James R.

James R. Email and Phone Number

C-Suite Advisor / Board Member / Board Advisor - Healthcare Operations, Governance, Risk, and Compliance Executive @ SunHawk Consulting, LLC.
James R.'s Location
Louisville, Kentucky, United States, United States
James R.'s Contact Details
About James R.

Accomplished and focused health and wellness executive equally comfortable and capable in the Board room or mentoring, coaching, and developing line staff to optimize their operations. Strong national and international experience both in the public and private sectors. Respected business partner and strategic leader with a track record of anticipating long-term trends and then envisioning the leaders, skills, processes, and technology to enable that vision.Experience in consulting and non-consulting roles across a broad range of organization functions and operations. Most recent experience providing strategic leadership over the evaluation of health and wellness industry operations including strategy alignment, organizational design, clinical operations, claims processing, enrollment, sales, budgeting, operational efficiency, compliance operations, risk adjustment, billing, and IT security.Deep knowledge of governance, enterprise risk management, compliance, process optimization, and process control methodologies. Strategic thought leader on GRC systems development and implementation. Experience providing oversight of fraud, waste, and abuse initiatives and investigations. Responsibilities have included overall program framework establishment and execution for Sarbanes-Oxley, COSO, COBIT, DOI Model Audit Rule, FCPA, and similar compliance frameworks. Leader, motivator, and mentor with highly regarded skills in recruiting, developing, and cultivating highly capable teams and fostering organizational culture and integrity. Patient, calming yet persistent style – known for an ability to diffuse conflicts and facilitate the creation of solutions.

James R.'s Current Company Details
SunHawk Consulting, LLC.

Sunhawk Consulting, Llc.

