Chief Clinical Officer
Current• Operates as an active and hands-on member of the leadership team to plan and execute adjustments to the clinical delivery model and operations to meet changing needs• Works with the leadership team to set utilization goals, operational and quality metrics. Oversees achievement of these metrics• Participates in the development of budgets, staffing plans, clinical loss ratio projections, and assuring the adequate allocation of resources to clinical management functions• Develops clinical programs and drives quality improvement efforts. Provides leadership, direction, and administration of clinical operations to ensure compliance with company objectives• Builds and maintains positive relationships with operational counterparts• Leads in areas of utilization management, clinical quality improvement, case management, provider relations, concurrent review, and disease management• Implements and monitors structures and processes which are measurable. Initiates process improvements as needed to meet financial, operational, and quality goals• Built and assumed direct responsibility for key high performing leadership departments responsible for executing on the organization’s mission including the following departments: o Learning and Developmento Compliance/Qualityo Payer Relations, o Utilization review• Develop and created a CMS compliance program to support the growth of the organization• Serving as the communication leader of the organization with payers and external stakeholders resulting in the obtainment of 15 in-network contracts and Medicare enrollment across 12 clinics.