Susan Perry Email & Phone Number

Canton, Ma, Us

Develop annual strategic & business planning process to advance vision of Chief Medical Officer (CMO). Create/revise long-range strategic plan and quarterly dashboard. Manage budget, including monthly reporting, accruals, and forecasting. Elevate issues requiring immediate attention to CMO, COO, and SVP. Review, interview, and progress candidates for executive roles. Streamline and consolidate processes companywide. Advise CMO and Health Care Services SVP on vended UM relationships. Partner with internal audit to maintain regulatory compliance. Lead continuous improvement and performance initiatives. Build connections among physician community by facilitating monthly meetings, organizing programs, and hosting annual retreat. Oversee 6 direct reports.• Set vision and strategy for cross-functional Medical Cost Trend Management Steering Committee. Lead group in identifying and driving medical cost savings initiatives, overseeing development of high-value UM projects, and re-engineering cost management workflow. Consult on medical drug, oncology, medical policy, and health equity accreditation initiatives. • Championed turnaround of high-visibility project to achieve NCQA Health Equity Accreditation and gain position as first health plan in New England to be accredited.• Liaise between Harvard Pilgrim Health Care and The Harvard Pilgrim Health Care Institute (Harvard Medical School Department of Population Medicine). Facilitate financial discussions and operational issue resolution. Partner with Institute leader in organizational navigation, monthly meeting preparation, annual symposium planning, and recruitment for new president. • Foster employee retention by cultivating relationships, resolving issues, advocating for needs, and recognizing successes. • Championed change management efforts for business unit merger activities focusing on team migration, integration, and office relocation. Communicated changes and maintained seamless operations during transitions.

Canton, Massachusetts, Us

Facilitated planning and development of CMO/Health Services strategic plan; prepared and led planning meetings and compiled plan components. Managed staff of 5 supporting implementation of cost savings initiatives. Created agendas for and hosted Implementation Oversight Committee, Pandemic Executive Response, Health Services All-Staff, and CMO team meetings.HARVARD PILGRIM HEALTH CARE - Manager of Strategy and Operations Health Services Continued•Launched patient-first oncology utilization management (UM) program period. Led RFP process, business case development, program launch for oncology programing, and expansion of medical drug prior authorization program, leading cross-functional Cost Savings Initiatives Committee and collaborating with legal team, IT and business stakeholders. - Developed synchronized prior authorization and claims system to enforce proper drug dosage and frequency which increased management of high cost or high-volume medical drugs often using off-label dosing.• Planned, designed, and implemented medical drug data base to drive medical drug strategy and future formulary. • Contributed to $30M/year cost reduction by managing Cost Savings Initiatives Committee, process, and pipeline. Reviewed trend data, news, provider performance data, and employer requests. Conducted competitor analysis of programs and medical policies with analytics team.

Canton, Massachusetts, Us

Delivered high-priority initiatives that advanced corporate strategy and goal achievement by providing leadership, consultation, facilitation, insight, and support to Cost Savings Initiatives Committee and stakeholders. Assessed opportunities and resource needs, synthesized data, and provided recommendations to senior leaders. • Collaborated with cross-functional teams to align resources and advance complex, large-scale projects from strategy to implementation, including initial medical drug prior auth, claim editing, NICU, cardiac, genetic testing, and site of care UM programs. Managed all projects through completion, improving medical cost control, medical drug management, and claim payment policy adherence.

Boston, Ma, Us

Evaluated provider relations, credentialing, and enrollment department operations, technology, and staffing. Prepared and implemented extensive optimization plan.• Executed assessment, performed diagnostics, and prepared recommendations for CEO involving operations for first year of 3-year strategic plan. Enhanced initial Balanced Score Card, defining measurable metrics, clarifying accountability, and resolving communication issues. • Planned and implemented companywide operations calendar and dashboard used by leadership for proactive planning.• Assessed and optimized BIDCO new client implementation and onboarding process, including project plans for Executive, IT, Clinical, Quality, and Professional Relations teams. Created structure and focused process by planning projects and setting timelines and meeting cadence. • Managed project to overhaul EMR data collection, programming testing, and reporting of updated Pioneer ACO and AQC quality measures in BIDCO data repository.

