Manage Technology / Business Operational Improvement Deployments and Enhancements across client business units. Work with leaders across multiple functional areas to deploy an issue resolution process that supports market and customer expectations. Collaborative partner with business on developing and executing on the strategy to drive utilization of the ServiceNow platform. Responsible for Issue Resolution KPI Performance Metrics & Targets across client’s business unit in partnership with Issue Management Leaders. Establish/negotiate Service Level Agreements in alignment with market and customer expectations for business unit. Accountable for developing reporting to support inventory controls and monitor issue resolution KPIs. Accountable for Preventative Action Process to reduce issue and turn-around time for issues within business units. Ensures effective and positive relationships across operations, product, growth office, and resolution partners for business units. Leads Issue Resolution business unit Governance Meetings and establishes the issue resolution operating rhythm for business unit. Responsible for achievement and tracking of financial benefits of the business.

Responsible for managing technology projects of varying levels of complexity from kickoff through launch w/ centricity to virtual urgent care & virtual primary care platforms. Lead & contribute to the development of program or project scope statements with applicable stakeholders. Identify project duration, effort, sequence, and dependencies of tasks required to meet applicable project objectives. Monitor and document project milestones and outcomes throughout the project lifecycle to ensure adherence to established quality standards. Develop, communicate, and implement program and project risk, issue management plans and strategies. Develop and implement contingency and recovery plans when deliverables are missed (e.g., identify critical path, document, plan for getting back on plan schedule, Business Continuity Plan, failover planning). Develop and maintain various project status reporting including proving verbal and written updates across a wide range of stakeholders. Act as a centralized facilitating point for the coordination of tasks and integrated execution of key strategic initiatives while reducing activities carried out in isolation. Identify potential risk or problems proactively and drive resolution across cross-functional teams. Influence and manage group relationships with diverse geographic locations, skills, and level of understanding of company processes and policy in a flexible, changing, and virtual environment, with the ability to be ready to adjust plans and direction in response to local feedback and the iterative nature of digital health projects.

Responsible for the coordination and completion of projects across all facets of operations w/ centricity to Quality Department. Lead the development / implementation of all project lifecycles, in consultation with applicable stakeholders (Executive Leadership). Ensured alignment and understanding of program/project scope and objectives with the organization's strategic objectives and the Voice of the Customer, in consultation with applicable stakeholders. Ensure that all impacted areas are identified, and that appropriate resources are engaged to participate in the scope definition process. Ensure that project scope, requirements and approvals comply with current governance guidelines and methodology. Monitor scope requirements and identify scope-related gaps and issues. Ensure that all project deliverables and success criteria are identified. Establish/implement/comply with change management processes to drive effective project execution (e.g., launch, deployment, revisions, change control). Program managed NPS across Enterprise inclusive of PM’ing all workstreams. In accordance w/ Accreditation Guidelines created, implemented and managed Policy & Procedure Processes across the business.

Responsible for the direction and guidance on clinical quality improvement and management project/programs. Provide resource expertise on clinical accreditation standards across ACHC and URAC. Conduct research and analysis for direction and guidance to executive leadership on clinical quality improvement opportunities. Conduct clinical quality/mock audits identifying risks, issues, and areas of improvement communicating with all key stakeholders, while maintaining responsibility for continuous management of programs operational oversight. Responsible for analyzing data/performance metrics for the development of performance improvement plans and programs. Provide ad-hoc consulting with functional areas on analysis, reporting, quality improvement plans and any other accreditation related project items. Actively participate in the development and documentation of Quality Improvement Projects and Process Improvement Measures.

Conduct, analyze, and facilitate Performance Improvement methods and best practices to exceed all OptumRx Accreditation and Certifications standards across ACHC and URAC. Ensure and evaluate operational readiness while training staff for on-site audits. Manage project timeliness and deadlines with strict adherence to state and federal regulations throughout a continuous life cycle. Work with cross-functional teams to ensure continued compliance for oversight of Accreditations and Certifications across all lines of business, while conducting Quality Management adhering to all program requirements. Promotion received based off performance to Senior Clinical Quality Analyst and to further acquire leadership/administrative skills.

As a Subject Matter Expert (SME) of Medicare clinical coverage audits/reviews, serve as team trainer and mentor for over 30 clinical staff members on department processes, protocols, clinical coverage reviews, and regulatory requirements. As the designated team-lead assist senior leadership in the supervision of 45 clinical staff members on medical case coordination, processing, auditing, credentialing, and implementation of Medicare regulatory compliance protocols with strict adherence to turn-around times. Assist senior leadership with the project development and management of providing analysis and execution of testing for new lines of business, system upgrades, and applications in comprehensive clinical testing environments (UAT testing).

As part of the Medicare clinical support team process and audit clinical coverage reviews/claims for accurate documentation of clinical data, patient demographics, product information, provider/facility contract status, ICD-9/CPT code usage, and appropriate clinical level notifications for acute hospitalizations, skilled nursing facilities, long-term acute care facilities, acute inpatient rehabilitation facilities, DME products, surgical requests, and network physician visits. Maintain key indicator goals of Medicare regulatory requirements and compliance while acting as a team resource to 15 clinical staff members for coaching, special projects, and assistance with trouble shooting/analytical problem solving. Review, revise, and audit internal physician denial and approval documentation assessing for Medicare compliance and criteria met policies. Promotion received based off performance to Senior Clinical Administrative Coordinator and to further acquire leadership/administrative skills.

Respiratory care practitioner aiding in diagnosing, treating, documenting, and managing patients conditions with various cardiac and respiratory illnesses within all areas of the hospital setting such as intensive care unit (ICU), emergency room (ER), labor and delivery, telemetry, trauma, and sub-acute. Specialist in life support management, cardiac resuscitation, code blue responses, respiratory medication delivery, and clinical respiratory procedures. Direct and manage the pulmonary rehabilitation clinic for hospital with new business analysis strategies and marketing techniques while conducting analytical projects with administrative departments to drive revenue and increase patient entry and satisfaction surveys. Assist Hospital Leadership on new business trends within clinic, while constructing quality improvement measures to implement into program. Conduct and coordinate weekly physician meetings with pulmonologist to discuss patient treatment progress. Conduct and coordinate in-services and educational training for hospital staff on respiratory clinical services.