Michael Kovner Email & Phone Number

Plano, Texas, Us

- Tufts Health Plan (now Point32Health) - Completed projects as assigned including PBM migration from Caremark to OptumRx, Medicaid re-determination process, Payment Integrity initiatives, KPI dashboards and Call Center performance indicators. Led the Medicare Advantage 2022 annual open enrollment efforts. - Keck USC Medical Center - Led several implementations and upgrades of commercial products including a new consolidated patient billing statement and payment portal for the academic medical center’s three acute care hospitals and large medical group. - Entergy - Led a legacy mainframe “lift & shift” project for a regional Energy Sector company using TmaxSoft Open/Frame on Linux. Responsible for managing gated project budget and schedule, adherence to PMO policies, management of twenty contractors from six vendors and implementation of 3rd party software tools.

St Louis, Mo 63141, Mo, Us

Led a project team of solution architects, developers and technical analysts for an on-premise implementation of a Cloudera big data platform solution for BCBS of Massachusetts. Responsibilities included; project planning and budgeting, procurement, licensing, design and implementation oversight. Platform standup completed on schedule and on budget.

Led a project team of developers, business analysts and enrollment specialists to resolve data quality issues with the QNXT enrollment system. Conducted daily/weekly open issue production meetings that identified and resolved business-critical enrollment issues impacting members, claims and trading partners.

Dublin 2, Ie

Led several strategy engagements including the Accountable Care Organization (ACO) product strategy for a large national health plan, the Audit Strategy for the EHR Meaningful Use Incentive Payment Program for the Centers for Medicare and Medicaid (CMS), and the design of an Analytics Center of Excellence function for a large national hospital system.

Led the implementation of a Health Information Exchange (HIE) pilot project for two major hospital systems serving Central Florida. Managed three teams of developers using IHE/HL7 standards. Established policies for patient consent, patient matching, privacy and security.

Armonk, New York, Ny, Us

Led several IT strategy engagements with academic medical centers to design their biomedical informatics functions in support of the NIH Clinical and Translational Science Award (CTSA) program. Defined governance structure, service delivery model and core processes for biomedical informatics design, clinical trials management systems and pre/post award research administration.

Us

Completed the selection and implementation of the MEDecision case and disease management system and the CaseAlert® and D2Hawkeye® predictive modeling tools for a national third party administrator (TPA). Directed the evaluation and selection process and negotiated the contract on an ASP-basis. Wrote and managed the project plan. Managed a project team of employees, contractors and vendor installers. Completed project according to schedule and budget.

Us

Planned and executed a $14 million HIPAA- compliance project to upgrade the claims administration system for the largest Prescription Benefits Management (PBM) company in the industry. Managed a team of fifteen business analysts to synchronize the current system functionality with the vendor’s HIPAA-compliant release and migrate 30 million covered lives to this new release. Completed project according to schedule and budget.

Round Rock, Texas, Us

Closed two long-term outsourcing contracts including; a 7-year IT outsourcing agreement with a not-for-profit hospital system which saved the client over $5M annually and a 5-year claims; and IT outsourcing agreement with a 1M member health plan which resulted in the transition of 800+ employees with a savings of $10 million annually and significant improvements in quality and customer service.

Dallas, Texas, Us

I was a key member of the Corporate Information Technology leadership team that managed the systems portfolio for national acute care hospital system. Among my responsibilities was the decision support application portfolio. I designed severity-adjusted benchmark comparisons of performance measures (e.g. complications rates, length of stay and cost variations) and led several initiatives with clinical panels across multiple facilities to identify clinical best practices and potential cost and quality improvement opportunities.

Mha, Health Administration

Ba, Public Adminstration