & Phone Number

St Louis, Mo 63141, Mo, Us

Senior Solutions Architect for AI in Healthcare and Life Sciences

Mclean, Va, Us

Healthcare AI within the Open Health Solutions division of the MITRE Corporation

Cape Girardeau, Mo, Us

Data science and machine learning executive responsible for developing and implementing the analytics strategy and infrastructure to enable Saint Francis to become an analytic center of excellence (ACoE). Successfully designed and implemented the Saint Francis Analytic Ecosystem (SFAE) on time and under budget in less than 12-months. This ecosystem enabled the following new analytic and reporting capabilities for Saint Francis:• Able to store and mine significant volumes of accurate, relevant, and timely data at scale• Able to rapidly develop and deploy customizable ML solutions into Epic EMR• Single source of truth; one stop data source.• Data governance framework for reporting, master data management, and data lineage.• Developed strong analytic and visualization capabilities using near-real time data and supported by Snowflake, Alteryx, and Tableau. • Developed a data science team with an abiding commitment to learning new skills and to helping Saint Francis achieve value realization through data mining and advanced analytics. • Saint Francis is now able to use analytics to proactively identify new opportunities for improving outcomes, lower costs, etc. • Enabled the enterprise to fully leverage their data as an asset by transforming raw data into actionable insights for sustainable strategic advantage.

Dublin 2, Ie

I was promoted to this role as a result of outstanding performance in my previous role. I lead the development of unsupervised and supervised machine learning algorithms to resolve complex business and clinical challenge for F100 payer and provider clients. To that end, I direct and oversee advanced analytics and AI for payer solutions using AI and simulation modeling to drive operational efficiency for national payers and providers. Some key results and activities include:⇨Transitioning organizations from fee-for-services to pay-for-value model by creating and implementing new analytic strategies. ⇨I also designed Accenture’s Stars and DSRIP solutions and co-developed the data quality management and risk score accuracy platform. ⇨I developed executive IS solutions that improved transparency of information regarding the cost and quality of care. This enabled the largest catholic healthcare delivery system to reduce variation in quality and costs for oncology, orthopedics, medical-surgical, gastroenterology, and cardiology.

Dublin 2, Ie

As a Senior Principal I delivered analytic bench and thought leadership in Stars and health quality. I supported asset development and improved brand awareness in the healthcare analytics space including driving go-to-market strategies, sales initiatives, and client-facing engagements. Key results include:⇨Transitioning a large catholic healthcare delivery system to transition from FFS to P4V with minimal disruption to network and margin. ⇨I introduced a pay-for-performance system framework to the CIO of the DoD to drive cost savings and quality of care/quality of service for active military and their families.

Saint Petersburg, Florida, Us

I was in charge of leading CMS Five Star initiatives via the Medical Management Operations and Quality Management departments while overseeing operations for UM as well as the prior authorizations re-engineering project. Facilitated the market growth of the company by improving the efficiency of the delivery process.KEY ACHIEVEMENTS⇨ Provided leadership for the development of medical analytics infrastructure, including RFPs for DSS and predictive modeling systems.⇨ Developed the plans first Stars performance monitoring and evaluation solution which enabled executives to identify the most impactable Stars measures for a given H-number. ⇨ Implemented SPC processes to identify root cause issues with high-volumes of CTMs; reduced CTMs to within normal limits as defined by CMS and improved Stars measures as a result.⇨ Used Monte Carlo simulation modeling to identify bottlenecks in PA processes; reduced expedited and routine prior authorization turn around times from >14 days to less than 48 hours; achieved compliance with CMS guidelines. ⇨ Oversaw the fulfillment of healthcare management, utilization, cost, and quality objectives per federal and state regulatory requirements as well as NCQA standards. Plan performance improved and the plan received a commendable rating from NCQA.⇨ Supervised Utilization Management and QM staff, including hiring, training, performance evaluation, and competency assessment.⇨ Established and carried out continuous evaluation of the utilization review as well as quality assessment processes.

Monterey Park, Ca, Us

In this role, I led Medical Management Operations including Quality, Concurrent Review, Pharmacy, Prior Auths, Retro Review, Member Services, and Appeals and Grievances. Facilitated an interdisciplinary team approach to ensure consistency in Medical Operations. I also managed staff development and applied SPC techniques to Medical Management to help identify common cause and special cause variation in operational processes. ⇨I effectively collaborated with the Chief Medical Officer to reduce acute inpatient in the Medicaid population from 900 to 650 in less than two years. ⇨I reduced AHCCCS health plan costs associated with acute inpatient readmissions by creating a readmission predictive model that used administration claims data and provided RNs with actionable information with which to manage readmission risk factors. ⇨I improved cross-functional collaboration as the AHCCCS Health Plan Officer and brought together 54 clinical, technical, and social work staff.

