Director of Product Management

• Sep 2023 - Present

Associate Director, Product Management

• Aug 2021 - Sep 2023

Director, Clinical Operations Integration & Automation

• Dec 2019 - Jul 2021

•Set vision, direction, and execution for automation clinical systems integration and automation initiatives.•Led user engagement team in initiative to drive user adoption of the Provider Portal for electronic submission of prior authorizations and notifications, increasing adoption from 15% to over 60%.•Defined key performance indicators (KPIs) and metrics to measure the effectiveness user engagement efforts.•Led the business ownership of automation projects, prioritizing all aspects of the UM Automation work plan.•Partnered with Config to implement standardized prior authorization requirements across multiple markets. •Partnered with IT to improve system integration and minimize complexity through standardized platforms.•Oversaw implementation and support of clinical systems and tools for interdisciplinary member care. Show less

Team Lead, UM Automation

• Jul 2018 - Dec 2019

• Provided oversight of Population Health Systems Analysts and Systems Engagement Specialist working with the Cite platform of products• Served as the technical SME and product owner for the Cite product and ensured product alignment with Utilization Management department goals.• Served as the Cite Technical & Functional Product Manager (TFPM), which includes responsibility for product planning throughout product lifecycle• Provided technical support in analyzing content of patches, upgrades and fixes to the production applications• Identified and documented business requirements for new development projects & prepare technical specifications• Developed relationships between department & its customers Show less

Population Health Systems Analyst

• Aug 2015 - Jul 2018

• Led assessment and implementation of ICD-10 remediation efforts.• Acted as a liaison between IT and the business community, facilitating communication and translating requirements.• Supported system maintenance, testing, and user support for Utilization Management software.• Evaluated current processes and offered recommendations for automation and improvement.• Developed and delivered Provider Portal and Cite AutoAuth training sessions to Providers and Internal staff.• Researched and resolved issues identified by Utilization Management team. Show less

Quality Accreditation Specialist

• Sep 2014 - Aug 2015

• Contributed substantially to a successful 2014 NCQA Desktop Submission. Responsible for multiple modules. • Interpreted and communicated new and revised standards to the appropriate business areas.• Partnered with key business areas to identify and obtain documentation needed to meet the intent of standards.• Collaborated with business owners to establish plans of action to address issues found.• Identified process improvements in the day-to-day functioning of the department.• Assisted IT with the design and implementation of the NCQA SharePoint Workplans. Show less

Accreditation Document Management Coordinator

• Jul 2013 - Sep 2014

• Assumed primary lead role for 2014 URAC HCC desktop submission. Responsible for all aspects of submission including correspondence with business owners and consultants and 100% upload with minimal oversight. Full Accreditation awarded for compliance with Health Call Center Accreditation Program.• Reviewed documents and ensured compliance to all applicable standards.• Coordinated the review, revision and creation company operational policies and procedures.• Maintained policy database and ensured annual review compliance for all marketplace and corporate policies. • Coordinated and maintained company-wide documents supporting SNP, NCQA and URAC Accreditations.• Collaborated with Accreditation Manager to ensure adherence to operational processes required by accreditation requirements, and CareSource business policies. Show less

Private Duty Nurse

• Jan 2008 - Feb 2013

• Provided comprehensive nursing care for disabled children and adults in home settings. • Documented assessments, treatments, medications, and follow-up care. • Ensured patient safety and well-being, including transportation to medical appointments. • Provided comprehensive nursing care for disabled children and adults in home settings. • Documented assessments, treatments, medications, and follow-up care. • Ensured patient safety and well-being, including transportation to medical appointments.