Kimberly Tipton Email & Phone Number

Franklin, Tennessee, Us

• Oversee communication with client related to legal and risk management issues, including periodic reporting relating to incidents or events, claim patterns and risk control• Work with internal research teams to establish project scale, road maps, and resource utilization • See to client confidence by providing accurate time frames, revenue management, and Return On Investment (RoI)• Aid company business development and be an integral part of the proposal process and management • Lead and build a team of program and project managers from scratch • Maintain a strong presence in company research and development efforts • Oversee and take control of product portfolio growth and ultimate success • Deliver project budgeting, forecasting, and cost analysis to the executive team • Own the overall strategy for client projects, providing efficient and effective plans to meet client engagement needs

Huntsville, Alabama, Us

Responsible for payor contracting and integration of clinical and quality design • Negotiated and closed health plan contracts covering more than 15 million lives for multiple lines of business • Influenced integration of clinical and quality metrics into the implementation of Diatherix service offerings throughout health systems• Designed new health plan contract process with billing and sales to include health plan coverage mapping• Coordinated interdepartmental communication, processes and procedures• Developed the policy and procedure for contract/pricing review and approval• Innovated a payor repository model• Strengthened relationships with payors• Promoted health plan collaborations through press releases• Participate on the Louisiana Health Plan Association Communications and Education committees• Educated internal personnel on clinical metrics and guidelines• Implemented competitive analysis resource

• Attracted and led a multi-disciplinary team to implement a utilization management, case management, disease management, and wellness platform and programs• Achieved NCQA Accreditation prior to health plan go live and ongoing• Shepherded clinical team in development of Quality Improvement Program, Provider Manual, Case Management and Disease Management Program Evaluations and all policies and procedures • Collaborated with team to generate reporting for quality metrics to include: NCQA, HEDIS, QRS, State, STARS, QHP, and CMS• Implemented strategies to control Medical Loss Ratio

Nashville, Tn, Us

• Led HIE technical implementation for secure clinical messaging and integration of multiple EMR systems• Consulted on evaluation of clinical workflows and meeting Meaningful Use metrics• Instituted and conducted HIPAA training for all employees• Assessed customer reporting and implemented account management personnel training

Franklin, Tn, Us

• Provided standards of care information to providers in relation to their member population in contractual agreement with a specific health plan• Collaborated with physicians to provide support for their practices and their patients with chronic disease• Identified customer needs to decrease health care costs by developing initiatives to improve their member benefit services• Managed large health plans and employer group accounts• Developed strategic programs for reducing medical trend for health plans and reducing healthcare risks for employer groups• Collaborated with a pharmacy benefit manager client on accounts to measure return on investmentDirector Product Development, 2006 – 2007• Reviewed current disease management products and analysis of data to determine appropriate products for implementation to health plansClinical Director, 2005 – 2006• Evaluated disease management statistics for health plans and developed strategies to improve healthcare trend for cost utilizationProvider Services Manager, 2003 – 2004• Reviewed disease management statistics specific to physicians and assisted them in improving pay for performance and developing clinical workflows to meet standards of care

• Developed medical, rehabilitation, and vocational individual plans for a case load of 30 clients monthly• Negotiated services’ fees, educational fees, and health related fees for clients• Developed Life Care Plans for catastrophic injuries• Marketed services and obtained multiple contracts leading to national contracts for the company

• Responsible for the overall operation of the Anesthesia based Pain Program in the hospital, integrating a private Neurology practice with the hospital program to complete a multidisciplinary approach for pain patients.• Providing State mandated rehabilitation services for the patients, physicians, and referral sources. • Responsible for day to day operations of clinics to include projected capital budgets physician recruiting, marketing, staffing, payroll, patient relations, and clinic education.

Bsn, Bachelor Of Science In Nursing

Ma, Health Care Administration