Experience

CommuniCare Advantage

• United States
• Insurance
• 1 - 100 Employee

• President

  • Sep 2021 - Mar 2023

  As President of a provider-sponsored integrated Medicare Advantage Special Needs Plan, I bring exceptional leadership skills to direct all aspects of operations, growth, and compliance across four states and over 80 long-term care facilities. My expertise lies in setting strategy, prioritizing initiatives, and executing opportunities aimed at achieving well-defined operational goals. For driving growth and ensuring operational excellence across a diverse enterprise of healthcare… Show more As President of a provider-sponsored integrated Medicare Advantage Special Needs Plan, I bring exceptional leadership skills to direct all aspects of operations, growth, and compliance across four states and over 80 long-term care facilities. My expertise lies in setting strategy, prioritizing initiatives, and executing opportunities aimed at achieving well-defined operational goals. For driving growth and ensuring operational excellence across a diverse enterprise of healthcare solutions and products I work closely with affiliated organizations. I am passionate about delivering high-quality care to patients and continuously seek out new ways to improve our services. Some of my selected contributions are: • Optimized 60% membership growth and 67% top-line revenue via the initiation of informed decisions. • Reduced admin spending from 16% to 11% and paid out $8M+ in risk share revenue to facilities and providers as a Managed Care Plan President. • Exceeded membership and revenue targets within the first nine months; reached and maintained exceptionally high member retention rates. • Quickly positioned start-up health plans as one of the top 10 Institutional Special Needs Plans (by membership) within the Medicare Advantage space.

• Chief Operating Officer

  • Dec 2020 - Sep 2021

  As a seasoned leader, I have successfully led end-to-end business functions and carried out operational accountabilities and necessary controls across cross-functional business teams, including health plan operations, business solutions, sales, marketing, and healthcare analytics/reporting. My passion for innovation has enabled me to formulate and implement cutting-edge/scalable solutions across the areas of sales, marketing, risk management, provider contracting and clinical… Show more As a seasoned leader, I have successfully led end-to-end business functions and carried out operational accountabilities and necessary controls across cross-functional business teams, including health plan operations, business solutions, sales, marketing, and healthcare analytics/reporting. My passion for innovation has enabled me to formulate and implement cutting-edge/scalable solutions across the areas of sales, marketing, risk management, provider contracting and clinical management. To ensure high-quality patient care I steered the utilization, grievance, and appeals management activities. My expertise in the CMS application and bid process allowed me to streamline business development processes and drive critical solutions for the health plan, the members we serve, our providers and stakeholders. By ensuring compliance with regulatory requirements and delivering exceptional results I headed initiatives in Model of Care, benefit, pricing, and operational design activities. A few of my selected contributions are: • Accomplished and maintained a voluntary dis-enrollment rate of less than 2% annually via proper execution of strategic initiatives that keenly focused on Medicare risk adjustment management, cost of care, audit, and reporting efforts in support of State Departments of Insurance and CMS oversight. • Developed and deployed advanced dashboards and portals to report "real-time" against Key Performance Indicators (KPIs) such as utilization rates, medical loss ratio, population capture and member retention rates.

• Vice President Integration & Solutions

  • Dec 2019 - Dec 2020

  Through the utilization of advanced knowledge and expertise in healthcare operations and compliance, I spearheaded efforts to build a Medicare Advantage Managed Care plan from 0-1 in less than 9 months. These efforts include but are not limited to securing Department of Insurance licensure in three States, successfully navigating the Center for Medicaid and Medicare Services (CMS) requirements for applications, care models, bids, and related deliverables for the target services. By… Show more Through the utilization of advanced knowledge and expertise in healthcare operations and compliance, I spearheaded efforts to build a Medicare Advantage Managed Care plan from 0-1 in less than 9 months. These efforts include but are not limited to securing Department of Insurance licensure in three States, successfully navigating the Center for Medicaid and Medicare Services (CMS) requirements for applications, care models, bids, and related deliverables for the target services. By collaborating with actuaries I developed, finalized, and submitted PBP submissions to CMS while ensuring regulatory compliance and delivering exceptional results. I spearheaded vendor and partner selection functions, including Third Party Administrator (TPA), Value Added Benefits, Pharmacy Benefit Management (PBM), and HealthCare Analytics Platform to ensure best in class capabilities were in place to support our start up mission and serve our members on day 1. Some of my selected accomplishments are: • Launched a start-up Medicare Advantage Part D (MAPD) Special Needs Plan in less than 9 months via managed care and health insurance operational activities. • Fulfilled all CMS requirements regarding access and adequacy by establishing a strong provider network within three states via solutions and strategies development.



Anthem, Inc.

