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VP/Senior Director of Healthcare

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Country: United States
Salary: Negotiable
Posted date: 10/11/2011   all resumes
Email: pii8u0@r.postjobfree.com
Contact Info: **********@*****.***
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Objective A role where my proven track record in Operations, Process Improvement and consulting to achieve or exceed Key Performance Indicators will support/lead an integrated team effort for success. I possess both Clinical and Business expertise and have a history of project success using the principles of Six Sigma CQI.

Summary of qualifications

I have designed and implemented multiple Case and Disease Management systems and programs as well as educational programs for various group. I have been a featured speaker on topics related to Care Management as well as clinical topics and concerns and Process Improvement and Systems Integration. I have several published articles on Clinical and Care Management topics as well as well highly rated Continuing Education offerings for Nursing, Social Work, Pharmacists and Physicians.

My experience has covered the areas of Clinical Operations, Quality/Case/Disease Management, P&L responsibilities, and oversight of clinical quality content, Return on Investment and Performance Metrics development and measurement/reporting. I also have a strong background (Current) in Hospital System integration and performance improvement across hospital systems.

Accreditations Certified Case Manager (CCM)
Advanced Certification in Care Coordination (A-CCC)
Registered Nurse (RN)
Six Sigma Greenbelt
LEAN

Professional Experience
• Charged with the Performance Improvement for this 13 hospital Acute Care system as well as reduction of Disputes and Denials from payer groups and reduction of Length of Stay overall to National Benchmarks
• Renegotiated contracts for Second Level Physician review determinations resulting in a $25 million savings in my first 90 days
• Set up internal system and training for in-house Physician Advisor program resulting in another $1.8 million in savings per year for the following 3 years
• Integrated unit nursing and Care Management teams to increase patient and provider satisfaction as well and a marked reduction in Length of Stay by facility as well as system
• Created systemized Case Management and UR training and procedures to ensure best practices and consistent performance across the corporate system
• Created and operationalized processes to decrease system readmission rates to below current National Benchmarks for 30 day re-admissions
• Streamlined processes for each facility to decrease wait times at point of admission and reduction of Avoidable delays

• Contracted as Interim Director of Case Management and provide assessment and leadership for hospital wide performance improvement initiatives of a 130 bed regional For-Profit Acute Care facility
• Performed full data analysis and research as well as full assessments to target areas of performance improvement needs.
• Developed both action and implementation plans for decreased length of stay, care coordination, targeted clinical programming, training of staff on the focus of the plan. Worked closely with the CFO and CEO as well as the service line VP’s and provided training for performance expectations; collaborating with cross functional teams.
• Lead implementation of a high profile corporate-wide compliance initiative focused on appropriate patient placement with 100% InterQual review prior to any facility admissions. All ports of patient entry covered 24/7/365
• Provided analysis of facility data to determine baseline performance measures and identified multi-disciplinary key performance measures. Provided assessment and a full cause analysis to develop an end to end action plan for facility wide performance improvement
• Developed a weekly Dashboard and reporting system for targeted KPI’s. Worked collaboratively with departmental leadership to ensure all KPI’s were met or exceeded across the facility
• Developed, trained and implemented new work flow processes for Care Coordination after move to a newly built, larger facility from the original medical center with lower patient census and CMI
• Worked closely with physician and nursing leadership to ensure their support and buy in for all initiatives.
• Developed Service Line programs based on analysis of all data and drill down to areas of greatest need. These programs resulted in increased client and patient satisfaction.
• Re-engineered care coordination models for the new facility and created an FTE role focused on Emergency Department case management. Focus was to support 100% ED patient review to identify appropriate admission levels of care for Observation and In-patient placements as well as pro-active discharge planning and needs assessments for patients not identified as requiring facility admission status.
• Increased departmental productivity while increasing both patient and physician satisfaction scores

