Iris Hamilton Email & Phone Number

Atlanta Ga

Responsibilities include Financial and Quality outcomes and overall Operational effectiveness for: • Care Management to include Utilization and Case Management Operations Support• Development and implementation of the 3 Geo Care Teams: North, East and South to support SHBP membership with the state of GA and the country• Interface with Client and Account Management team• Managed all client communications for Medicare Advantage and served as liaison with various matrix partners to ensure client contractual requirements and obligations were met and maintained• Provided subject matter expertise on day to day business issues, advised of overall impact of CMS regulatory changes and industry trends• Support the account management team with quarterly client reporting

Atlanta Ga

• Designed and implemented first Stars Outbound Call Program Call Center focused on targeted population management within Medicare Advantage membership to encourage members to address gaps in care. Responsibility also includes telephonic outreach to members and providers• Expanded outbound call center operations internationally• Management of complete day-to-day responsibility for 100+ associates from a clinical and operational perspective as well as strategic planning and budgeting• Designed reporting to track staff and program performance• Successfully implemented multi-sites to support Stars Ratings for Medicare Advantage products

Atlanta Ga

• Maintained oversight for daily clinical operations for Medicare Advantage Case Management services which entailed 18 registered nurses and 5 non-clinical staff• Supported implementations of designated senior service initiatives• Supported call center initiatives for Senior Business as clinical SME• Performed and reviewed monthly clinical audits with staff• Coached and mentored frontline staff to success

Atlanta Ga

• Managed 3 clinical supervisors with 65 personnel (RN and LPN mixture)• Oversight of clinical and operational components of care center to service over 65 designated employer groups that provides Disease Management (Chronic Kidney Disease, Diabetes, CHF, Coronary Artery Disease, Asthma and Low Back Pain) Health Coaching, Depression and Wellness programs • Maintained excellent client relations with client managers and clients• Participated in clinical outcomes meetings with clients as needed to deliver the ROI for the program• Executed and enforced the implementation of program and system enhancements and modifications• Aligned regional site operations with organizational strategic initiatives• Integrated the management, education and quality improvement components to ensure optimal clinical performance• Monitored and managed outcome and performance guarantee measures to ensure optimal results • Developed and implemented client specific action plans as needed• Supported and key member of the cross-functional policy and procedure committee instrumental in the preparing the organization for upcoming NCQA September 2008

Master'S Degree, Public Administration

Concentration in Health Care

Associate Of Science (A.S.), Registered Nursing/Registered Nurse

Bachelor'S Of Science, Cardiopulmonary Science

Respiratory Therapy