Providing consulting to healthcare industry organizationsProviding innovation for population management design, data engine requirement build, staff coaching and training, clinical document design, provider and member collateral build, operational logistic enhancement, clinical product and service advancement, contract development and review, board advisor

Charged with effectively implementing, monitoring and executing on Optum’s Care Delivery Organizations (CDO’s) quality programs: HEDIS; CMS 5-Star; P4P; ACO; Medicaid; vendors, and other programs. Leading strategy around new program needs to bridge any gaps identified between quality initiatives, Optum partners and risk/clinical affordability programs. Lead functions: Oversight of quality processes related to operational and clinical programs, helping to drive best practice sharing, implementation, and education; Oversight of quality reporting solutions and implementation across a diverse selection of tools and analytics, work with third party payers to ensure clinical program is accurately represented, work to ensure optimization of programs operation by developing processes of operational and clinical use effectively meeting State/Federal requirements; develop and execute resource plans to ensure CDO support and success; Coordinate and development of infrastructure around people, process, and technology to achieve scale; Partner with other internal Optum teams to design and develop clinical capabilities that will drive improvement; develop and provide education and training on quality program innovations; present at national innovation conferences for development of innovations, write internal position papers to lead strategy for departmental advancement; Monitor external professional medical organizations, accrediting bodies, legislation, and regulatory organizations for potential impacts to current quality programs and tools; development of centralized quality vendor management team; contracting external vendors for advancement of quality initiatives, vendor relationship management.

Strategic resource managing multiple programs and projects that are focused on improving HEDIS, Healthcare effectiveness for all LOS. Analyze to establish effectiveness and ROI of financial and clinical incorporated into initiatives. Design “new” innovation programs and create segmentations to existing groupings to have the “right program, reach the right member at the right time”. Lead functions: Innovation, design/development/implementation/enhancement/oversight of clinical quality programs to decrease gaps in care, improve STARS and HEDIS ratings, design UHC member direct services, member education, provider education, marketing, data collection, vendor contracting and management, provider contracting and management, drafting/negotiation of MSA’s and SOW’s, coordination and implementation of member rewards programs, design mobile direct service clinical programs and act as SME for other program leads. Direct design/management Walgreens Retail, Walmart Vision, Osteoporosis Screening, Breast Cancer Screening, Diabetic Care, Annual Wellness Visit, retail programs, Mobile Eye Exams and Screening UHC clinical programs. Implement first clinical research engagement programs partnered with pharmaceutical companies. Targeted engagement outreach, various outreach programs, primary response team SME to local and national professional associations/groups, analysis of existing programs for enhancement, utilization of Smart Data, provider/vendor financial settlements, ensuring direction and communication is in line with current UHC goals, directives and messaging, designed and implemented new provider type for UHC or our Closed Network Medical Logistic Providers, mitigate regulatory and compliance risks for innovation deployment, mitigate risk for compliance/regulation for federal STARK and steerage laws, vendor relationship owner for several providers, NCD/LCD SME for clinical engagement programs, internal presentation and quality SME to multiple levels.

Strategic resource managing various programs and projects that include: analyzing, reviewing and presenting information for operational and business planning as well as developing enhancing and maintaining operational information and models. SME for short and long term operational/strategic business activities – by engaging in cross-functional planning and process review and applying effective communication skills to influence the strategic activities.Lead functions: intersegment relationship management/contracting, management of internal and external vendor programs, maintenance & updates of clinical program rules for utilization/health population management services, creation and updating of inventory of utilization/health population management inventory services, SME for definitions and standards of rules adhering to UHC clinical programs, Liaison with Regional Medical Directors for business operations, SME for utilization management protocol, rules, standards, implementation, design and maintenance of UHC evidence based guidelines for medical utilization/health population management, SME for NCD/LCD edits, UHC advancement of Clinical pipeline, direct design/implementation/oversight/enhancement of cardiology, radiology, specialty drug and standard medical utilization programs, coordinated oversite of fraud waste and abuse, compliance/regulatory efforts, SME responder for ODAG CMS clinical audits, SME and medical liaison for provider breach of contract litigation, oversite and SME for appeals and grievance interrater audits and coaching, design and maintenance of claim processes, internal presentations to multiple levels of management and markets.

Acting as a SME in healthcare policy design and implementationLead functions: identifying new business opportunities, scoping and defining opportunities, determining problem solutions, policy development, requirement elicitation, reporting capabilities, subject matter expert, understand functional and non-functional needs, document analysis, health population management policy, federal and state regulatory and compliance, develop educational material, developed many new leading health policy designs and implementations including the first functional deployed accountable care policy.

Responsible for day-to-day operations of clinic (billing/coding, accounting, maintaining staff, patient retention, education, marketing, treatment, facility management) Implement and update practice management and EMR software application and training. Decrease overall clinic overhead costs. Lead as primary portal of entry physician.Lead functions: manage all clinic staff and supporting staff, Portal of entry physician, organizational change, solves unique and complex problems, business process analysis, create use cases, map requirements elicit software requirements, develop training material, file management, identifying new business opportunities, scoping and defining opportunities, determining problem solutions, requirement elicitation, subject matter expert, understand functional and non-functional needs, document analysis

Responsible for treatment of this high volume portal of entry clinic. Additional responsibilities include implement new EMR capabilities, patient education, increasing patient retention, population, reactivation, direct marketing, portal of entry physician, and working as primary physician contact to managed care networks. Lead functions: solves unique and complex problems, business process analysis, create use cases, map requirements elicit software requirements, develop training material, file management, identifying new business opportunities, scoping and defining opportunities, determining problem solutions, requirement elicitation, subject matter expert, understand functional and non-functional needs, document analysis

Medtronic, Parker Hughes Cancer Center, University of Minnesota, Donaldson Inc., MSI Insurance, Leonard Street Deinard& Associates, Relief DoctorLead functions: solves unique and complex problems, business process analysis, create use cases, map requirements elicit requirements, develop training material, file management, identifying new business opportunities, scoping and defining opportunities, determining problem solutions, policy development, subject matter expert, understand functional and non-functional needs, document analysis, report capabilities. Involved in many legal healthcare litigation as SME, designed several medical device prototypes as part of engineering team, medical science liaison and educator to Medical device companies and staff, Medical research for clinical research centers, and practice support of other health centers, Federal and State healthcare bill drafting