Shane J. Email & Phone Number

Washington, Dc, Us

United States

Strategic director of day to day operations to support Specialty Drug Launches.

Silver Spring, Maryland, United States

Mr. Shane Johnson is the Senior Director of Health Policy Analytics at TD&P Consulting, Inc. (TD&P). He has broad clinical experience and an extensive background in case management and FDA policy. Over his career, Mr. Johnson has developed a reputation as a thought leader and advocate in the District of Columbia’s Medicaid, insurance, and HIV/AIDS community.Prior to joining TD&P, Mr. Johnson worked with Vertex Pharmaceuticals and AmeriSource Bergen, as a Senior Reimbursement Case Manager. In this role, he worked with patients, healthcare providers, and insurance companies to determine the benefits and coverage for specialty medications treating rare genetic disorders. Mr. Johnson’s breadth of knowledge regarding payer systems and the reimbursement of specialty pharmaceuticals has established him as a leading subject matter expert for co-pay assistance programs, home-infusion therapy benefits, and benefits coordination for Medicare/Medicaid dual-eligible persons. Mr. Johnson holds an Associate Degree of Applied Science in Nursing from the University of the District of Columbia, and a Bachelor of Science Degree in Biology from Georgia State University. He is also an alumnus of the National Institutes of Health’s Intramural Training and Research Award Program where he completed a training fellowship with the National Institute for Nursing Research. In 2017, Mr. Johnson was appointed Chairperson of the University of the District of Columbia AASN Advisory Committee. In that capacity, he works with Nursing Faculty to improve the quality of Nursing Education in the UDC system. Mr. Johnson lives in Washington, DC.

I was promoted! My work duties have not changed, but I have the added responsibilities of legal project management for our consultation services.

Responsible for managing and directing the organization's valuation of healthcare delivery services based on Federal, State, and Local standards regulating Utilization Review. Research costs of care associated with catastrophic personal injury cases (medical malpractice/negligence, products liability, and on the job injuries)Conduct a thorough review of all medical records and Life Care Plans to ensure that medically necessary items are covered by various health care systems/programsKeep abreast of changes to Commercial, Medicaid, and Medicare plans to provide analysis for calculating healthcare costs.Work collaboratively with leadership and staff to ensure that healthcare delivery and reimbursement analysis of Life Care Plans is supported by industry/best practice standards for utilization review, care coordination and progression, and quality healthcare outcomes.

Arlington, Va

Dynamic leader of a team of 10 supervisors, approximately 50 Support Brokers, and 10 Administrative Coordinators to successfully manage 1,383 participants, 3,563 participant directed workers, and coordinate financial management services (FMS)/fiscal employer agent (FEA) services for Self-Dierected Medicaid eligible elderly and disabled clients with an annual budget over $60,000,000.00Implement policies and procedures to increase sustained compliance with 21 Century Cures Act key performance indicators (Electronic Visit Verification, Audit Compliance, Program Integrity) thus increasing compliance with Electronic Visit Verification by 300% and taking a program from 0.2% compliance to 97% compliance in 4 monthsEvaluate support brokers and administrative staff regarding work performance including pulling performance reports, data analysis, and having weekly individual coaching sessions to foster professional developmentDemonstrate keen understanding of CMS, State, and Local rules and regulations governing Medicaid and Medicaid Waiver Programs to mitigate waste, fraud, and abuse/misuseServe as the lead liaison for Patient Advocacy, Client Escalations, between External and Internal DepartmentsCollaborate with other departments and contractors to successfully complete projects for the DC Department of Health Care FinanceCollect and analyze territory score cards, dashboards, and other key performance indicators including customer satisfaction, for contract management and improved process workflowCreate training materials to educate Beneficiaries, Case Managers, Providers, Payers and other Community stakeholdersSuccessfully onboarded United Healthcare DSNPs Program for Medicaid Waiver eligible beneficiaries interested in self-directionConduct advance reimbursement research to resolve complex claims adjudication, compensation analytics, prior authorization, and recertification escalations

