Quality Assurance Process Improvement

TIMOTHY A. MCINTYRE, MSW, LCSW St. Louis, MO 314-***-**** ***************@*****.*** LinkedIn

OPERATIONAL & QUALITY IMPROVEMENT LEADER

Process Improvement Provider Engagement Leadership A seasoned, results-oriented Quality Improvement Director highly regarded for leading effective quality improvement programs, large scale projects and providing exceptional operational leadership for healthcare organizations. Strong auditing experience, recognized for continuously meeting stringent customer and accreditation standards. Strategic thinker able to see the big picture and develop process improvements that maximize productivity corporate wide. Motivated leader, supervisor, and trainer who excels at turning under-producing individuals into teams that work efficiently and exceed all expectations. Selected Highlights include:

Successfully implemented provider profiling strategy.

Served in a key management role supporting claims processing and compliance and accreditation activities.

Successfully managed key quality initiatives and improvement projects including business justification analysis, outcome measurement/monitoring/reporting and ROI development and presentation to increase quality and effectiveness.

Robust background in change management with success surpassing customer requirements and meeting performance guarantees through the use of data and measurements to monitor individual and team performance.

Proven track record of meeting both internal and external customer, state, and accreditation requirements.

Strong quality assurance oversight developing appropriate KPI and scorecard methodologies. CORE COMPETENCIES:

Relationship Building Process Improvements Research/Analytics Operations Management Delegating Project Management Needs Assessments Regulatory Compliance

Stakeholder Collaboration Budget Management Quality Assurance Clinical Social Work PROFESSIONAL EXPERIENCE

Magellan Health Services Maryland Heights, MO 2000 – 2017 Provider Profiling & Quality Senior Director: 2012 – 2017

Spearheaded the implementation of the national provider profiling project and related quality improvement initiatives to drive continued operational efficiency and increased collaboration.

Collaborated with multiple stakeholders to develop and define key business requirements for optimal project success.

Organized IT teams in the development of functionality while skillfully managing all project timelines, milestones and remain within budget.

Collaborated with consultants to develop algorithms and scorecard methodology to meet customer, state, and internal constituents’ requirements.

Partnered with providers to improve performance and increase engagement surrounding member outcomes and key performance targets. Collaborate with facilities on improvement initiatives and best practices.

Supported initiatives targeting improving HEDIS performance through profiling and engagement activities. Service Operations Quality & Compliance Vice-President: 2002 – 2012

Directly oversaw 10 business functions with an annual budget of $8.2M, developing innovative operational strategies and effectively leading teams in attaining performance expectations.

Conducted extensive analysis and interpretation of data to improve outcomes and identify areas for enhancement.

Managed report development and oversight of key performance indicators as part of the robust and operationally integrated quality improvement program.

Closely supervised the compliance unit accountable for the implementation of state, federal and customer compliance requirements while ensuring strict adherence to all regulations.

Developed and implemented key policies and procedures, facilitated customer audits, maintained compliance plans and provided detailed documentation and training to end users. Timothy A. McIntyre, MSW, LCSW St Louis, MO 314-***-**** ***************@*****.*** Page 2 of 2 Service Operations Quality & Compliance Vice-President - Continued

Assured full adherence to Sarbanes-Oxley, SSAE-16/SAS-70 and HIPAA standards for claims and network operations units including facilitating audits conducted by internal auditors and external sources.

Directed all facets of the quality assurance auditing program, auditing claim associates to meet individual and account performance requirements and conducting error trend and root causes analysis for recommendations to improve performance based on quantifiable results.

Developed the design and delivery of technical and non-technical training for the claims division ensuring employee’s complete understanding of their responsibilities and policies and workflows.

Oversaw the implementation of quality initiatives targeting increasing quality and effectiveness with ROI development and presentation, business justification analysis and outcome measurement/monitoring/reporting.

Negotiated critical vendor contracts and provided exceptional oversight of achievement of financial goals and key metrics.

Spearheaded operations of the recovery unit, running reports and auditing claims data to identify and collect overpayments

($8M in 2011) while supporting the cost of care initiatives through analytics and data-mining.

Directed the claims customer service unit dedicated to providing exceptional service to inquiries and claims issues.

Collaborated with teams to change the culture to a "quality mindset" utilizing data and measurements to monitor individual and team performance while supporting the attainment of customer requirements and meeting performance guarantees. IBM Unit QI Director: 2000 – 2002

Successfully led the unit’s quality improvement (QI) program structure and chaired the local QI oversight committee.

Closely monitored QM and UM performance data, coordinating with leadership to conduct root cause analysis and develop strategic performance improvement plans.

Thoroughly prepared for and facilitated extensive QM audits with the IBM vendor oversight committee.

Developed, implemented and monitored a number of corrective action plans defined by the vendor oversight committee. United Behavioral Health Itasca, IL 1998 – 2000 Regional Quality Manager

Ensured utilization management practices were compliant with URAC standards and State and Federal laws.

Collected and reported performance management data and QI measures to site and divisional QI Committees.

Implemented QI program structure and chaired the site QI oversight committee in support of delegated NCQA compliance.

Used key indicator data to identify outliers and worked with site leadership to develop and monitor corrective action plans.

Developed and maintained QI studies.

Collected and presented QI performance results and studies to health plans and functioned as a liaison with health plan QI staff, training on URAC standards, policies and procedures. EDUCATION

Master of Social Work – Loyola University of Chicago, Chicago, IL Bachelor of Arts in Psychology – Eastern Illinois University, Charleston, IL PROFESSIONAL DEVELOPMENT

Lean Six Sigma Black Belt

Leadership Connections Leadership Development Program Licensed Clinical Social Worker, MO & IL

TECHNICAL PROFICIENCIES

Microsoft Office Suite (Word, Excel, PowerPoint), Microsoft Visio, Microsoft Project

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