Yelena Gregor Email & Phone Number

New York, United States

Oversee the administrative branch of Clinical Operations for Oscar's speciality teams including: Complex Case Management, Transplant, Oncology, and Behavioral Health and Care Navigation

Greater New York City Area

• Head of Operations for Oscar’s Complex Case Management (CCM) program from its creation, program impact resulted in 30k average annual reduction in utilization per member
• Built staff productivity dashboards tracking monthly home and facility visits, and outreach frequency, which led to an action plan that increased staff productivity by 15%.
• Scaled CCM program to six markets with a 50% increase in staff and oversaw program budget.
• Oversaw hiring, training and professional development of 10 direct reports including RNs, Social Workers, and Care Guides.
• Owner of all CCM regulatory, compliance and delegation oversight responsibilities.
• Established and operationalized CCM policy and procedures for daily functions of clinical staff.

• Developed escalation workflows within JIRA platform to receive referrals to CCM program from internal Concierge and Utilization Management teams to meet NCQA compliance.
• Created productivity Jira dashboards for clinical staff to prioritize daily functions and projects
• Obtained and hired outside vendors as necessary and approver for all vendor invoices
• Co-wrote and partnered with Marketing team to implement surveys to measure member satisfaction
• Co-wrote data collection queries on performance metrics, and presented quarterly to quality subcommittee.
• Monitor and develop CCM Metrics including: successful clinical interventions for the prevention of ER/Inpatient admissions, and member engagement

Greater New York City Area

• Responded to all Supervisor call back requests from members.
• Coached Member Service Representatives by providing real-time feedback on de-escalation techniques
• Managed the team’s 50 daily cases, ensured case completion within Service Level Agreement (SLA)
• Participated in pilot program to create a new network navigation process. Improved workflow by creating new patient assessment questionnaire guidelines. Reduced incorrect escalations by 10%.

Greater New York City Area

• Resolved 30 daily member questions regarding eligibility, claims, and IT problems
• Assist members with reprocessing incorrectly denied claims ranging from $10k - $500k in medical bills.
• Coauthored Member Services Disaster Response Plan for the Department of Financial Services review. Workflow outline operations for the first week post natural/war disaster including chain of command.

Brooklyn, NY

• Oversaw up to 20 crews to respond to emergencies in high stress, quick thinking environment.
• . Managed 40 field EMTs daily. Assigned emergency calls and scheduled crew break times.
• Communicate with insurances Medicaid (Logisticare, National Med Trans, MTM) and Medicare to get authorization for non emergency calls

Brooklyn, NY

• Respond to 911calls for MVA,trauma, cardiac, respiratory, diabetic, psych emergencies
• Provide patients transport for dialysis, hospital discharges, and medical procedures
• Proficient in use of both paper and EPCR writing
• Measured patient vitals signs and able to asses level of patient stability

Haifa, Israel

• Training on responding to terror attacks in the Middle East
• Israeli Defense Force medic base training including intubation and IV administration
• Learned different methods to tourniquet and rapid bleeding control in a battlefield

Stony Brook, NY

• Front desk customer service to students and parents
• Presented to my peers on teamwork and communication in the work environment
• Attend monthly departmental trainings ranging on customer service and initiative in the office

Bachelor’S Degree, Sociology, Biology

"Voyage To Medicine" Program, Medicine , Emergency Medicine