Rockville, Md

Provided advanced reimbursement support, case management, advanced payer and reimbursement research.Conducted comprehensive insurance verifications for complex infusion therapies that treat genetic lysosomal storage disorders (LSD and HAE) and Cystic Fibrosis.Tracked industry trends and changes among payers, clients, competitors, and government agencies to ensure that patients experienced no lapses in treatment. Operated as an subject matter expert in Benefit Investigations for Medicaid MCO/HMO plans. Determined eligibility for enrollment in Patient Assistance Programs and Co-pay Assistance programs to ensure that patients do not interrupt therapy for cost prohibitive issues.Communicated with Payers, Clinicians, and Pharmacy personnel regarding benefit coverage structures.Exercised independent judgment in methods, techniques and evaluation criteria for obtaining results. Trained and coached newer or inexperienced Reimbursement Case Managers.Performed related duties as assigned.

Washington, Dc

- Performed care coordination for Medicaid members with acute, complex and chronic care needs, with an emphasis on the Nursing Process, CMSA standards, NCQA, and HEDIS quality measures- Worked with the Utilization Review, Pharmacy, and Member Services departments to assess members and determine eligibility for case management/disease management programs- Developed care plans designed to optimize members’ health and wellness, with an emphasis on self-management- Worked in partnership with members and healthcare teams to develop and implement successful treatment plans- Monitored care plans to ensure compliance and effectiveness in achieving treatment goal outcomes- Created and implemented screening tools to assess members’ level of acuity- Utilized Interqual criteria, current Evidence Based Practice research, and Best Practice Models to determine medical necessity for procedures and DME.

I was President of the UDC - CC Student Government Association, a HRSA NurseCorps Scholar, a NIH CCSEP Summer Research Fellow, A Kaiser Permanente Health Opportunity Scholar, a SDS Opportunity Scholar, and a Freedmen Foundation Scholar. Most important, is that I am a civic-minded, active, informed, and engaged voter and citizen of the District of Columbia.

Created focused presentations on HIV/AIDS risk, provide administrative support to PI, created HIV testing and outreach events.

Washington D.C. Metro Area

Served as the primary liaison among consumers, case managers, housing coordinators, and government officials Monitored, evaluated, and audited housing programs that received awards through the HUD SuperNOFA competition to ensure programmatic and fiscal compliance with local and federal regulations Coordinated and implemented programmatic initiatives for the 4.2 million dollar, Shelter Plus Care (S+C) , permanent housing program for former chronically homeless individuals and families living with severe disabling conditions such as Mental Illness, Chronic Substance Abuse, or AIDS Provided technical assistance and subject matter expertise to program and sponsoring agency staff regarding updates to federal regulations governing the program Conducted Federal Housing Quality Standards unit inspections on an annual basis to ensure federal housing quality standards are maintained Successfully transitioned approximately 1100 homeless families and individuals from emergency shelters to transitional or scattered site, community-based housing between 2009 and 2011 Created Contract Compliance Review Instrument implemented throughout the DC Continuum of Care

Performed comprehensive biopsychosocial needs assessment for each client to determine eligibility for community, medical, and housing resources In conjunction with Clinical Supervisor and clients, developed client-focused action plans for self-management, life skills building, and self-empowerment, emphasizing a strengths-based social work approach Provided emotional, mental, and crisis intervention support Completed monthly, quarterly, and annual programmatic reports to include consumer demographics, reimbursement expenses, and progress narrative Coordinated and administered programmatic deliverables for a facility-based HOPWA transitional housing project that served 12 unduplicated clients in an operating year

•Suggested and coordinated services required for successful action plan implementation•Followed-up with clients for plan evaluation and modification as necessary•Authored paper addressing the healthcare needs of homeless persons living with terminal illnesses•Provided emotional, social, and physical support to hospice/palliative care clients and their families•Raised $20,000 for local HIV/AIDS organizations through direct solicitation and charitable event planning