Experience

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  Loma Linda University Health

  • San Bernardino County, California, United States

  • Executive Director Managed Care and Quality Management

    • Feb 2018 - Present
    • San Bernardino County, California, United States

    • Re-envisioned strategies and enhanced operational infrastructure for Loma Linda University Health and Loma Linda University Faculty and Physicians Value-Based Programs: Medicare Advantage, Commercial, and Managed Medi-Cal. Increased Managed Care membership by >400% and managed 9,000 ACO lives.• Update Senior Leadership on dynamic changes impacting academic medical centers and affiliated provider groups.• Refined Managed Care contracting strategies to standardize language, identify carve out opportunities and enhance reimbursement.• Implemented Lean Six Sigma methodology to improve business process efficiency and effectiveness. Lead annual improvements in organizational financial position.• Responsible for overall management of the Managed Care Business Lines including development of short- and long-term strategy, physician engagement, member communications, marketing, and population health initiatives.• Oversee development and negotiation of Letters of Agreement, as needed.• Collaboratively develop assumptions for annual budget and long-range financial plans.• Developed strong interdepartmental relationships for Managed Care and ACO lines of business.• Established performance goals for department and provided methods for reaching milestones.• Work with the LLUH Office of General Counsel and Compliance to align regulatory and Health Plan education and enforcement activities.

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  Arrowhead Regional Medical Center

  • San Bernardino, California

  • Clinic Operations Supervisor

    • Nov 2014 - Feb 2018
    • San Bernardino, California

    Accountable for operation of the McKee Family Health Center an ambulatory care clinic that serves vulnerable populations in San Bernardino, CA. Responsible for overall management and day-to-day clinical operations, business development, strategic planning, physician relations and regulatory compliance. Work closely with the Medical Group to ensure oversight of clinical personnel and delivery of high-quality patient care and the efficient utilization of resources.• Service – Partnered with medical group and staff to develop, organize, implement, and monitor process improvement initiatives to enhance healthcare quality and operational outcomes, e.g., patient flow, provider scheduling/availability, ancillary staff medical acuity, and fiscal diligence. Utilize Lean Six Sigma and “warm and welcoming” modalities to improve customer satisfaction with healthcare services. Customer satisfaction scores improved 10+ basis points. Patient perception of “office staff quality” increased by 15+ basis points.• People – Developed and implemented strategies to ensure recruitment, development and retention of staff. Enhanced employee engagement scores by 20 basis points. Assure that clinical and ancillary staff are following organizational policy and work within their scope of practice. Lauded by site Medical Director and the Chairman of Family Medicine for innovation, collaboration and enhancing service delivery.• Quality – In collaboration with ARMC leadership defined and monitored quality outcomes (TJC, EH&S, CMS) and their reporting to internal and external regulatory constituencies. Improved auditing and monitoring protocols contributed to an audit “pass” rate of 100%. Improved mammography-screening rates and the percentage of patients with a diabetes self- management goal to 98%.• Finance – Oversaw capital and operating budget planning, development and monitoring for the McKee FHC. Exceeded per unit revenue (↑3%) and expense (↓21%) targets.

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  Kaiser Foundation Health Plan

  • Oakland, California

  • Executive Director

    • Jan 2002 - Dec 2013
    • Oakland, California

    • Leader Nonmember Access Project – mapped current state of IT systems, interface, data elements and business processes. Quantified current volumes, interregional variance and proposed opportunities to enhance Kaiser Permanente's market penetration, revenue and business process alignment.• Developed and implemented KFHP & KFH Boards and program wide governance and control infrastructure for Community Benefit and select Tax Exemption risks. Community Benefit governance and control infrastructure was recognized as “best in class” in a national study of nonprofit organizations.• Business Leader Sarbanes Oxley deficiency identification and remediation efforts. No significant deficiencies 4+ years.• Led development of standards, training curriculum and submission of annual statutory reports (IRS 990 Schedule H, CA – SB 697) which articulate how KFHP/H met and/or exceeded statutory requirements for nonprofit healthcare organizations.• Authored eleven organizational policies and procedures to clarify expectations for the nonprofit entities.• Worked closely with organizational leadership and board of directors to guide operational strategy.• Developed and implemented functional budget, forecasting and strategic planning business processes.

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  Kaiser Foundation Hospital

  • Manager

    • Jan 1996 - Jan 2002

    Leader statewide Community Benefit operations ($500M portfolio).Created statewide (CA) Community Benefit governance, operational and risk management structures (subsequently replicated in all Kaiser Permanente regions). Enhanced transparency, accountability and organizational engagement and financial support for long-term strategy attainment.Collaborated with Labor to redesigned and implement a centralized business-processing unit to adjudicate charity care claims, improved response time by 25%, reduced system variation and improved customer satisfaction. Directed professional staff and consultants of 100+.

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  Kaiser Foundation Health Plan

  • Southern CA - Pasadena

  • Integration Consultant

    • Jan 1991 - Jan 1996
    • Southern CA - Pasadena

    Integrated regional functions (External Affairs, Community Benefit, Government Relations and Communications) into one statewide team. Assessed and realigned people, systems and business processes to achieve organizational efficiency goals. The integration effort reduced overall costs by 15% while developing aligned goals, objectives and monitoring (dashboard) protocol. Created statewide governance structure to guide division and facility Internal and External Affairs. Supervised and developed pricing and actuarial financial models for employer groups, pharmacy, mental health and all other KP benefit offerings. Redesigned business processes to better serve our customers and developed performance guarantees, an expedite process, expanded telephone access (12 hours daily) and partnership with sales and marketing staff. Decreased cycle time by 50% and increased team output.
Created a market Competitor Analysis Program to enhance market intelligence of pricing, benefit and contracting trends and to facilitate strategic price and benefit decisions. Identified benefit and price point opportunities to enhance financial performance and market competitiveness.Senior Pricing Representative of 3,000+ members. Developed and presented utilization and cost information to consulting firms, brokers, and large client groups.Directed activities of underwriting and pricing staff of six.