Collaborate with executive leaders to develop and drive operational and clinical strategy. Drives action by ensuring availability of lead and lag reports. Identifies process improvement, reporting, analysis and automation opportunities, partner with corporate on technology needs and pilots, and lead the development of various initiatives and outcome measures. Current oversight of 140 employees in business and data analytics, process improvement, project management, operational auditing, credentialing, enrollment/eligibility, provider terminations, and member complaints and escalations.

Responsible for operational performance improvement including the following departments: business analytics / process improvement, data analytics, operational auditing, and operational training.

Responsibilities included treatment and clinical record reviews, continuous quality improvement, quality of care concerns process, complaints and grievances, development of annual QI program description, work plan and QI/UM evaluation, performance improvement projects, accreditation, and policy, procedure and workflow development.

- Conduct barrier analysis, track interventions and manage the in depth analytical review of each program’s effectiveness.- Develop performance goals related to performance improvement programs, member incentives, HEDIS, and Health Plan clinical programs and interventions. Measure performance against these goals. - Direct the senior clinical team in the development and implementation of sound interventions to address each product’s needs. - Identify and development of needed member interventions to improve HEDIS measures for all products.- Manage external quality audits, performance improvement activities, and related reporting requirements for the various products and their respective government agencies. This includes performance improvement projects, work plans, and the SNP Model of Care and Quality Improvement Program development and analysis.

- Served as primary information resource for the internal Medicaid analytical staff.- Developed and maintained detailed project plans, this included utilizing standard project documentation and methodology and project tracking and reporting procedures.- Developed and implemented cross-functional and change management strategies, ensuring that all of the participating parties have committed to effective implementation of the processes and procedures.- Developed and implemented key metrics to measure trends and process improvement opportunities across departments within Medicaid.- Coordinated and analyzed Medicaid performance against operating budget goals by performing cost/benefit analysis. Provided analysis and outcomes to management.

- Managed comprehensive analysis of data and information for the Medicaid and SNP products. Responsible for the identification, documentation, and communication of the project outcomes by providing an executive summary.