• Senior Consultant in Consulting
• Lead Performance Improvement initiatives for several Acute and Post-Acute Care facilities and lead integration for a large 5 hospital system.
• Performed full data analysis and research as well as full assessments to target areas of performance improvement needs.
• Developed both action and implementation plans for decreased length of stay, care coordination, targeted clinical programming, training of staff on the focus of the plan. Worked closely with the CFO and CEO as well as the service line VP’s and provided training for actual performance collaborating with cross functional teams.
• Monitored the progress and outcomes of the project and communicated all results and needs assessments to leadership on a monthly and quarterly basis.
• Supported the leadership of each facility in achieving all key performance indicators and ensured the targeted KPI’s were met or exceeded in all cases.
• Decreased facility LOS (Length of Stay) an average of 1 full day by year 1 on all projects
• Worked closely with physician and nursing leadership to ensure their support and buy in for all initiatives.
• Developed Service Line programs based on analysis of all data and drill down to areas of greatest need. These programs resulted in increased client and patient satisfaction.
• Re-engineered models for contracted facilities for moving patients through the care continuum appropriately from acute admissions to post-acute transfer and care. Worked closely to develop vendor relationships to ensure discharge needs for patient populations would be met in a timely manner.

• Started business as a healthcare consultant for Care Continuum processes as well as Case and Disease Management program development for large Managed Care corporations and Acute care hospitals and systems
• Served as Interim VP of Medical Management for year long periods to turn around struggling medical management systems. Hired and trained permanent replacements for the ongoing role of VP, Medical Management
• Worked with both acute and post-acute hospital facilities and systems to provide analysis, full assessment of opportunities for the facilities and targeted implementation plans.
• Provided support and plans for system integration (multi-facility system integration) and developed plans for performance improvements in the areas of length of stay, Acuity/Case Mix Index, Clinical Programming development, overall performance improvement and worked with the facility team to implement and support the success of the plan.

VP of Disease Management hired to aid in the integration after acquisition. Worked closely with the integration team to help integrate the five healthcare companies that were acquired as part of an initiative to branch the company out into a more robust healthcare management corporation.
Managed the process for implementing a new software system with a focus on Disease Management and Wellness programs. Project lead for the new platform integration.
Performed full data analysis and research as well as full assessments to target areas of performance improvement needs.
Developed plans for performance goals and measurements and implemented while educating the team on appropriate guidelines and achievement of team goals.
Worked closely with the CFO and CEO as well as the service line VP’s for the 5 companies being integrated to ensure the success of the new health plan goals.
Monitored the progress of the project and communicated all results and needs assessments to leadership on a regular basis.
Supported the leadership of each facility in achieving all key performance indicators and ensured the targeted KPI’s were met or exceeded in all cases.
Was a Subject Matter Expert for the Sales and Marketing team and went on client presentations to deliver initial sales presentation to prospective clients as well as helping to close final contracts.
• Responsible for ongoing client relationships and client satisfaction as well as problem resolution with Service line and “C” level leadership.

Under my consulting business/role, took interim role as VP of Disease Management for this national Medicaid Managed Care health plan. Internal consultant for the Disease Management department.
Developed three new disease management programs and prepared the team for full NCQA accreditation for each of the programs (Bi-Polar Disorder, Obesity Management and an outreach program for lower risk OB members).
Used Six Sigma principles to realign department and processes for more efficient management of member population.
Lead growth of disease management programs from 4 in early 2006 to 8 NCQA accredited programs by the end of 2006.
Developed improved reporting metrics for the corporate disease management group and implemented a new CQI project which lead to increased penetration rates corporate wide.
Worked closely with the “C” level leadership in making process improvements and developed initiatives to support the future goals of the company.
Developed Key Performance Indicators for the Medical Management team integration with Behavioral Health. Monitored and reported achievement of the targeted KPI’s.
Worked with the Sales and Marketing team to make client presentations to secure additional business as well as performing full analysis of data from the prospective client to determine clients’ true needs and develop targeted programs to ensure client satisfaction and interest.

