Patient Care Senior Director
Resume:
CAREER SUMMARY
• Executive Leader with **+ years of experience and extensive background within the
healthcare industry, focusing on leading top-performing teams in leveraging data and transforming it into actionable information to solve business problems, improve performance, and drive growth and success.
• Recruited for expertise to work with leadership to build out the unit reporting capability, gaining specifics concerning patient care and creating specific reporting that translated into understandable terms.
• Oversaw the efforts to construct and maintain provider fee schedules that are equitable, fiscally responsible, and consistent across health plan contract agreements covering $200M.
• Provided coaching and mentoring to the Sales team utilizing direct customer contact in sales presentations and project deployment specifications, resulting in over $20M in contracts.
• Spearheaded a Value-Based Care program that incentivized quality clinical outcomes, practice efficiency, and patient satisfaction, resulting in $50M in distributions based on models developed by the team during leadership tenure. PROFESSIONAL WORK EXPERIENCE
ARCHWELL HEALTH – NASHVILLE, TN
Senior Director, Medical Economics 2023
• Recruited for expertise to work with leadership to build out the unit reporting capability, gaining information concerning patient care and creating specific reporting that translated into understandable terms.
• Collaborated with leadership and provided direction and guidance concerning ongoing performance tracking and monitoring, providing revenue trend analysis, clinical utilization, and medical costs to drive decision-making concerning resources, ensuring efficient medical cost management.
• Worked with Clinical and Network Operations to develop and implement strategies focused on improving service delivery.
• Introduced actuarial data and leveraged it to establish performance goals based on product, geography, and service type.
• Utilized best practices to translate advanced business analytics problems into technical approaches with actionable recommendations within diverse domains, including product development, marketing research, supply chain, technical industrial process, and public policy.
WELLPATH – NASHVILLE, TN
Director, Clinical Analytics 2021 – 2022
• Performed as Director of Clinical Analytics for the organization working within the correctional space of healthcare, overseeing the establishment of clinical analytic capabilities unique to the corrections industry.
• Examined current data flow and reporting to understand analytic capabilities and created a strategic plan to modernize available options and construct governance protocols.
• Analyzed the nascent HEDIS reporting processes and led the introduction of a complete overhaul of computation and distribution.
• Provided direction and guidance in establishing the framework for a Pay-for-Performance, a 1st within the corrections industry.
• Responsible for the management of the RFP process to acquire risk adjustment software, providing the tools needed to support complex care management and multi-regional utilization analysis.
• Oversaw the design of a corrections-based risk adjustment program, incorporating Social Determinants of Health as well as multi- system HER clinical data.
• Focused on changing the organization from a staffing agency to a truly managed care organization, collaborating with IT to gather data and, within 6 months, delivered a strategic plan to transform into an outcomes-based clinical management leader with optimized patient experience and outcomes.
Dan Ayala, MBA
925-***-**** Nolensville, TN ************@*****.*** LinkedIn
Product Management
Data Synthetization
Value-Based Care Models
Complex Problem Solving
Analytics Innovation
Business Development
Strategic Planning & Execution
Financial & Clinical Analytics
Integrated Team Management
Concept Testing
Relationship Building & Management
Leadership Coaching & Mentoring
Product Development
Data-Driven Decision-Making
Continuous Process Improvement
Change Management
CORE COMPETENCIES
FLOOR COVERING INTERNATIONAL FREMONT – FREMONT, CA Owner 2017 – 2020
• Followed an entrepreneurial passion and purchased and launched an organization under a franchise arrangement with a significant flooring industry leader.
• Oversaw all areas of operations for the organization, including customer relations, financial reporting, and subcontractor management, as well as introducing marketing strategies spanning local networking and digital marketing partnerships.
• Responsible for directing 100s of installations that consistently gained 5-star reviews on Google, establishing a solid customer base that generated a year-over-year revenue increase of 10% until selling the company. ATOS/ANTHELIO HEALTHCARE SOLUTIONS – PLEASANTON, CA Director, Healthcare Analytics 2014 – 2017
• Functioned as Director of Healthcare Analytics and led multiple teams in designing, developing, and deploying a vast array of healthcare compliance applications, defining market requirements, and spearheading the launch of analytics solutions supporting major healthcare systems.
• Effectively extracted data from hospital HRs that were previously unattainable or undecipherable and translated into useful information to understand performance.
• Pivoted into product development during an organizational acquisition and gained significant knowledge concerning producing a compelling product that improves performance and facilitated more real-time metadata and transparency for leadership.
• Delivered ongoing product oversight, technical specification documentation, client solution development, and delivery of product enhancements that secured contract extensions.
• Collaborated with prospects and clients concerning comprehensive analytics solutions, including clinical analysis, risk management, and population health analytics, leading to new engagements. HILL PHYSICIANS MEDICAL GROUP – SAN RAMON, CA
Director, Informatics 2010 – 2014
• Responsible for leading a team of 20 Analysts in maintaining financial, clinical, and patient satisfaction analytics, focusing on melding the disparate data into actionable information to drive decision-making and support the physician compensation systems.
• Directed multiple cross-functional teams in developing clinical profile metrics that realized industry pay-for-performance standards and delivered real performance improvement.
• Oversaw the efforts to construct and maintain provider fee schedules that are equitable, fiscally responsible, and consistent across health plan contract agreements covering $200M.
• Developed strategic metrics and performance reporting tools for routine evaluation of clinical outcomes and cost trends, ensuring ongoing performance effectiveness and efficiency.
• Spearheaded a Value-Based Care program that incentivized quality clinical outcomes, practice efficiency, and patient satisfaction, resulting in $50M in distributions based on models developed by the team during leadership tenure. MEDEANALYTICS – EMERYVILLE, CA
Senior Director, Payer Sales Support 2009 – 2010
Manager, Product Management Payer Solutions 2007 – 2009
• Created and launched an innovative analytic platform and customized templates to align with business needs, supporting the sales and deployment processes.
• Provided coaching and mentoring to the Sales team utilizing direct customer contact in sales presentations and project deployment specifications, resulting in over $20M in contracts.
• Developed and marketed financial, clinical, and operational analytic solutions and provided to payer organizations across the US.
• Facilitated deep dives to gather market research concerning competitor offerings and leveraged to lead the Engineering and Architecture departments in product management and the addition of new capabilities. Additional Experience:
Hill Physicians Medical Group – Senior Financial Analyst in Healthcare Analytics EDUCATION
California State University – MBA, Finance
University of California at Santa Barbara – BS, Economics
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