Senior Healthcare Operations Management ExecutiveA seasoned and accomplished administrator with significant leadership contributions in nursing, clinical operations, insurance, and healthcare technology. Known for exhibiting a collaborative approach and as a strong leader who can adapt to various working environments, from start-ups to corporate settings. A resourceful healthcare leader able to communicate across all levels who can add value by:• Working with senior leaders to implement strategic vision and objectives with firsthand experience in funding, initial setup, developing partnerships, and executing market-entry strategies.• Building robust clinical teams, efficiently delivering high-quality care, tackling new challenges, proposing innovative solutions, and generating significant, impactful results. • Merging clinical and technology insights to address challenges, enhance efficiencies, and improve quality outcomes.AREAS OF EXPERTISEHealthcare Strategy, C-Level Decision Support, Operations Management, Clinical Services Administration, Financial Management, Business Process Reengineering, Call Center Management, Change Management, Database Design & Management, Government Programs, Strategic Roadmaps, Team Leadership, System Development/ImplementationEDUCATION | CERTIFICATIONS | INDUSTRY ACUMENDEGREES: Bachelor of Science (BS) Nursing, DeSales University-Allentown, PA; Nursing Excellence Award for the highest GPA in graduating classCERTIFICATIONS: Critical Care Registered Nurse (CCRN); Hershey Medical Center Trauma Certified PROFESSIONAL MEMBERSHIPS: Sigma Theta Tau, nursing honor societyKNOWLEDGE OF OTHER BUSINESS CULTURES: Worked with offshore call center resources from India and clients based in Puerto Rico.INDUSTRY INSIGHTS: Management Consulting, Call Centers, Elderly Care Services, Medical & Surgical Hospitals, Insurance, Medical Devices & Equipment, Mobile App Development, Healthcare Software717-816-4718| ldonovan0706@icloud.com
Pennsylvania Employee Benefit Trust Fund
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Chief Operating OfficerPennsylvania Employee Benefit Trust Fund May 2022 - PresentHarrisburg, Pennsylvania, United StatesSteer a broad scope of operations, integrating everything from customer service to mailroom services under a unified management strategy. Cultivate and maintain relationships with providers and vendors, ensuring seamless collaboration. Align operational activities with strategic plans and manage the annual budget, focusing on delivering value while optimizing resources.
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Vice President Medical ManagementCapital Blue Cross Feb 2016 - May 2022Harrisburg, PennsylvaniaVice President Medical Management Feb 2016-Apr 2022Provided leadership in medical management, overseeing various functions. Directed initiatives targeting medical trends and quality, established development roadmaps, and managed budgets and resource allocation. Executed strategic initiatives to showcase exceptional service, ROI, and quality improvements. Led a diverse utilization management committee, including external providers, vendors, and internal staff. Managed seven direct and 203 indirect reports.KEY FUNCTIONS & SKILLS: utilization management, capacity planning, health administration, policy, quality, strategic planning, billing, customer service, care management, medical trends assessment, medical procedure, program management, corporate coding, prior authorization, concurrent review, medical claims, operational strategy, patient care, complianceSELECT ACHIEVEMENTS• Generated savings of $8M and $13.45M in the first two years by targeting the high musculoskeletal spending and implementing a specialized musculoskeletal program - a first in Central Pennsylvania.• Elevated the medical management team to the highest employee satisfaction and engagement rank within two years through strategic leadership revamping and employee development initiatives.• Saved $5.3M one year post-implementation by successfully introducing a new medical management system after previous failed attempts, using an effective change management strategy later adopted for other large-scale IT projects within the organization.• Reclaimed $4.37M and improved provider satisfaction through agile utilization management by dynamically adjusting ICD codes requiring prior authorization and optimizing staffing resources.• Realized $8.27M in cost reductions over two years by strategically managing the site of service and implementing prior authorization for medical specialty injectables. -
Vice President Clinical ProgramsSeniorlink/Vayu Technologies Jan 2015 - Feb 2016Boston, Massachusetts, United StatesVice President Clinical Solutions Jan 2015-Feb 2016Orchestrated the development of a market-ready member/caregiver support tool intended for sale to health plans. Assembled a proficient team to facilitate application development and management while establishing essential processes and procedures for effective implementation. Managed five direct reports.KEY FUNCTIONS & SKILLS: product design, product management, clinical program development, business development, client implementation, digital health, clinical operations, clinical care, care delivery, client services, executive leadership support, claims management, provider relations, clinical experience, insurance experienceSELECT ACHIEVEMENTS• Led the successful deployment of the SeniorLink mobile app, enhancing communication among caregivers and health providers, thus enabling its marketing to healthcare plans.• Advanced the development of AI for the SeniorLink app to enhance senior caregiver communication, reaching the final testing phase for the initial release trial.
