Kari H. Email & Phone Number

Madison, Wisconsin, United States

Madison, Wisconsin, United States

• Designs and deploys innovative and industry leading clinical programs for Commercial and Medicare lines of business to include clinical support and management • Ensure high value, competitive clinical programing in the areas of Utilization and Case Management, Clinical Review, Provider Partnerships, and Ad-Hoc Clinical Initiatives or Programs for specific lines of business such as ASO• Develop and oversee the Clinical Programs budgets, metrics/goals and performance… Show more • Designs and deploys innovative and industry leading clinical programs for Commercial and Medicare lines of business to include clinical support and management • Ensure high value, competitive clinical programing in the areas of Utilization and Case Management, Clinical Review, Provider Partnerships, and Ad-Hoc Clinical Initiatives or Programs for specific lines of business such as ASO• Develop and oversee the Clinical Programs budgets, metrics/goals and performance reporting• Create organizational structure and talent to deliver Clinical Programs metrics and goals • Determine and implement tools to support the Clinical Program team and work• Ensure work is performed meeting all Quality and Accreditation standards, advance and create standards, policies, and procedures • Ensure accuracy and timeliness of output and deliverables for assigned functional areas. Implements and ensures compliance with corporate management policies, practices, and procedures Show less

Boise, Idaho

• Drives healthcare transformation in quality, cost and consumer experience by working with key strategic partners to enable success in Regence’s alternative payment models (APM) and transformation initiatives• Develops and maintains collaborative working relationships with key providers to enable market level initiatives, support contracting, drive collaborative innovations and facilitate practice transformation• Works closely with network team, government programs and other internal… Show more • Drives healthcare transformation in quality, cost and consumer experience by working with key strategic partners to enable success in Regence’s alternative payment models (APM) and transformation initiatives• Develops and maintains collaborative working relationships with key providers to enable market level initiatives, support contracting, drive collaborative innovations and facilitate practice transformation• Works closely with network team, government programs and other internal teams to enable providers in STARS performance and member experience• Proven ability to build positive relationships, gain trust and respect and influence others while managing 10+ priority provider relationships in multiple markets• Demonstrates strong analytical and problem-solving ability with skills to interpret and present complex data at both provider and market levels• Key leader in Ideation/implementation of clinical transformation role including programming and development of tools and resources to support provider work across four markets o Consultant, leader and developer of required tools including Joint Operating Committee template, clinical assessment and clinic tracking tools and Master Deck, 300+ slides with quality best practices, ED reduction best practices, education on supplemental benefits, etc. o Successfully developed and deployed new engagement model to include vendor partners into clinical collaboration meetings o Developed and implemented new process with internal teams to collaborate with providers to decrease network leakage and improve single case agreement processo Developed care management identification solution to surface high risk members for APM providers through the Impactable Member Dashboard, deployed to four marketso Developed approved proposal for innovative care management solution aimed to decrease utilization costs through reducing network leakage and leveraging high quality, low cost providers Show less

Salt Lake City, Utah

- Responsible to plan, develop and execute programming and collateral to support the new sales process and a sales team of 26 including the development of five product programs and program briefs, clinical collateral and sales decks, demo environment development and script creation- Creates, executes and leads the market Steering Committees and Clinical Consensus Groupso Redesigned structure and programming for both Steering and Clinical Consensus Groups in early 2018o Developed and… Show more - Responsible to plan, develop and execute programming and collateral to support the new sales process and a sales team of 26 including the development of five product programs and program briefs, clinical collateral and sales decks, demo environment development and script creation- Creates, executes and leads the market Steering Committees and Clinical Consensus Groupso Redesigned structure and programming for both Steering and Clinical Consensus Groups in early 2018o Developed and implemented new processes and collateral to support these groups and deployed in five new markets- Partners with the GM’s in each market to ensure they have the clinical support needed- Built and lead the clinical team to do the following:o Develops and executes standard engagement processes and procedureso Provides ongoing clinical expertise and support to the delivery team in onboarding and ongoing customer engagement o Ensures the clinical efficacy and effectiveness of current productso Supports the product team in the development and advancement of products that meet the needs of existing and new customerso Leads market clinical initiatives, collaboratives and projects - Lead the market engagement of new products to determine level and type of support to ensure ongoing customer sustainment and engagement- Created a clinical engagement model that reflects current customer engagement and a set of tools that improve customer engagement- Serves as a clinical resource and partner in the development of products to ensure their efficacy, supporting the clinical accuracy and clinical use for our existing products and as new products are considered and developed and nurses clinical representation in all aspects of our business Show less

