• Oversee, inform, and enhance the ingestion and exporting of eligibility/financial data to upstream/downstream trading partners (vendors, data warehouses, integrated systems, etc.)• Reconcile data integrity issues and implement data handling procedures• Lead the business requirement definition for new business expansions and core administrative program migration to QNXT 6.0 from legacy system• Business owner of eligibility file data accuracy and timeliness processing for the entire health plan organization, spanning Medicare Advantage, Medicaid, Commercial Groups, and Individual products• Stand-up a new Eligibility CRM tool utilizing Salesforce and enhance existing QWE (Quoting/Web Enrollment) product to integrate seamlessly via web APIs to configure new groups in QNXT• Analyze and enable RPA solutions to reduce enrollment work queue volume and required resources• Support reorganization of the team and attract new talent to embrace a new operating model for eligibility and premium billing operations• Implement processing improvements by transitioning inbound data processing from a legacy platform to Edifecs and QConnect

• Guidepoint – Evolent Health – 8/2023• Stream Research – Value Based Care – 3/2023• proSapient – Clinical Administrative Solutions – 10/2022• Stax – B2B Data Integration – 9/2022• Optimum – Healthcare IT – 6/2022• proSapient – Care Management Vendors – 3/2022• proSapient – Orthopedic Health Solutions (Billing and Payors) – 2/2022• Tegus – Alignment Healthcare – 10/2021

• Build business cases and represent Enrollment Operations for cross functional resource allocation, budget, and supports in Health Plan Review Board meetings• Complete, implement, manage, and refine business processes to deliver expected business results. Anticipate market changes and consult with market growth teams on partner development.• Lead technical implementation team to stand-up new client operations and lead systems development initiatives with engineering support to create business solutions• Oversee and govern operational teams during post go-live implementations. Responsible for future production support as the result of efficiency benefits, regulatory changes, P&L, action plans, governance, and market shifts for 10 Evolent Health Services partners (health plans) spanning Medicare Advantage, Medicaid, IFP, and Commercial Group markets• Maintain a position of high visibility with executive operations, stakeholders, internal functional areas, and external entities (clients/partner administrators, health plan leaders, government regulators, SMEs, etc.) to promote transparency and collaboration towards shared business objectives with consistent communication, executive meetings, and development of custom reporting and dashboards• Spearhead and strategize for consumer growth initiatives in partner markets through innovative means in digital and print media, with compliance to state and/or federal regulations• Conduct a re-org of department to improve capability of cross-training teams for volume-based rebalancing of client work, and streamline interoperability of operational and technical teams• Accountable for creating highly specialized teams to stabilize operations and improve SLA/OLA/KPI performance. Engage with project management, product, and market operations teams to provide executive sponsorship and support• Resigned in 4/2022 to focus on personal health issues that have since been resolved

• As derived by membership populations, areas of risk, planned efficiency opportunities, contracted rates, anticipated revenue, and other factors, regularly design staffing models that are both cost and performance efficient• Follow best-practices in team management utilizing Lead-Six Sigma attributes and values to employ a successful governance strategy• Complete client and provider contract analysis to determine internal SLAs and KPIs for operational teams. Strategize for the most optimal and efficient operational performance.• Develop and embrace SMART inspired goals and objectives for org. management consisting of 10 teams; managers/ADs, ICs, and analysts• Design an Agile inspired backlog method to join operationally derived enhancement requests to improve quality outcomes, improved partner satisfaction, and quick returns on technical investments• Analyze capacity of leadership roles within org and align their responsibilities for new client implementations, large-scale projects, existing partner support, and potential disruptors• Monitor workload fluctuations and adjust staff assignments accordingly between onshore/offshore teams• Regularly track group/departmental costs, ensuring these are managed within budget. Employ cost containment measures while retaining quality and efficient operations and a productive, healthy work environment. Anticipate expenses and identify potential budgetary concerns.• Define roles and accountabilities for staff, within the group and in the context of the broader process/operation in support of cross-functional efforts.• Hire for, develop, and recognize the experience and knowledge/skills/abilities required for a successful team.

• Domain Technical Lead (DTL) for Enrollment Operations and Health Plan Implementation • Implement, manage, and refine business processes required to deliver expected business results.• Ensure the timely and accurate delivery and maintenance of new and existing enrollment data, including system set-up, cross-departmental communication, and exception reporting with proficient use of SQL.• Build a reconciliation program and team for IFP/Exchange markets Evolent operates in. Utilize available technical resources to inform the program. Develop/facilitate internal trainings on reconciliation, in collaboration with the Learning and Development team, and attend regular CMS meetings on this subject.• Perform socioeconomic and geographic analysis to determine strategic premium rating approaches for new and renewing markets of IFP plans, and determine growth projections for new market opportunities• Lead technical writers in creation of various forms of documentation (implementation related playbooks, and develop SOPs, Job Aids, and Desktops) for new processes. Aid in training and development of employees assigned to new health plan partners.• Ensure team has appropriate resources and highlights areas of need to Director/VP for resolution.• Ensure the timely and accurate exchange of information/data with relevant stakeholders of the operation.• Monitor the work environment and the business operation. Address concerns that may affect the morale and/or operational effectiveness of the group.• Participate in cost/benefit analyses of operational changes in support of future business requirements.• Develop and maintain metrics and measurement to support a consistent, informative, and timely management reporting package.• Regularly analyze and report on the productivity and effectiveness of the operations in comparison to established performance metrics. Identify areas of improvement and recommend resolution

