Michael M. Email & Phone Number

United States

Managed a team of 5 Program Analysts•Oversaw the delivery of Network Standard Reporting for Pharmacy Listings, Geo Access Analysis, Network Disruptions•Maintained oversight of compliance reporting and network adequacy utilizing CMS Standards, and meeting Performance Guarantee Measures•Enhanced productivity by looking for process improvements with Standard Flows in an Alteryx environment•Developed macro language processing for internal programs in a Microsoft environments•Developed Salesforce reporting and dashboards to monitor utilization and request intakes •Developed base standard DTP process documentation for 98 process flows used on monthly, quarterly or annual bases•Provided Quality assurance on daily intake of standard network tickets and adhoc for contracting, legal and compliance, network management•Worked with senior leadership to identify roadblocks, process enhancements, strategy and clear vision•Worked with team to migrate from a SAS base data environment to Google Cloud Platform (GCP) for all process•Developed initial product framework for the Network Management team

Eden Prairie, Minnesota, United States

•Oversaw program analytics including optum behavorial health and member profiling, leading to an 16% increase in engagement targets•Responsible for estimating, managing and coordinating requirements for large, high-visibility cross-segment programs, including resource estimating and forecasting•Worked on high-visibility national projects•Managed a team of Sr Business Analysts and Program Analyst•Resource allocation and estimates•Working with Business Team to measure satisfaction•Coordinated overall program direction in conjunction with EPMO Team and Senior Leadership•Oversaw projects involving external payer clients•Facilitate cross-departmental forum to share project information in order to build consensus on business priorities•Perform cost-benefit analyses, including dimensioning benefit realization plans and cost estimates•Secure technical resources for project completion and negotiate delivery dates•Work extensively with the business to define current processes, desired improvements and detailed requirements •Conduct Joint Application Design (JAD) sessions, uniting business and technical resources•Field questions during design process, review technical design for completeness, and track all development dates•Ensure business preparedness; track completion of operational documentation•Track delivery milestones and facilitate cross-departmental deployment communications•Document project details, including financials, for business sponsors and senior management•Partnered with Health Care Economics teams to develop reporting KPIs prior to product development to allow for improved directional product development•Drive product strategy for building data products for Payer and Provider. •Drive Data Governance & Stewardship functions to protect client for Data Usage & Rights (DUR), Data obligation and Data retention policies & procedure.

Eden Prairie, Minnesota

Manage a team of 15+ individuals that provide data analysis, research and reporting metrics. •Part of the OptumHealth Population Health Management team. The team is designing new programs, interventions, reporting capabilities, and evaluation techniques based on member individual needs.• Help manage the $100 million population health program for AARP Medsupp members.•Leveraged the “Propensity to Succeed” predictive modeling that identifies member characteristics associated with success (quality of care, return on investment, and quality of life) in each of the health management programs offered by OptumHealth.•Strive to move away from the traditional clinical model to more holistic approach incorporating behavioral and social determinants of health that may have a greater impact on older adults’ health and well-being.•Evaluate and enhance health management programs for other UHG internal customers (e.g. OptumHealth, UnitedHealth Care, Optum Rx, Medicare & Retirement, and Community & State), large external employers (e.g. Pfizer, PSEG, and Dell), and other external health management vendors (e.g. StayWell, Silver Sneakers, MDViP, and HealthCore).•Supervise a health services research team that supports clinical teams at UHG who are developing new disease management, high risk case management, depression management, and associated pharmaco-compliance programs for AARP members. The ultimate goal is to improve health care delivery and outcomes for AARP members, and to enhance public policies that will have an impact on AARP members.

Eden Prairie, Minnesota, United States

Manage a team of individuals that provided data analysis, research and reporting metrics. Worked and shared results of data analysis with internal business partners, vendors, and government contracts. Managing oversight of all KIR, ROI and predictive Analytics. Review and edit manuscripts around clinical data needs.•Managed $200M ancillary benefit line-of-business for approximately 4.4M national membership, including operational performance, competitive intelligence, strategic planning, financial oversight, vendor contracting and client management.•Oversaw development of wellness programs for employer space (approximately 26M members), including tobacco cessation, wellness coaching, Employee Assistance Plan (EAP), biometric screening and annual flu shots.•Oversaw development of clinical (MSK and Diabetes-focused) programs for Medicaid, Medicare and Employer markets.•Responsible for estimating, managing and coordinating requirements for large, high-visibility cross-segment programs, including resource estimating and forecasting.•Facilitate cross-departmental forum to share project information in order to build consensus on business priorities,•Development and implementation of creative strategies•Integrated member-level and operational data store for all products offered by program, allowing for deep-dive analytics surrounding member-, product-, and market-level engagement trends•Coordinated Senior Leadership and Client (AARP) meetings to ensure alignment across all channels in anticipation and support of Medicare open enrollment and strategic initiatives•In coordination with internal and external (vendor) stakeholders, developed product scoring methodology, resulting in:o$40M in annual savingso27% YOY increase in engagemento12% YOY increase in member satisfaction

Eden Prairie, Minnesota, United States

Working directly with both internal and external clients to focus on analytical needs around numerous Healthcare metrics.•Oversaw day-to-day execution of creative deliverables and acted as client-agency liaison of data analytics and reporting solutions•Accomplished professional with a broad range of experience developing complex programs and managing projects through the entire life cycle•Plan and manage multiple complex project plans to ensure that initiatives stay on course and are delivered on time and meet customer expectations•Support Payment Integrity, Risk Adjustment, Quality Gaps and Care management business Analytics and Reporting data domains.•Responsible for the Dara Release Governance (DRG) for the PHI, PII, HIPPA and Employee Claim data. Build SFTP and data Encryption mythology for the secure data transfer between client and vendor•Provided Project Management function to support development and testing work•Led Configuration Management, Change Control, Test Case Development, and Testing Execution

Eden Prairie, Minnesota, United States

Working for optum as SAS programmer. High level litigation and behavior health analysis. Primarily adhoc work focusing on multiple projects at given time. Creating customized detailing reporting use Healthcare claims and clinical data.•use BASE SAS and SAS SQL in versions 9.3, 9.1 , and 8.0. to test and provide analytical reporting solutions•use SQL to read DB2 and Oracle data warehouses•perform regular and AdHoc claims reporting and data extraction•maintain ACCESS databases•Convert CMS excel data into DB2 compliant tables•Provided research and analysis for the Legal, Behavioral, State and Federal Governments, Medicaid, Medicare and Commercial insurers•Developed Desktop Scripts to execute batch SAS jobs•Program and report using SAS 9.4 on UNIX using EG, Reflections and Ultra Edit

Greater Minneapolis-St. Paul Area

Chemistry intern.

Bachelor Of Science (B.S.), Mathematics

Activities and Societies: Lacrosse Club

Bachelor Of Science (B.S.), Chemistry

Activities and Societies: Lacrosse Club