Jim Dalen Email & Phone Number

Scottsdale, Az, Us

San Diego, Ca

Co-lead specialized consultancy firm providing strategic guidance for California health plans, provider groups, and MSOs on HEDIS, Align.Measure.Perform (AMP) process improvements, encounter data, risk score and predictive modeling, and dual outreach. Serve as SME to health plans on California Department of Managed Health Care (DMHC) requirements; validation and administration of Provider Appointment Availability Surveys; and administration of other required survey activities. • Drove… Show more Co-lead specialized consultancy firm providing strategic guidance for California health plans, provider groups, and MSOs on HEDIS, Align.Measure.Perform (AMP) process improvements, encounter data, risk score and predictive modeling, and dual outreach. Serve as SME to health plans on California Department of Managed Health Care (DMHC) requirements; validation and administration of Provider Appointment Availability Surveys; and administration of other required survey activities. • Drove 50–100% YoY revenue increases for enterprise due to outstanding service delivery, improved industry engagement with key players, and proven track record in enhanced quality management strategies. Show less

Launched, led, and grew performance analytics group with solutions for healthcare organizations nationwide, managing teams across multiple US office locations in member outreach, risk, and quality functions. Created predictive modeling for risk adjustment and quality metrics, business intelligence reporting, live and automated outreach analytics, and operational reporting. Provided strategic oversight of predictive modeling for Medicare, Medicaid, and commercial risk score infrastructures… Show more Launched, led, and grew performance analytics group with solutions for healthcare organizations nationwide, managing teams across multiple US office locations in member outreach, risk, and quality functions. Created predictive modeling for risk adjustment and quality metrics, business intelligence reporting, live and automated outreach analytics, and operational reporting. Provided strategic oversight of predictive modeling for Medicare, Medicaid, and commercial risk score infrastructures. ● Designed optimized predictive model and analytics infrastructure for enterprise’s core product, determining dual eligibility Medicare Advantage beneficiaries to drive participation and outreach for equity in access to care and improved reimbursement.● Facilitated assessments and supported integrations of 5 acquisitions into firm. Show less

Scottsdale, Az

Founded and led managed care industry consultancy, analyzing demographics of managed care populations and conducting performance measure validation, pay for performance, and HEDIS audits. Developed predictive models to determine likelihood of program eligibility and member participation from outreach initiatives.

Phoenix, Az

Steered analytics department, managing Medicare and Medicaid programs across 10 states in quality care studies, population analysis, contractual compliance, and quality reporting. Pioneered companywide standardized analytical methods and reporting processes for HEDIS and CAHPS evaluations, and created global network adequacy reports for MCOs. ● Tripled small analytics group in size while maintaining zero turnover.

Phoenix, Az

Earned progressive leadership scope to scale enterprise analytical capabilities. Launched new health economics group for MCO with commercial, Medicare +Choice, and Medicaid products. Drove survey research efforts and led HEDIS project management. Evaluated methodologies and analysis of quality metrics and evaluation studies.

Phoenix, Az

Master Of Arts, Economics

Bachelor Of Arts, Economics