Portland, Oregon Area

-Leads Common Care pilot program tasked with providing clinical support to strategic provider partners, developing innovations in care management, providing innovative data solutions for providers and coordinating with multiple internal teams to provide integrated provider solutions. Pilot was recently funded for expansion in 2018, with plans to triple the number of providers engaged-Responsible for engaging clinic executives in a collaborative care management model, including outlining of… Show more -Leads Common Care pilot program tasked with providing clinical support to strategic provider partners, developing innovations in care management, providing innovative data solutions for providers and coordinating with multiple internal teams to provide integrated provider solutions. Pilot was recently funded for expansion in 2018, with plans to triple the number of providers engaged-Responsible for engaging clinic executives in a collaborative care management model, including outlining of proposed relationship, assessment of care management abilities and implementation of coordinated programs-Developed and implemented care management model with programs targeting quality, care management and utilization including presentation of program metrics to executives at Joint Operating Committees-Consultant to Data Science team for multiple care management product solutions including multiple innovative solutions aimed towards providers-Consultant to Platform Solutions teams for product development of care management software solutions. Leads/participates in demonstration and provider pitch for other internal software solutions marketed to providers-Led internal implementation of PreManage software within pilot program including development and implementation of utilization programs centered around tool both internally and with provider partners-2017 PreManage Community Clinical Consensus Group member for Portland, OR. Consults/leads internal efforts to effectively utilize tool in collaboration with other community stakeholders-Leads and manages team tasked with closing commercial and MedAdvantage care gaps including development, coordination, alignment and execution of member outreach strategy-2017 Cambia Value Awards Nominee and Finalist-Current Leadership Journey Participant, 9 month leadership training, Cambia Health Solutions Show less

Portland, Oregon Area

-Developed an in-depth, clinical analytic process to evaluate risk factors for populations and identify gaps in processes by utilizing a holistic perspective, resulting in multiple findings which required organization-wide collaboration to resolve issues surrounding high dollar claims and benefits language. This process led to significant cost savings across the organization and the development of a new type of care management-Co-led project to create and implement a new care management… Show more -Developed an in-depth, clinical analytic process to evaluate risk factors for populations and identify gaps in processes by utilizing a holistic perspective, resulting in multiple findings which required organization-wide collaboration to resolve issues surrounding high dollar claims and benefits language. This process led to significant cost savings across the organization and the development of a new type of care management-Co-led project to create and implement a new care management program utilizing unique analytic process, including development of strategy, process and workflow as well as writing policies, procedures and desk references-Collaborate with internal partners to identify, evaluate, and apply interventions to address identified issues as well as improve member experience, improve internal processes, increase collaboration across the organization, assist executives in evaluation and change of needed network and benefit changes, and other identified interventions-Collaborate with executives on weekly basis to plan, develop and implement innovative care management program including recruitment and on-boarding of new team members-Nominated for 2016 4Q Outside In Award Show less

Vancouver, Washington, United States

• Mastered multiple roles within the organization including case manager/utilization management RN, maternity health coach, health coach and disease management RN• Successfully managed members with acute and chronic conditions by providing education, support, coordination of services, development of a care plan and collaboration with primary care physician• Reviewed post-acute stays for appropriateness utilizing MCG criteria as well document and communicate decision• Coordinated… Show more • Mastered multiple roles within the organization including case manager/utilization management RN, maternity health coach, health coach and disease management RN• Successfully managed members with acute and chronic conditions by providing education, support, coordination of services, development of a care plan and collaboration with primary care physician• Reviewed post-acute stays for appropriateness utilizing MCG criteria as well document and communicate decision• Coordinated transitions of care, ensuring appropriate supports are in place for successful discharge and readmission avoidance• Utilized numerous population health applications including predictive analytics software, care management software, pre-authorization/medical necessity software and report management programs• Successfully led numerous projects including acting as MBO Lead for Community Resource Project, Pulse Committee Member, Leadership Development Series Graduate, CEO Roundtable Participant• Assisted in program design and process standardization – AmeriBen Disease Management Program• Project member for company-wide predictive analytic software implementation, subject matter expert responsible for educating and training new staff members • Responsible to research, develop and design health education, including pamphlets and newsletters for specific populations• Acted as backup Disability Case Reviewer for 2.5 years• Leadership roles include: MBO Lead for Community Resource Project, Pulse Committee Member, Leadership Development Series Graduate, CEO Roundtable Participant Show less

Nampa, Id

- Assessment and identification of patient problems/needs, establishing a plan of care, and implement and evaluate the nursing process for postpartum mothers and newborns- Provide care for sick newborn in Level 2 nursery- Document patient care in EMR- Float to pediatrics floor as needed- Maintain professional standards and credentials including BLS and NRP- Provide exceptional patient care and customer service