• Lead a team of 12 field-based Clinical Care Coordinators tasked with the development of service and care plans for Managed Medicaid beneficiaries across the Chicagoland area. • Guide and instruct team members to validate member enrollment using MEDI, 834, and supplemental data sources to determine shifts in Medicaid and/or Medicare eligibility, thus navigate members around the intricacies of spend-down periods and dual eligible status changes• Complete routine quality audits and performance-based management oversight • Developed a successful cost-savings program directed at reducing the over utilization (in excess of $1 million in SFY16) pertaining to Individual Provider services for HCBS waiver eligible adults in the Department of Rehabilitation Services (DRS) Home Services Program• Enhanced an Excel based HCBS waiver service tool to advance staff understanding of service rate determinations, promote inter-rater reliability across care coordination, reduce overturned appeals, and effectively monitor and manage changes in a member’s condition • Liaison to the enterprise Learning and Performance team to aid in the development of individualized learning environments and curriculums across care management • Functioned as a Medical Management Health Plan SME during the implementations of the MLTSS line of business in 2016 and CountyCare Care Management Services Agreement (CMSA) in late 2017. Wrote and reviewed portions of both contracts with HFS and CountyCare, respectively.• Oversee the seamless integration of enrollment data between CountyCare and Aetna to ensure Aetna’s care management platform accurately depicted member eligibility• Collaborate with internal and enterprise-level informatics teams to develop medical management focused compliance reporting and analytics

• Initiated and routinely determined home and community based waiver and SNF/SLF/SMHRF services for managed Medicaid, Medicare/Medicaid (Duals), TANF, and Expansion (ACA) recipients in face-to-face home visits largely in the Chicago metropolitan area • Conducted needs-based and condition specific evaluations of health plan members with use of motivational interviewing approaches to identify psychobiosocial strengths and barriers • Developed member-centered, interdisciplinary care plans built upon concurrent assessment data, consultations with members’ care team participants, and healthcare providers • Provided on-going face-to-face and telephonic case management to health plan members to aid in navigating health plan intricacies, close gaps in care, and obtain healthier outcomes • Co-facilitated a behavioral health discharge planning program to guide care managers in assisting members to seek post-acute follow-up care leading to reductions in readmissions and medication errors • Hosted on-going groups consisting of care managers to pilot processes changes/implementations, collect participant feedback/statistics via review of custom-designed surveys, and develop proposals

- Conduct intake assessments with utilization of substance abuse, functioning level, and general psychological scales- Apply psychoanalytic interviewing to evaluate a comprehensive psychobiosocial background of newly admitted patients- Facilitate/Co-facilitate process/therapeutic, psychotherapy, life-skills, art/music therapy, and movement groups- Determine Axis I and Axis II diagnoses of newly admitted geriatric patients as defined by DSM-V criteria with consideration of possible associated dementia conditions - Provide case presentations to an interdisciplinary team to establish primary problem designations and develop treatment/discharge/aftercare plans and reviews- Comply with Illinois Statue 405 ICLS 5/ Mental Health and Developmental Disabilities Code guidelines regarding involuntary petitions and consent agreements- Perform Utilization Reviews with various insurance companies and public programs; including Medicare/Medicaid- Maintain chart organization and perform internal audit reviews

• Trained and supervised a group of 4-6 direct reports in a residential mental health facility • Guided newly hired reports through on-boarding, training, and provide post-hire mentoring • Routinely tracked staff productively to identify deficits, implemented re-trainings, hosted team meetings/1:1’s, and presented remediation strategies to management. • Developed a 12 week clinical curriculum involving psychoeducation to conduct group therapy sessions with oversight by clinical staff (LPHA/QMHP) • Utilized crisis intervention, community support, case management services, mental health assessments, treatment plan development, and psychotropic medication monitoring/training of 10+ client caseload • Coordinated and consulted with psychiatrists/primary care physicians on clients’ behalf during interdisciplinary rounds to promote treatment progression

- Developed ability to acquire strong professional relationships and rapport with clientele- Conduct intake/admission interviews in an acute psychiatric in-patient unit. Adult population.- Lead art therapy and GROW program groups- Observed 50+ hours of clinical therapy groups in acute and chronic units- Design testing constructs using standard methods with data obtained from clientele- Lead a research team to collect research and analyze data

- Generate individual lesson plans to promote development of math and reading skills with developmentally disabled children.- Consult with parents and teachers of clients to ensure of clients’ proper skills progression on a daily basis- Assist teachers in classroom and computer lab settings to support individual students