Under my consulting business/role, took interim role as VP of Health Management for this Disease Management and CMS SNP contracted corporation.
Responsibilities included: Oversight of clinical quality and content, account relationship management, product development and design, all aspects of the RFP/RFI process, reporting and ROI (return on Investment). Staff of 6 direct reports.
Leading member of team for design and implementation of two disease management/wellness offerings that lead to a successful launch of the product offering and increased revenue for the company by eight million dollars the first year of launch.
Lead the team that successfully launched one of the first CMS contracted Special Needs Programs (SNP) for a pilot of having a Disease Management focus for Medicare members under an HMO/PPO product line (In South Dakota).
Worked on a CMS study of CHF patient management in Northern California in conjunction with several healthcare providers. Managed the overall program. Hired and trained the permanent replacement locally for the role on an ongoing basis.
Identified potential new clients by researching reported issues and concerns using journals and the internet.
Developed a Bariatric support program for a large East Coast Health Care Provider/Group and proactively reached out to this potential client. The outreach was positive and the company eventually got the contract which added a new program and an additional income stream of $6Million dollars net revenue for my client company.

Under my consulting business/role, took interim role as Director of Care Management to turn around the struggling department.
Took the facility from an overall 6 day LOS down to a 4 day LOS in 120 days by making process improvements and working with Service Line leadership and the CFO to ensure success and a focus on the team goals.
Analyzed and reported weekly results and provided trend lines and action plans to ensure successful achievement of goals.
Managed a staff of 4 direct reports with 100 staff total. Responsibilities included a budget of 6 million dollars, profit and loss, departmental redesign, training, etc. for this award winning medical center in the Southeastern United States.

• Responsible for the Case and Disease management departments of this managed care organization with over 3.5 million covered lives.
• Reorganized the departments and tripled staff in three months and increased productivity and cost savings 200% within six months of taking leadership.
• Responsibilities included oversight, hiring, training and development of a staff comprised of 54 registered nurses,4 Social Workers, 2 Registered Dieticians and 7 support staff.
• Was a member of the business team that developed and implemented a new healthcare services software package that streamlined workflows for the Medical Resource Management area (Including Population Health and Wellness).
• Served as an advisor to the Network Management team making recommendations on contracts and negotiation of rates. Subject Matter Expert (SME) for the Healthcare Services area of the company presenting at finalist presentations on a weekly basis.
• Developed several Disease Management programs and worked collaboratively to develop an end to end care management program and philosophy on which all new programs are now designed.
• Brought the team to delivery of a return on investment of 3.5:1 (ROI)
• Created reporting and analysis outcome measures for the Medical Management department at the service line level. Trained the team to focus on results vs. activities. This resulted in increased productivity and increased business for BCBSNC due to the ability to report results of the programs to prospective and current clients.

• Supervised 12 case managers and 5 support staff in the Medical Management department while managing an active patient case load of Medicare members.
• Acted as a liaison/advisor to the managed care contracting department reviewing prospective provider contracts and making recommendations on fee schedules.
• Created and implemented new policies and procedures, as well as, modifying and implementing existing case management policies and procedures according to NCQA guidelines, TDI, TDH and HCFA Rules and Regulations.
• Interviewed and trained all new hires to the case management department and acted as mentor to all case managers preparing to sit for case management certification exams.

• Case Management, Utilization Management, PSNE/Research/Staff Nurse,
• Started at this world-renowned cancer center while a nursing student in the Texas Medical Center.
• Continued to work as an agency Per Diem nurse for a year after leaving the full time employment to keep up clinical skills.
Education Texas Woman's University Houston, TX
• MBA/MHA
• In-Process.
Texas Woman's University Houston, TX
• BSN-Nursing; BS-Biology
• Completed a dual major in Nursing and Biology with High Honors (Magna Cum Laude)
Bethany College Bethany, W. VA
• BA-Anthropology
• BA in Anthropology (Summa Cum Laude)
Houston Community College
• AA-Social Sciences
• AA in Social Sciences with High Honors (Summa Cum Laude)

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