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Clear Coverage Implementation Services Project DirectorMckesson Health Solutions Sep 2011 - Jan 2015Boston, MaDirector Implementation Services | Consultant Oct 2011-Jan 2015Established and led a multi-disciplinary implementation team overseeing various services. Contributed to sales strategy, implementation, executive communication, product management, and application development planning. Managed 35 direct reports.KEY FUNCTIONS & SKILLS: product management, strategic account management, workflow optimization, accreditation compliance, vendor relations, account support, turnaround timeframes, accreditation standardization, business operations, application development planning, team structure and developmentSELECT ACHIEVEMENTS• Created a scalable model for McKesson's Clear Coverage software, resolving client issues and leading successful implementations, driving new business, including multi-state and national accounts.• Secured major clients for Clear Coverage, including Fortune 500's Molina Healthcare and various Blue Cross plans, leveraging improved processes and proven ROI.• Reduced implementation time by approximately 35 days, enhancing efficiency and eliminating redundancy through system improvements to Clear Coverage. -
Chief Nursing OfficerMedsentry Mar 2011 - 2014Boston, MaCofounder | Chief Nursing Officer Feb 2011-Feb 2014Cofounded a company that innovated medication monitoring technology for improved accuracy and daily compliance. Served as the subject matter expert (SME) in product development, creating a functional product ready for clinical trial. Spearheaded the development of clinical support services to complement the medication monitoring device. Managed five direct reports.KEY FUNCTIONS & SKILLS: product design and development, development of the program’s clinical content creation, service management and oversight, account management, implementation, executive communications, preventive care, financial objectives, startup environment, customer service, call center development and operationsSELECT ACHIEVEMENTS• Facilitated presentation to large-scale provider network to secure a first clinical trial for new technology. • Secured patent for the MedSentry Device, a medication adherence device; built and led clinical support services for the trial phase. • Provided clinical input for product development, build, and testing, resulting in a functional product for the clinical trial.
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Contract ConsultingIndpendent Healthcare Consultant Oct 2010 - Oct 2011Software Development Contractor | Game Show Network Oct 2010-Oct 2011Engaged in developing innovative gaming software intended to enhance healthcare outcomes among low-income pregnant individuals by fostering consistent clinic visits, advancing health literacy, and promoting effective communication via an interactive gaming platform. The application was successfully introduced for pilot testing among a select demographic via a collaboration with Northeastern University in Boston.Implementation Services Director | CaseNET Jul 2008-Oct 2010Oversaw the implementation team for Medical Management Software, ensuring project success. Facilitated executive-level communications between sales and implementation teams. Contributed significantly to product innovation and development while managing key client accounts and ensuring customer satisfaction. Led RFP responses, designed strategic programs, developed efficient workflows, and operated business processes. Managed ten direct reports.Director Medical Management | Pennsylvania Health & Wellness Jun 2004-Feb 2008Directed medical management services, including utilization and care management. Led the RFP process for the Medical Management Application, ensuring careful selection and acquisition. Oversaw the complete system implementation, guaranteeing a successful roll-out and transition. Managed up to 76 direct reports.KEY FUNCTIONS & SKILLS: contract management, data gathering, quality measurer, healthcare software development, care management, RFP process, system implementation, national teams management, policy & procedures, criteria development, reporting and state-specific requirements, workflow development, compliance, sales, product development
Lori Donovan Education Details
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Registered Nursing/Registered Nurse
Frequently Asked Questions about Lori Donovan
What company does Lori Donovan work for?
Lori Donovan works for Pennsylvania Employee Benefit Trust Fund
What is Lori Donovan's role at the current company?
Lori Donovan's current role is Hands-on Accomplished Senior Healthcare Operations Executive/Leadership Experience in Nursing, Clinical Operations, Healthcare Insurance & Healthcare Technology.
What schools did Lori Donovan attend?
Lori Donovan attended Desales University.
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Lori Donovan
Columbus, Nj4yahoo.com, medimedia.com, yahoo.com, navisyncllc.com1 +160929XXXXX
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3donovanreporting.com, donovanreporting.com, gmail.com2 +177049XXXXX
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Lori Donovan
Associate Director Of External Engagement - University Of Michigan, School Of InformationAnn Arbor, Mi2archive.org, gmail.com3 +120840XXXXX
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