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Most recently, Nick was responsible for leading the strategy & development of Elevance’s new Medicaid Value-Based Payment (VBP) programs. He was specifically focused on developing programs for Medicaid Specialty populations (Behavioral Health, LTSS, Foster Care) and he led the development of Elevance's Social Drivers of Health Provider Incentive Program (SDOHPIP). Additionally, Nick's leadership helped to incorporate the first health equity-related incentive measure into a VBP program. Nick obtained broad operational experience working as a Principal Consultant and as the AVP of Health Plan Operations and Plan Compliance Officer for the Nevada Medicaid Health Plan. As Senior Manager on the Operational Excellence Team, Nick was certified by Juran as a Six Sigma Black Belt following the completion of his project which resulted in a 34% reduction in authorization-related, pended claims. Also in this role, Nick trained hundreds of managers and senior leaders in Six Sigma.Prior to joining Amerigroup in 2006, Nick worked for Northrop Grumman at Newport News Shipbuilding as an Operations Coordinator, forecasting labor for the Supply Chain Management division consisting of approximately 750 employees. In this role, Nick received a Model of Excellence award for his contributions on the USS Eisenhower Material Finance Team which contributed $8M of increased profit. In addition, Nick was a General Manager in his family’s 13,000 sq. ft. restaurant, bar, deli and banquet facility.Over his career, Nick has proven to be an execution-oriented, collaborative and data-driven leader with a diverse background in payment innovation, operations, data analytics, change management, training, and performance improvement roles. In 2014, Nick was selected as a participant in WellPoint’s Emerging Leaders Program.Nick earned his B.S. in Business Information Technology from Virginia Tech and earned his MBA from the College of William and Mary. He received his PMP certification from PMI in 2014. Nick resides in Virginia Beach with his wife, Ashley, and 3 kids.
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Network Development DirectorElevance Health Dec 2015 - Oct 2023Virginia Beach, Virginia, United StatesLed the strategy & design of new Medicaid Value Based Payment (VBP) Programs spanning 20 markets, 200+ participating provider groups, representing approximately 5.8M attributed members, and totaling over $4M in annual provider incentive payouts. Led the design of our Social Drivers of Health Provider Incentive Program (SDOHPIP) which has been deployed in virtually all Medicaid markets. Designed the following Behavioral Health (BH) focused VBP Programs: BH Inpatient Facility Incentive Program, Pediatric Residential Treatment Quality Incentive Program, Substance Use Disorder Facility Incentive Program, BH Emergency Department Incentive Program. Incorporated health equity-related incentive measures (focused on improving racial disparities in health outcomes) in multiple Medicaid VBP Programs. Managed cross-functional incentive program design teams consisting of Medical Directors, Health Plan Leadership, Clinical Quality, Provider Solutions, Business Development, and Healthcare Analytics. Managed 1 Program Manager (indirectly). Enlisted to give performance feedback annually for 6 associates on Payment Innovation Team. Developed the infrastructure and process for an oversight and governance committee for our Medicaid VBP Programs. -
Principal ConsultantAnthem, Inc. Jan 2012 - Dec 2015Virginia Beach, VaLed a wide variety of business improvement projects across the enterprise including: Long Term Services and Supports Optimization, Pharmacy Authorizations Future-State, Pharmacy End-to-End Benefit Improvement, Dual Demonstrations Program Design, and Health Homes Best Practice Model. -
Associate Vice President - Health Plan Operations NevadaAmerigroup Corporation Dec 2008 - Jan 2012Partnered with Implementation department to stand up local Operations in Las Vegas and Reno. Supported NV Executive Staff to ensure that key corporate initiatives are met. Ensured that all corporate operational areas were supporting and meeting the needs of the NV Health Plan. Developed and maintained the NV Operations Dashboard showing key performance indicators. Resolved complex provider claim payment issues. Responsible for the timely creation and submission of numerous NV DHCFP regulatory and ad-hoc reports. Initiated and managed all NV claim underpayment projects. Established NV Internal Resolution Unit as part of the New Provider Experience. Managed and trained 3 Provider Claim Resolution Reps. -
Senior Manager - Operational ExcellenceAmerigroup Jul 2006 - Dec 2008Partnered with my manager in developing the Six Sigma Program for AGP. Developed the materials, and trained over 700 Managers across AGP in OPEX / Six Sigma Training. Led a Black Belt Project which resulted in a 34% reduction in authorization-related pended claims. Developed, documented formal Policies and Procedures for NY Long Term Care Plan, which resulted in $12M in cost avoidance. Executed claims testing in a Facets Development Environment, which is projected to increase claims auto-adjudication, reduce unnecessary work in Claims, and dramatically increase claim to auth matching accuracy. Mentored several Black Belts and Green Belts in various departments. Developed Fax Authorization Productivity and Turnaround Time metrics for the National Contact Center. Well-versed in all Authorization processes, Auth-Related Pended Claims Resolution process, Facets Claim / Auth matching logic. Developed and trained Black and Green Belts on using Excel for data analysis.