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C-Suite Advisor / Board Member / Board Advisor - Healthcare Operations, Governance, Risk, and Compliance Executive
James R. Work Experience Details
  • Sunhawk Consulting, Llc.
    Managing Director, Healthcare Practice Leader
    Sunhawk Consulting, Llc. Jul 2018 - Present
    Zionsville, Indiana, Us
    Managing service design and delivery to the provider and payer markets. Providing enterprise risk management, compliance program design, complex claims statistical analysis, IRO services, and compliance assessments directly to healthcare organizations and external counsel. Served as Chief Compliance Officer for a private equity owned dental practices group.
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  • World Health Organization
    Expert Advisor To The Staff Health Insurance Global Oversight Committee
    World Health Organization Oct 2017 - Present
    Geneva 27, Ge, Ch
    Provide expert advice on the operations, management, finance and investments, audit and controls, benefits and best practices, wellness incentives, rules and governance of the global health insurance program for the approximately 40,000 participants encompassing approximately $3 billion in long-term liabilities. Working with 194 Member States from more than 150 offices, World Health Organization staff are united in a shared commitment to achieve better health for everyone, everywhere.
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  • The Alastair Group, Llc
    Senior Managing Director
    The Alastair Group, Llc Jan 2019 - Present
    Providing management consulting to non-profit healthcare, education and governmental organizations in the U.S. and abroad. Specializing in process improvement, enterprise risk management, governance facilitation, and compliance assessment. Served as Interim Chief Executive Officer and Chief Financial Officer for $3 million+, 30+ associate non-profit social service agency.
  • Jefferson County Public Schools
    Chairperson, Audit And Risk Advisory Committee
    Jefferson County Public Schools Jul 2018 - Present
    Louisville, Ky, Us
    Appointed by the JCPS Board of Education to establish the Audit and Risk Advisory Committee. The Committee is made up of finance, education, business, health, and public relations experts who focus on the risks to the acheivement of the JCPS Strategic Plan (Vision 2020), Audit Recommendation Closure, and Equity Policy Implementation as well as ongoing Audit and Compliance Oversight Matters. As one of the largest urban districts in the country, JCPS has a budget in excess of $1.5 billion and serves over 90,000 students.
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  • Aperture Credentialing, Llc
    Chief Financial Officer
    Aperture Credentialing, Llc Oct 2016 - Jun 2018
    Louisville, Kentucky, Us
    Aperture is the largest and most reliable healthcare provider credentialing company in the nation. With more than 16 years of experience - health plans, state governments, and provider organizations can rely on our market-leading operational and financial scale. We adhere to URAC, NCQA, CMS and state-driven requirements. Accountable to the CEO and organization's private equity board of managers for supporting strategic planning, capital expenditures including technology investments, human resources, enterprise program management office, client services team, and overseeing financial management of the organization.
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  • World Food Programme
    Chair, Audit Committee
    World Food Programme Jul 2011 - Jul 2017
    Roma, Rm, It
    WFP is a $5+ billion UN Agency delivering food to 100 million in over 70 countries. The Audit Committee oversees the WFP's global governance, risk, and compliance processes in accordance with UN, private, and public sector best practices. The Committee advises the Executive Director of the WFP as well as the Executive Board (equivalent to a private sector Board of Directors) which is made up of diplomatic representatives from member nations. The European Court of Auditors and United Nations Audit Committee council cited WFP's Audit Committee as a model of good practice in 2016. Term began in July 2011 running through July 2017.
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  • Navigant
    Director
    Navigant Jul 2014 - Jan 2017
    Chicago, Il, Us
    Director and payer sector compliance practice leader within Navigant's Healthcare and Life Sciences - Disputes, Investigations, Regulatory and Compliance Practice. Responsible for payer sector thought leadership, offering development, engagement oversight, and client support.Clients have included national and regional payer organizations, provider systems, and key payer vendors. Engagements have focused on compliance program development, systems re-engineering, data integrity reviews, organizational design, external counsel support, risk adjustment, false claims act analysis, and CMS independent validation audits. Clients outside payer organizations have included pharma, clinical, higher education, and other organizations interested in maturing their overall governance, risk and compliance infrastructure.
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  • Humana
    Vice President - Chief Audit Officer
    Humana Aug 2011 - Jan 2014
    Louisville, Kentucky, Us
    Board elected officer responsible for Chief Audit Executive duties as well as facilitation of Humana's Enterprise Risk Management (ERM) Program. Leadership of 80+ professionals with diversified backgrounds including finance, audit, IT, nursing, actuarial, law, investigations, pharmacy, and operations. Led comprehensive ERM and audit consulting program focused on assessing top risks to the attainment of Humana’s strategic and financial objectives. Our success required an ability to comprehend and analyze large-scale complex program design as well as methodologies in healthcare strategy, change management, root cause analysis and operations leadership.Facilitated Executive Team and Operating Committee meetings on behalf of the CEO and COO including strategic initiatives review, corporate metrics analysis, agenda items, presenter coordination, master schedule and action item follow up. Established shared services teams which provided enterprise investigations support, external regulatory audit facilitation, enterprise GRC system thought leadership and implementation, and process documentation support. Envisioned and helped facilitate development of data governance program.
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  • Humana
    Corporate Director, Internal Audit
    Humana Feb 1999 - Aug 2011
    Louisville, Kentucky, Us
    Chief Audit Executive responsibilities for Humana covering all aspects of health and wellness operations including insurance, pharmacy benefit management (PBM), mail order pharmacy, disease management, direct patient clinical operations, corporate functions, and information technology. Provided comprehensive risk, root cause, and process improvement analysis to executives and board members regarding strategic, operational, financial reporting, and compliance matters. Led or provided strategic oversight to the development of enterprise initiatives such as Sarbanes-Oxley reporting, process maturity assessments, and risk adjustment coding review.
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  • Commonwealth Of Kentucky, Auditor Of Public Accounts
    Director Of Performance Audit
    Commonwealth Of Kentucky, Auditor Of Public Accounts Apr 1996 - Feb 1999
    Created Commonwealth's first Performance Audit Division that continues to exist today. Developed methodology and led efficiency, effectiveness, and business process improvement reviews across various state programs including Medicaid, Information Technology, Labor Laws, and Guardians Ad Litem. Recommended over $8 million in savings some through the introduction of ACL and CAATs methodologies. Testified before legislative panels.Director of Financial Audits for 1st year with APA, supervising 50+ employees conducting financial statement audits across over 200 local entities covering $1 billion in receipts. Supervised forensic accounting investigations with subsequent case files being used by local, state, and federal prosecutors. Eliminated 32,000 hour backlog while reducing total headcount.
  • Usaid
    Foreign Service Officer
    Usaid Jan 1992 - Apr 1996
    Washington, District Of Columbia, Us
    Office of the Inspector General - Postings in Washington D.C., Budapest, Hungary, and Bonn, GermanyEvaluated economic development and privatization programs in Russia, Central and Eastern Europe, and Central Asia including stock exchange development, voucher and shareholder privatization programs, housing distribution, trucking and warehouse distribution privatization, as well as, country mission project management. Maintained Diplomatic Passport and Top Secret Clearance.
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  • U.S. House Of Representatives And U.S. Senate
    Congressional Aide
    U.S. House Of Representatives And U.S. Senate May 1989 - Aug 1989
    Researched appropriation and regulatory legislation. Drafted talking points and statewide newsletters. Lexington, Kentucky and Washington D.C. - Summers of 1986, 1987, 1989