Louisville, Kentucky, Us

I was accountable for championing the company’s business proposition and the use of advanced analytics to showcase the impact of case and disease management to 30+ Fortune 500 self-funded and fully-funded clients. Responsible for the development and of analytics as a core enterprise capability to support strategic goals and objectives. Provided analytical interpretation of medical data including comparative benchmarks for evaluation of clinical practices.KEY ACHIEVEMENTS⇨ Showcased SHPS value proposition to F-500 clients. Enabled clients with insights to help reduce adverse utilization and costs associated with ambulatory care sensitive conditions. ⇨ Developed and enhanced ROI analytics, performance metrics, and program monitoring and the program monitoring and evaluation infrastructure for F-500 clients.⇨ Transformed the reporting and analytics function from a cost center into a consulting service in 18 months, generating ~$350K in new revenue, covering the costs of two additional FTEs, and producing a 20% margin.⇨ Refined and implemented innovative supervised machine learning algorithms to solve complex business and clinical challenges for Fortune 500 clients.⇨ Identified value architecture through industry insights and implemented it through strategy development, client relationship development, and key account management.

White Plains, Ny, Us

Responsible for oversight of utilization management and health quality and service quality. Responsibilities include: ⇨ Develops and continually refines operational processes within the healthcare delivery system to promote system-wide best practices and produces analysis documents to guide strategic planning.⇨ Ensures the integrity of processes and reports associated with the tactical initiatives.⇨ Collaborates in developing and implementing clinical programs in accordance with the goals of HHSTM’s mission, vision and values, the needs of the health plan, federal and state regulatory requirements and URAC standards.⇨ Evaluates programs regularly.⇨ Ensures that medical management activities are contracted, reviewed and reported according to established criteria.⇨ Develops medical management policy, procedures and guidelines to ensure compliance with specific medical management standards.⇨ Serves as a clinical leader to Medical Management associates.⇨ Works collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problem resolution.⇨ Analyzes data and evaluates necessary plan services for cost containment.⇨ Develops the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.⇨ Ensures compliance with state reporting on utilization management activities for accuracy.⇨ Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting.⇨ Supports and participates in disease management program initiatives.⇨ Promotes plan-wide understanding, communication, and coordination of Medical Management Programs.⇨ Explores alternatives in the UM/CM process.⇨ Mentors and provides guidance to team members and subordinates.

Baton Rouge, La, Us

Provide vision, strategy and operational leadership relating to the data integrity, tools and analysis of medical data needed to support BCBS-LA's key business goals and objectives. Responsible the company’s health economics data relating to strategic goals and objectives. Provide analytical interpretation of medical data including comparative benchmarks for evaluation of clinical practices and the development of financial and contractual modeling. Achievements:⇨ Create an analytical environment that enhances clinical and medical cost decisions.⇨ Provide ROI and cost-effectiveness analytics for disease management, case management, prior authorizations, and retrospective review.⇨ Implement predictive modeling application to support proactive identification of high-risk members for disease and case management.⇨ Oversee the analysis and interpretation of health economics data from various sources and outcome reporting packages and develop company-wide standards for reporting and use of data. ⇨ Develop physician profiles and report cards to support identification of cost-effective providers and recontracting of physicians in the network.⇨ Develop DRG trend analytics to identify actionable opportunities to impact utilization and cost trends in inpatient, professional, pharmacy, and DME. Assist actuarial area with trend analytics and forecasting.⇨ Collaborate with Pharmacy Department to develop and implement prescription cost-savings measures. ⇨ Develop RFP for Medical Management's decision support software suite. ⇨ Evaluate new tools and develop new models to analytically support existing and future business.⇨ Integrate health economics analytic reporting and tools with data warehouse capabilities.

Doctor Of Science (Scd), ★ Health Systems Management: Medical Economics And Health Outcomes Research

Post Graduate Program In Ai And Machine Learning (Pgp-Aiml), Artificial Intelligence And Machine Learning; Analytic Ecosystems

Machine Learning, Machine Learning And Computer Science

Msha, Health System Management: Emphasis On Healthcare Finance, Biostatistics, And Decision Science.

Nursing Excllence Program, Registered Nursing/Registered Nurse

Nursing Excellence Scholarship, Registered Nursing, Nursing Administration, Nursing Research And Clinical Nursing

Bscn, Cum Laude, Registered Nursing, Nursing Administration, Nursing Research And Clinical Nursing

Masters In Classical Guitar Performance, Music Performance, General

Ba -Music, Music/Liberal Arts