Iris Hamilton Email & Phone Number

Develop and managed dedicated care management team with over 100 FTEs. Focused on improving clinical outcomes, member satisfaction, manage trend and program integration for national account clients.• Provide strategic and operational direction for the delivery of performance based medical management• Develop and maintain strong relationships with clients, consultants, account management team and internal matrixed partners• Manage risk drivers for the population• Select and build high performing teams through training, diverse assignments, coaching, mentoring, monitoring, auditing, performance management and development techniques• Participate in client calls/meetings as needed• Participate/direct Clinical audit meetings and represent the dedicated team • Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency • Develop, implement and evaluate policies and procedures to meet the client’s needs

Indianapolis, Indiana, Us

Direct Financial and Quality outcomes and overall Operational effectiveness. Care Management includes Utilization and Case Management Operations Support. Provide subject matter expertise on day to day business issues, advised of overall impact of CMS regulatory changes and industry trends.• Developed and implemented of Central EGR team that supports membership and decreased average length of stay.• Acted as Clinical SME for EGR Medical Management providing immediate response to all issues.• Supported all client communications for Medicare Advantage and serve as liaison with various matrix partners to ensure client contractual requirements and obligations are met and maintained.• Supported account management team with quarterly client reporting.

Directed Financial and Quality outcomes and overall Operational effectiveness. Interfaced with Client and Account Management team. Provided subject matter expertise on day to day business issues, advised of overall impact of CMS regulatory changes and industry trends.• Developed and implemented 3 Geo Care Teams: North, East and South to support SHBP membership with the state of GA and the country.• 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.• Supported account management team with quarterly client reporting.

Management of complete day-to-day responsibility for 100+ associates from a clinical and operational perspective as well as strategic planning and budgeting.• Designed and implemented 1st Stars Outbound Call Program Call Center focused on targeted population management within Medicare Advantage membership to encourage members to address gaps in care.• Designed reporting to track staff and program performance.• Implemented international operations with 20+ full time employees that supported Stars Ratings for Medicare Advantage products.

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

Managed 3 clinical supervisors with 65 personnel (RN and LPN mixture). Provided oversight of clinical and operational components of care center to service over 65 designated employer groups that provide Disease Management Health Coaching, Depression and Wellness programs. Executed and enforced the implementation of program and system enhancements and modifications. Developed and implemented client specific action plans.• Participated in clinical outcomes meetings with clients as needed to deliver the ROI for the program.• Integrated management, education and quality improvement components to ensure optimal clinical performance.• Monitored and managed outcome and performance guarantee measures to ensure optimal results.• Supported and acted as key member of cross-functional policy and procedure committee instrumental in preparing organization for NCQA September 2008.

Maintained oversight for daily clinical operations for dedicated employer groups which entailed 2 supervisors, 40 registered nurses and 2 non-clinical staff.• Implemented Health Returns System for Health Advocate documentation activities with members by acting as instrumental project team member.• Developed comprehensive dashboard for reporting bi-weekly metric to client and consultants by leading and participating in weekly client calls to represent clinical operations

Master'S Degree, Public Administration

Associate'S Degree, Registered Nursing/Registered Nurse

Bachelor Of Science - Bs, Respiratory Care Therapy

Bachelor Of Science - Bs, Respiratory Care Therapy/Therapist