James R. Skills

Enterprise Risk Management Risk Management Auditing Business Process Improvement Leadership Financial Risk Risk Assessment Strategy Sarbanes Oxley Act Strategic Planning Financial Audits Corporate Governance Health Insurance Cisa Internal Controls Healthcare Assurance Fraud Accounting Financial Reporting It Audit Process Optimization Cpa Operations Management Six Sigma Managerial Finance External Audit Coso Compliance Financial Services Medicare International Development Government Procurement Medicaid Managed Care Public Sector Consulting International Ngos

James R. Education Details

  • Patterson School Of Diplomacy And International Commerce
    Patterson School Of Diplomacy And International Commerce
    Diplomacy And International Commerce
  • Massachusetts Institute Of Technology
    Massachusetts Institute Of Technology
    Enterpreneur Boot Camp Seminar
  • Stanford University
    Stanford University
    Executive Program In Strategic Decisions - Center For Professional Development
  • The University Of Chicago Booth School Of Business
    The University Of Chicago Booth School Of Business
    Executive Program In Corporate Strategy
  • Wu (Vienna University Of Economics And Business)
    Wu (Vienna University Of Economics And Business)
    International Marketing Studies - The Business And Economics University Of Vienna - Summer Of 1990
  • University Of Kentucky
    University Of Kentucky
    Accounting
  • Humana Development Programs
    Humana Development Programs

Frequently Asked Questions about James R.

What company does James R. work for?

James R. works for Sunhawk Consulting, Llc.

What is James R.'s role at the current company?

James R.'s current role is C-Suite Advisor / Board Member / Board Advisor - Healthcare Operations, Governance, Risk, and Compliance Executive.

What is James R.'s email address?

James R.'s email address is jr****@****ana.com

What is James R.'s direct phone number?

James R.'s direct phone number is +150258*****

What schools did James R. attend?

James R. attended Patterson School Of Diplomacy And International Commerce, Massachusetts Institute Of Technology, Stanford University, The University Of Chicago Booth School Of Business, Wu (Vienna University Of Economics And Business), University Of Kentucky, Humana Development Programs.

What are some of James R.'s interests?

James R. has interest in Education, Environment, Poverty Alleviation, Disaster And Humanitarian Relief, Health.

What skills is James R. known for?

James R. has skills like Enterprise Risk Management, Risk Management, Auditing, Business Process Improvement, Leadership, Financial Risk, Risk Assessment, Strategy, Sarbanes Oxley Act, Strategic Planning, Financial Audits, Corporate Governance.

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