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Execution Director, GBD Strategy and Planning

  • Oct 2017 - Dec 2019

  As a leader in the Medicare and Medicaid space, I managed a multi-million-dollar portfolio of initiatives focused on new implementations, cost containment, member experience, and provider collaboration. My responsibilities included owning initiatives sponsored by top leadership, such as E2E Journey mappings, M&A Operational Integrations, Novations, and Annual Medicare Product Launch as part of the Medicare Strategy and Planning team. I implemented technology-enabled strategies to support… Show more As a leader in the Medicare and Medicaid space, I managed a multi-million-dollar portfolio of initiatives focused on new implementations, cost containment, member experience, and provider collaboration. My responsibilities included owning initiatives sponsored by top leadership, such as E2E Journey mappings, M&A Operational Integrations, Novations, and Annual Medicare Product Launch as part of the Medicare Strategy and Planning team. I implemented technology-enabled strategies to support organizational goals and ensured theseamless execution of initiatives. A few of my major achievements are: • Recognized as a core part of the Government Business Division Strategic Planning and Execution team, chartering to identify, prioritize, and execute opportunities across Medicare and Medicaid lines of business nationwide during separation from Anthem. • Amplified exposure, understanding, and immersion related to Health Plan Operations and Execution through a transition from IT service delivery to IT account management as a gateway. • Led multiple start-up projects for one of the larger health insurance organizations in the world including multiple Medicare Advantage & Medicaid Managed Care Plans Various Positions,

• Project Director

  • Dec 2015 - Oct 2017

  As Project Director for the Amerigroup Kansas Medicaid Managed Care Plan, I hit the ground running and quickly demonstrated my exceptional performance. I worked closely with other plan leaders to design and implement a robust IT strategy and solutions that met the basic requirements of the frontline business. With my cross-functional team, I delegated IT and customer account projects from inception to completion. One of my key accomplishments was generating comprehensive reports for the… Show more As Project Director for the Amerigroup Kansas Medicaid Managed Care Plan, I hit the ground running and quickly demonstrated my exceptional performance. I worked closely with other plan leaders to design and implement a robust IT strategy and solutions that met the basic requirements of the frontline business. With my cross-functional team, I delegated IT and customer account projects from inception to completion. One of my key accomplishments was generating comprehensive reports for the President that helped her make data-driven decisions. By enabling and streamlining process and program improvements throughout health plan implementation, I was able to achieve desired results in member experience, compliance reporting, and financial performance. As a trusted advisor and consultant, I worked closely with business leaders, external partners, and regulators to ensure that all stakeholders were aligned and informed. I actively participated in several meetings with partners and regulators, including CMS and State Medicaid agencies, to represent the IT unit and ensure that all requirements were met.

• IT Customer Account Management Senior Advisor

  • Jan 2014 - Dec 2015

  Partner with internal and external business owners who have Information and Technology (IT) needs; work through the various areas in IT to satisfactory resolve the needs; enhance the understanding of the business within the IT organization; and represent the IT organization on external customer calls and meetings such as audit, state conference calls and meetings.

• Director, Service Management, ITS

  • Jul 2011 - Dec 2013

  Designed and applied robust IT strategy and solutions for achievement of basic requirements of frontline business by liaising with local market leaders. Delegated IT and customer account project lifecycle from inception to completion in close coordination with cross-functional teams. Generated comprehensive reports for President that supported in initiating data-driven decisions. Attained desired results in member experience, compliance reporting, and financial performance by enabling and… Show more Designed and applied robust IT strategy and solutions for achievement of basic requirements of frontline business by liaising with local market leaders. Delegated IT and customer account project lifecycle from inception to completion in close coordination with cross-functional teams. Generated comprehensive reports for President that supported in initiating data-driven decisions. Attained desired results in member experience, compliance reporting, and financial performance by enabling and streamlining process and program improvements throughout health plan implementation. Performed as a trusted advisor and consultant for company and stakeholders by working business leaders, external partners, and regulators. Actively partook and represented IT unit in several meetings with partners and regulators, such as CMS and State Medicaid agencies. ● Ensured and delivered world-class and top-quality end-user experience of related enterprise IT services, like desktop, laptop, and mobile device support as well as deskside service delivery, application packaging, deployment, and executive support. ● Pinpointed and exceeded all IT requirements of member-facing teams and regulators by carrying out Enterprise Role across Government Business Division, while acting as a first point of liaison for local market and IT service delivery teams. ● Designed and implemented a plan for completing desktop and laptop migration of a 20K device network from Microsoft XP to Windows 7.



Electronic Systems, Inc.

• United States
• Information Technology & Services
• 200 - 300 Employee

• Technical Services Manager

  • Oct 2000 - Jun 2011

  Management professional with extensive experience with both project and program management for technology solutions implemented in a wide range of business environments from enterprise level healthcare providers to industrial defense contractors. Expert in identifying current state and future state requirements for a variety of projects and developing strategic and tactical plans to efficiently transition between the two. Skilled in developing staffing models based on industry best practices… Show more Management professional with extensive experience with both project and program management for technology solutions implemented in a wide range of business environments from enterprise level healthcare providers to industrial defense contractors. Expert in identifying current state and future state requirements for a variety of projects and developing strategic and tactical plans to efficiently transition between the two. Skilled in developing staffing models based on industry best practices and benchmarks. ITIL trained and experienced. Proven ability to lead seamless implementations and deliver next-generation technical solutions improving revenues, margins and workplace productivity. Show less Management professional with extensive experience with both project and program management for technology solutions implemented in a wide range of business environments from enterprise level healthcare providers to industrial defense contractors. Expert in identifying current state and future state requirements for a variety of projects and developing strategic and tactical plans to efficiently transition between the two. Skilled in developing staffing models based on industry best practices… Show more Management professional with extensive experience with both project and program management for technology solutions implemented in a wide range of business environments from enterprise level healthcare providers to industrial defense contractors. Expert in identifying current state and future state requirements for a variety of projects and developing strategic and tactical plans to efficiently transition between the two. Skilled in developing staffing models based on industry best practices and benchmarks. ITIL trained and experienced. Proven ability to lead seamless implementations and deliver next-generation technical solutions improving revenues, margins and workplace productivity. Show less