Canton, Massachusetts, Us

Directed budget operations for health services, network services and product business units with combined budgets of 100M+. Managed budget planning and development process for each business unit, creating communications, timelines, and instructions. Prepared accruals, forecasts and allocations for each budget and business unit. Tracked and consolidated budget submissions, advised on reduction strategies, and managed final delivery of approved budget.• Advised executive leaders in development and reconciliation of annual budget targets for each business unit, reconciling dollars owed between units and providing expertise on discretionary and non-discretionary expense strategies.• Prepared monthly aggregate budget reporting for business unit executive leader, identifying anomalies and highlighting drivers of variances, potential trends/issues, and saving/spending opportunities.

East Boston, Ma, Us

* Provided consulting services for the following time periods: 7/02-12/02, 4/03-8/03, 10/05-6/06* Coordinated the ESP Admin staff in the preparation of their required CMS PACE Application* Evaluated and rewrote all ESP policies, procedures & operations to meet CMS PACE Regulations* Developed preliminary training requirements to transition current operations to new operations* Provided technical expertise for the on-line management of project & preparation of final application* Developed preliminary readiness plan for State and Federal site visits, assisted with staff training and overall readiness and provided support during actual site visits

Canton, Massachusetts, Us

• Developed and maintained quarterly utilization reports combining the data for several delivery systems. • Designed and loaded sophisticated utilization data models used for business development and group negotiations.• Evaluated the First Seniority Intake Process and made recommendations to automate and streamline department operations resulting in the elimination of temporary staff and outside system consultants. • Led and managed the development of the Geriatric Assessment System incorporating the First Seniority system needs including: writing functional and system specifications, data clean-up, and system and user acceptance testing and reporting specifications.

Canton, Massachusetts, Us

• Develop and maintain core resource library consisting of Supplier Quality Monitoring & Improvement strategies, tools and internal and national benchmarks which was used for 1995 NCQA inspection.• Coordinate delivery system data collection and produce division wide analyses to support lead teams: Ambulance, Physical Therapy, and Home Infusion Therapy.• Provided delivery system data collection and produce division wide analyses for first HPHC Disease State Management Lead Team (Congestive Heart Failure).• Serve as IS business analyst between Provider Contracting and their outside systems consultant in the redesign and improvement of Provider Contracting Data System.

Boston, Ma, Us

This was a new division of Fidelity specializing in the administration of Health and Welfare Benefits outsourced by large corporations.• Conduct system analysis to evaluate vendor software against Health and Welfare business requirements.• Create standards for Product Development area to document Health & Welfare system requirements.• Manage the development of a vendor prototype Health and Welfare administration system.• Develop the system Plan Design client implementation process.• Manage the client functional testing of the Health and Welfare administration system.• Support the Product Development and Operations areas by: facilitating system design sessions, creating applications to increase their efficiency, and provide training on various system tools.

Responsible for planning and developing systems and operations procedures for a national startup company, ecuCare, which will broker and administrate managed care services to Insurance Companies and Third Party Administrators based on a proven pilot company called TotalCare• Responsible to administrate the operations and systems of TotalCare managed care products in order to produce accurate utilization and financial data to many audiences including clients and investors.• Created and managed TotalCare managed care data base, account set up and billing system.• Produced monthly and YTD product savings reports.• Evaluated and recommended managed care program vendors; (pharmacy and home infusion providers).• Presented sales demonstrations to prospective self funded employer groups.• Supervised staff of two performing medical code review and other pre-processing claim procedures.• Coordinated and co-developed a managed care (catastrophic case identification) software program. •Managed, coordinated and integrated all service vendors with ecuCare systems and ecuCare clients.