Kansas City Metropolitan Area
I am a data-driven senior healthcare executive, known for advancing operations and maximizing outcomes through people, process, and tools. My expertise lies in driving change, creating foundations that support growth, and executing impactful programs. I have successfully overseen divisions including Care Management, Utilization Management, Clinical & Financial Analysis, Quality /Accreditation, Stars, and Risk Adjustment, and have managed a $400M P&L. ๐๐ข๐๐๐๐๐ข๐ฅ๐๐ง๐๐ฉ๐ ๐๐ซ๐๐๐๐๐๐ก๐๐ & ๐ฉ๐๐ฆ๐๐ข๐ก๐๐ฅ๐ฌ ๐๐๐๐๐๐ฅ๐ฆ๐๐๐ฃ I excel in uniting technical experts, visionaries, and business leaders. With more than a decade of experience collaborating with Chief Medical Officers, Product & Tech partners, actuaries, and CEOs, I transform visions into actionable plans, shaping end goals and driving tangible progress, ensuring objectives not only come to life but also thrive. My track record includes enabling significant triple-digit growth in dynamic and fast-paced settings. ๐๐ซ๐๐๐จ๐ง๐๐ฉ๐ ๐๐๐๐๐๐ฅ๐ฆ๐๐๐ฃ & ๐๐๐ฅ๐๐๐ง๐๐ข๐ก As an authentic leader, I execute critical initiatives and programs across diverse divisions, influencing and fostering collaboration to drive business excellence and build cultures that embrace data-driven strategy, innovation, and results. I have successfully led 1100-member global teams, managed multi-million dollar budgets, and presented to high-stakes audiences, including Board of Directors, Executive Leadership, Congressional Offices, and Government Committees. ๐ง๐๐๐๐ก๐ง ๐๐๐ฉ๐๐๐ข๐ฃ๐ ๐๐ก๐ง My superpower lies in discovering high-potential individuals, whether within the organization or through external searches, and empowering them to grow, develop, and lead. I excel in fostering talent and driving organizational success by harnessing the full potential of individuals. ๐ ๐ ๐ ๐ฎ๐ป๐๐ฟ๐ฎ: We have to be efficient AND effective. Healthcare matters deeply to me, and I am dedicated to driving positive change in the industry. ๐๐ซ๐ฃ๐๐ฅ๐ง๐๐ฆ๐ | ๐๐ข๐ฅ๐ ๐๐ข๐ ๐ฃ๐๐ง๐๐ก๐๐๐๐ฆ โข Strategic Business Planning & Execution โข Transformation & Change Management โข Clinical Performance/Services โข Value-Based Patient Care โข Medicare, Medicaid, ACA โข Business Intelligence, Analytics & Data-Driven Strategy โข Process Improvement โข Program Prioritization & Management โข Multi-State Program Implementation โข Financial Performance Management โข P&L Oversight โข Global Leadership โข Quality โข Care Management โข Utilization Management โข Risk Adjustment โข Regulatory Compliance
I'm thrilled to join Stellar Health's mission to support payors, health systems, and providers in the transformation towards Value Based Care. I am eager to drive operational excellence and customer outcomes as Stellar continues to grow and scale to support new regions and products.
I had the privilege to lead transformative initiatives at Bright Health, a multi-state health insurance and healthcare company. With a global team of 400, I supported over one million members and led the system transformation approach for a 125,000-life Medicare Advantage business. I drive impactful programs to surpass business objectives, emphasizing member care, customer experience, cost optimization, and operational compliance. ๐๐ฒ๐ ๐๐ฐ๐ต๐ถ๐ฒ๐๐ฒ๐บ๐ฒ๐ป๐๐: โบ Established operational framework and support structure to sustain significant growth within fast-paced organization that increased from 150K members to 1M+ within 2 years. โบ Guided prioritization of business resources during 3x higher than expected levels of growth with <6 weeks notice, mitigating medical cost impacts and ensuring compliance. โบ Drove improved stratification, automation, and timely use of data to achieve a 30% reduction in readmissions and ER visits vs. control groups. โบ Co-built and piloted implementation and adoption of care and utilization management platform leading teams to effectively utilize the system, streamline processes, and improve organizational outcomes. โบ Established in-house Utilization Management division, saving 50% in administrative costs and improving turnaround time. Obtained URAC accreditation and licensed UM operations across multiple states to support 1M members. โบ Led integration and compliance revamp for two acquired Medicare Advantage plans (120K lives), reducing audit findings from 10+ to 1 within 9 months in UM and SNP Care Management. โบ Fostered culture of business excellence and strategic alignment through coaching, fostering collaboration, empowering high-performing teams, and driving process excellence. โบ Chosen by CEO to lead Medicare Advantage system transformation. Partnered with operational and IT teams to refine roadmap, establish budget, and set milestones, enhancing administrative efficiency and customer experience.
In my role as Senior Vice President, I was accountable for Utilization Management, Care Management, Quality, and Clinical Analysis, leading an executive team and overseeing 1.1K employees with a $130M budget. I played a pivotal role in shaping future-focused decisions and growth objectives for the organization, which experienced remarkable growth from $850M to $10B in annual revenue during my tenure. ๐๐ฒ๐ ๐๐ฐ๐ต๐ถ๐ฒ๐๐ฒ๐บ๐ฒ๐ป๐๐: โบ Transformed and scaled operations across divisions to improve efficiency, quality, and greater data-driven decision making abilities through improved analytics. โบ Implemented a private Health Information Exchange (HIE) to reduce time to action and improve efficiency through automation, capturing 60% of admission notices via HIE in 2019. โบ Partnered with IT to launch $7M advanced analytic solution, integrating NLP, machine learning, and data visualization. Generated $30M in cost savings, reduced preventable hospitalizations by 20%, and improved medication adherence by 3% without additional staffing. โบ Executed turnaround of long-term care product, transforming it from a $30M loss to profitability within 12 months, benefiting 14K members. โบ Held 4-Star Medicare rating for 3 consecutive years and #1 and #2 NY State Medicaid Quality ranking for 4+ years.
Led Clinical Quality, Clinical Analysis, Credentialing, and Delegate Oversight divisions, managing 120-member team and $20M budget. Drove business optimization through restructuring, enhanced analytics, and streamlined processes. ๐๐ฒ๐ ๐๐ฐ๐ต๐ถ๐ฒ๐๐ฒ๐บ๐ฒ๐ป๐๐: โบ Increased Medicare Star rating from 3 to 4. Achieved highest Star Rating for plans in NY region with members dually eligible for Medicare and Medicaid. โบ Elevated Healthfirst rankings on NY State Medicaid Quality Incentive from 16th to 1st out of 18 plans, increasing Medicaid revenue by $100M+ from associated quality incentive. โบ Launched innovative Provider Incentive program to drive engagement and achieve quality targets, distributed $65M annually to PCPs and hospitals to meet goals. โบ Represented organization in discussions with NCQA, MEDPAC, CMS, AHRQ, AHIP, and congressional offices.
Accountable for $400M P&L and tasked to turn around a financially struggling cohort where Healthfirst took direct insurance risk, improving financial performance by $10M in first year.