• Led a 40-person team responsible for clinical programs for multi payor global risk (75K members) and value-based contracts (>150K members) in New York (NY) and New Jersey (NJ).• Worked with Data Analytics and Quality partners to define program metrics, create a prototype staff productivity model and operational/payor reporting for all clinical programs. Advanced staffing model.• Improved backlog for the low-risk transition program in NY from allowing providers to bill for post hospital visits, improvement of quality scores for Timely Follow Up (TFU) and readmissions. Increased 7-day and 14-day PCP follow up visits.• Successfully moved local clinical programs from the legacy platform (Arcadia) to the enterprise platform (Curo). Tested data (ADT) feeds to ensure accurate identification of all in scope members.• Collaborated with Optum Health kidney program to improve ACO Reach engagement/reach rate.• Implemented National Affordability team initiatives (Emergency Room, Pharmacy) to reduce TCOC.• Developed reporting and conducted report outs to National Population Health Committee, Payors, CMS• Met with payors to review program performance against quality and Key Performance Indicators (KPI’s)• Implemented CMS required Social Determinants of Health (SDoH) screening and follow up program for ACO Reach (ACOR) population.

• Led team of Clinical Consultants and Project Managers responsible for end-to-end clinical implementation and program consultation in multiple regions. Aligned markets to standard clinical solutions and created cost effective/compliant non-standard programs.• Solved for the addition of NY and NJ value based (ACO/upside) contracts on standard platform.• Collaborated with several Optum national teams including Optum at Home (OAH) and National Affordability team. Supported partner relationships to ensure alignment with new and existing initiatives.• Gained consensus across matrixed stakeholders: Compliance, Regulatory Adherence, local affordability, CDO and Optum Care leadership) to ensure all payer, State, Federal and NCQA requirements were met.• Created Optum Market operational reporting with Enterprise Reporting & Analytics (ERA)

• Successfully implemented clinical programs and new contracts for Community & State business totaling 1.2 million Medicaid and Dual Special Needs Plan (DSNP) members living in AZ, CA and WA.• Designed and/or developed integrated medical/behavioral care management and state specific contractually required programs balancing regulatory requirements with financial and clinical outcomes.• Regular review of actual to target program metrics with Health Plan to drive value and performance.

• Developed and supported identification and stratification process including product specifications, exclusions and variations to ensure appropriate members were managed• Developed business case, communication, training and implementation for an automated ID strat using eVisor

• Evaluated new enterprise affordability proposals for deployment• Analyzed clinical data, utilization and cost trends to support program implementation • Communicated findings and shared recommendations across enterprise wide matrix partners• Successfully deployed two large prior authorization initiatives across multiple lines of business with over $10 million in annual savings.• Developed new cost saving clinical programs using evidence-based guidelines to drive improved outcomes

• Lead the development of policies and standards to ensure consistent and effective clinical messaging• Drove strategic development and review of member facing clinical collateral across M&R clinical programs• Created a standardized preventive messaging platform to support HEDIS/STARS gap closure,regulatory requirements and member engagement initiatives • Developed/implemented enterprise-wide fulfillment ordering system driving increased access to documents, consistency in program content and better pricing• Created a cross segment policy and process that leveraged a best practice for website approval ensuring compliance with Corporate copyright initiatives/guidelines

Managed a caseload of low income dual eligible (DSNP) members and completed required documentation and processes.Provided fiscal oversight by keeping member costs under case mix cap and by analyzing cost effective alternatives. Advocated to assist member preventative care to address gaps in care Negotiated Customized Living service package pricing.

Progressive experience within Allina organization:- Select Care/Medica, Manager, Provider Relations, 1993 - 1996- Health One, Contract Manager, Managed Care Division - 1993- 1996

Concurrent Review Nurse - 1986 - 1989Clinical Analyst, Claims Audit and Fee Review, Medical Directors Office - 1989-1990