Consulting firm providing operational support for risk adjustment and quality operations to health plans, risk bearing Medicare Advantage, ACO, Medicaid physician groups. Services offerings include analytics, reporting, data submission, documentation education, coding and CDI services, assessment and retrospective program management.

Serve as Chair for doctoral students in the social & behavioral sciences. Certified and served as chief methodologist on the committees of doctoral students choosing mixed, quantitative and or qualitative paradigms – trained in all 3 methodologies.

Certified and served as chief methodologist on the committees of doctoral students (PhD, Ed.D) choosing mixed, quantitative and or qualitative paradigms – trained in all 3 methodologies. Promoted to University Research Reviewer, conducting oversight of the quality of committee work for the university.

Managed a division comprised of five departments and 57 reports, including (1) Risk Adjustment; (2) Quality, Population Health & Patient Experience; (3) Patient Assessments & Screenings & Physician Education; (4) Clinical Data Management & Analytics; (5) Clinical Oversight, including delegation reporting, compliance, appeals & grievance.• Led comprehensive COVID-19 Taskforce to address new challenges related to virus, including, testing sites, telemedicine implementation, new clinical practice initiatives and conversion to a remote workplace.• Implemented telehealth program to screen patients for needed wellness exams and quality improving revenue via increased documentation and closing of care gaps.• Sponsored and implemented new suspecting platform for risk, quality and social determinants of health improving revenue and fiscal integrity, including alignment of forecasting with total cost of care.• Implemented data reconciliation process recouping more than $50M in lost revenue as crisis remediation effort over a 2-month span.• Optimized Quality and Risk integration points driving improved quality and risk assessment scores.• Served as the strategy leader for new physician compensation model, including physician engagement.• Launched new PEP (Provider Education Programs) aimed at besting patient experience and provider performance.

Oversaw the Risk Division and owned end-to-end risk adjustment process, including the design of the annual coding program, all chart review (internal and 3rd party vendors), audits, physician education and compensation as well as suspecting and screening programs for Optum’s southern California region, including 16 IPAs and 5 acquisitions that included Quality & Risk performance.• Solved for and maximized profitability of all new acquisitions.• Managed a team of 8 direct reports and an overall department of 20 and engaged with other key internal and external stakeholders as the leader of risk.• Accumulated more than $950M in risk revenue with a network average RAF of 1.6. During tenure improved RAF by 20% and doubled IOI. • Business/process owner for risk adjustment.• Oversaw, coordinated, or performed data mining and data-driven analysis to forecast/evaluate the performance of the risk adjustment program and refine strategies to achieve optimal performance. • Oversaw physician performance and outreach, nurse practitioner embedded and clinical programs, and home assessments.• Managed and optimized the end-to-end risk adjustment processes and identify risks and opportunities associated with current processes.• Maintained management oversight of the coding department.• Aligned vendor management including contracting and management of assessment providers, chart review vendors, data analytics and successor risk adjustment tools.• Planned for and initiated recoupment and revenue maximization of all acquisitions.• Analyzed business process information to identify key issues, trends, and root causes (e.g., training issues; lack of understanding by user community) that point to improvement opportunities.• Designed annual risk adjustment programs including but not limited to physician outreach, physician education, goal setting, and forecasting.• Worked synergistically with Quality, 5 Star, HEDIS and P4P departments.

Commanded national Medical Management and Clinical programs and operations related to risk adjustment including provider programs, call centers, distribution houses, marketing, training, vendors, and vendor contracts, sales. P & L responsibility and posted earnings approaching $480M over a 350k membership base.• Established and managed national Medicare walk-in clinic operations for promoting annual assessments with business partners such as Take Care Health Systems.• Established and managed national in-home healthcare program for Medicare members; including the vetting, contracting & oversight of 3rd party health services vendors.• Identified, proposed and executed new strategies given market need, e.g., vascular identification programs, diabetes maintenance, and other health promotional incentive programs.• Leadership Development Discussion Group Facilitator. Designed, led and monitored the Enterprise Solutions Office’s leadership development cohort.

Taught classes in research and design, philosophy, critical theory & literacy

Created and managed wellness programs for businesses.