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Operations CoordinatorNorthrop Grumman 2004 - 2006Analyzed, estimated, forecasted, and progressed labor for the Supply Chain Management (SCM) division consisting of approx. 750 employees. Identified numerous cost savings and synergy opportunities through a Material Requirements Summary Report. Created Priority Purchase Order agendas utilizing Microsoft Access and COGNOS Impromptu, linking multiple shipyard systems to support material procurement for Overhaul Programs. Partnered with Engineering and IT to remove duplicate demand, ensuring MRP accuracy. Monitored material availability on Aircraft Carrier Overhaul contracts. Team Leader of a Greenbelt Project for the pricing and estimating of vendor technical representative services. Developed Supply Chain Management Labor Proposal for the Accomplishment Contract on the USS Carl Vinson and the USS Toledo. Established a Labor Progressing Methodology for SCM. Nominated for a Model of Excellence Award for my contributions on the USS Eisenhower Material Finance Team who contributed to the $8M of increased material profit. Worked closely with management on process improvement projects and cost savings initiatives, in and outside of Greenbelt teams, crossing all Programs and numerous functions in the organization. Responsible for managing and analyzing SCM’s performance to the $126M material budget on the USS Carl Vinson. -
General ManagerUncle Louie'S Restaurant / Bar / Delicatessen Jun 1994 - Aug 2003Managed and scheduled 40 front of the house employees in a 13,000 sf. restaurant, bar, delicatessen and banquet facility. Trained service staff resulting in improved service quality contributing to a 20% increase in revenues for the summer season. Developed performance evaluation system resulting in a 50% increase in employee retention. Enhanced customer relations; resolved conflicts among staff, customers, which produced increased staff productivity and overall customer satisfaction. Designed company website allowing users to place takeout orders, leave feedback, and view pictures of the store providing the business with an additional revenue stream while providing customers increased convenience and information.
Nick Eisenberg Skills
Nick Eisenberg Education Details
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Business Information Technology -
Business Information Technology
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High School Diploma -
Business Information Technology
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Business Information Technology
Frequently Asked Questions about Nick Eisenberg
What is Nick Eisenberg's role at the current company?
Nick Eisenberg's current role is Medicaid Value Based Care Innovator | Healthcare Operations | Management Consulting | SDOH SME | MBA | Six Sigma Black Belt.
What is Nick Eisenberg's email address?
Nick Eisenberg's email address is ni****@****hem.com
What is Nick Eisenberg's direct phone number?
Nick Eisenberg's direct phone number is +175734*****
What schools did Nick Eisenberg attend?
Nick Eisenberg attended The College Of William And Mary - The Mason School Of Business, Virginia Tech - Pamplin College Of Business, Virginia Tech - Pamplin College Of Business, Norfolk Collegiate, Virginia Tech - Pamplin College Of Business, Virginia Tech - Pamplin College Of Business.
What are some of Nick Eisenberg's interests?
Nick Eisenberg has interest in Panera Bread, New York City, Bachelor Parties, Health, Virginia Tech Hokies, Children, Education, Environment, Waffle House, Science And Technology.
What skills is Nick Eisenberg known for?
Nick Eisenberg has skills like Process Improvement, Six Sigma, Program Management, Leadership, Business Process Improvement, Management, Data Analysis, Analysis, Project Management, Strategic Planning, Supply Chain Management, Healthcare.
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3kumc.edu, slu.edu, us.af.mil1 +191378XXXXX
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