Business Strategist
Resume:
HEALTH PLAN PRODUCT EXPERIENCE
EDUCATION
BACHELOR OF ARTS
Interdisciplinary Studies,
Concentration in Health & Society
Michigan State University
FUTURISTIC.
STRATEGIC.
ACHIEVER.
BELIEVER.
RELATOR .
CLIFTON STRENGTHS
Atlanta, GA
******.*******@*****.***
CONTACT INFO
Customer
Experience
Leadership
Portfolio
Management
Communication
Research & Data
Analytics
Accreditation &
Compliance
Quality
Reporting
Branding &
Marketing
Operational
Strategy
Product
Innovation
Web
Development
Consulting
Content Design
Project
Management
Request for
Proposal (RFP)
Risk
Management
NCQA & HEDIS
Training
Development
Process
Improvement
Technology
Solutions
Performance
Evaluation
PROFESSIONAL SKILLS
TECHNICAL SKILLS
Microsoft Excel
Power BI
Adobe
Professional
Salesforce
Microsoft Power
Point
JIRA
SharePoint
Quick Books
Microsoft Project
Kanban
ServiceNow
Alation
A B O U T
As a professional who finds the greatest motivation through intrinsically rooted factors, I find it most rewarding to not only meet expectations but exceed them. I am passionate about leading and initiating positive change by exposing the opportunity for growth and innovation through human-centered methodologies. My skillset broadly consists of experience in leadership, senior level project management, organizational transformation, operational development, quality and product strategy. Through both my education and professional experience, I've developed the ability to flourish in the most demanding situations. I specialize in creating and executing solutions in start-up environments and managing complex cross-functional corporate initiatives. As a former educator and advocate for continuous learning, I’m always in the posture of expanding knowledge and skillset for myself and those around me. Currently I’m seeking an opportunity in which I can apply my diverse scope of healthcare knowledge to influence excellence in project execution, product strategy and stakeholder experience. KRISHAN R. DAWSON
REFERENCES
Michelle Finley Finance of America
Jason York Centene
Brittany Knox BCBSM
HEALTHCARE STRATEGIST
Medicaid
Medicare
HMOs
PPOs
POS Plans
HDHPs
HSAs
FSAs
Pharmacy
Durable Medical
(DME)
Behavioral
Health
Preventative &
Wellness Care
Chronic Disease
Management
Non-Emergency
MedicalTransport
Skilled Nursing
(SNF)
Telehealth
Optum Health (Contractor)
Senior Implementation Manager
Jan 22 – Sep 22 Remote
• Support executive leadership in driving execution of corporate strategic business transformation projects
• Drive end to end implementation of enterprise-wide business technology solutions geared towards improving operational efficiency, member, provider and key stakeholder experience
• Evaluated organizational competencies against business readiness standards to validate service delivery preparedness prior to project commitment
• Developed and managed a streamline Project Management Reporting Strategy that promotes cross functional transparency of budget, resource allocation, value, prioritization, strategic alignment and delivery outcomes on a weekly basis
• Lead development and successful launch of three (3) Virtual (In-Home) Patient Preventative Health Projects estimated to generate a combined, $4.6 B in healthcare savings and revenue annually
• Collaborated with Marketing Strategy division to develop program specific content aimed to target the chronically ill, aged above 60, and at-risk member population
• Lead, coach and developed a team of program managers to support the execution and ongoing performance of the Virtual Health Program
• Managed vendor selection, onboarding and performance for two In-Home Healthcare Solution Organizations ensuring commitments to SLAs were being honored and all issues impacting the customer experience were escalated and resolved in a timely manner
• Lead cross-functional project work groups of more than 50 internal employees to ensure that programs are implemented consistently with contractual commitments, on time and on budget
• Conducted industry research and analysis to improve and validate implementation strategies and service delivery models
• Documented E2E cross-functional project requirements to support product manager teams in assessing feasibility and capability of individual implementation plans
• Acted as a subject matter expert in health plan specialty services for external and internal stakeholders – consulting on ad hoc, non-traditional implementations and strategic projects as business needs arose
• Collaborated with account management division to review program outcomes against performance targets and provide recommendations for improvement of the E2E customer journey
• Identified and documented year over year performance gaps to help initiate implementation plans geared towards organizational process improvement CORE WORK EXPERIENCE
Blue Cross Blue Shield of MI
CX Manager Corporate Marketing & Customer Experience Feb. 19– January 22 Detroit, MI Senior Project Manager Operations Development & Learning Management Oct. 17 – Feb.19 Detroit, MI
• Support senior leadership in coordinating and prioritizing critical corporate efforts
• Conduct assessments of enterprise-wide projects to identify factors that will impact the member experience and assign resources to support any associated process innovation gaps, business change demands, and critical ROI opportunities
• Facilitate and lead executive level and non-executive level workgroups to promote cross-functional collaboration and problem solving for high-priority efforts
• Represent Customer Experience Division in aggressive Issue & Experience Management for BCBSM and BCN
• Tracked and assessed cross-functional business area deliverables for multi-phased projects to ensure appropriate funding & resources were allocated
• Conducted corporate and operational business area needs analysis by facilitating deep dive sessions & cross functional side by side process monitoring
• Provided recommendations to bridge knowledge and operational deficits and customize learning material by learning style & knowledge level to improve these deficits
• Developed role specific tools and standard operating procedures to enhance department productivity and improve internal/external business processes
• Managed & coordinated multiple high priority corporate initiatives from the stage of initiation through post-implementation
• Supported the successful completion of BCBSM’s health plan accreditation status by coordinating required efforts for three NCQA standards (QI, MEM and RR) and achieving the highest possible report accuracy rating of 100%, surpassing our established goal of 90%
• Worked with customer experience leaders to achieve and assess corporate goal, “improve patient experience with providers(2017)” and performed audit of Physician Group Incentive Program (PGIP) data for 251 physician organizations associated with the Greater Detroit Area Health Council
(GDAHC)
• Worked with leaders in 30 business areas across the blues to design individualized department application exercises intended to strengthen their ability to align business processes with customer-focused methodologies
• Demonstrated BCBSM’s commitment to quality by conducting an analysis of the 2017 CAHPS and HEDIS data and composing a 27-page report capturing evidence of, corporate implemented initiatives and recommendations focused on improving the member experience.
• Analyzed member complaints to identify improvement opportunities and tracked evidence for corporate interventions initiated to mitigate these quality barriers
• Lead Project Manager for 70 customer experience immersion initiatives, delivering training to more than 1000 employees on CX practices
• Constructed collaborative tool to obtain member, provider &enterprise insights on healthcare language
• Researched and analyzed business trends to strengthen corporate intelligence amongst competitors and disruptors
• Demonstrated validity and relevance of project goals through root-cause analysis
• Provided technical and strategic learning support to internal and external Blues technology users Centene Health (Contractor)
Organizational Strategy & Development Manager
Jan. 23 – Nov. 23 Remote
• Lead the end-to-end development and execution of organizational strategy initiatives for Product Intake, Value Creation, QA Functional Testing Analytics and Delivery Process Management
• Engage with senior leadership and key stakeholders to identify business goals and opportunities for improvement
• Conduct industry research to gather the competitive intelligence needed to make informed decisions regarding the organization’s strategic goals
• Evaluate company’s health by measuring and documenting the state of it’s financial performance, value-add operations, product portfolio, market presence and customer satisfaction
• Built an interactive Project Management dashboard to integrate data between JIRA, Power-BI and SharePoint to track and monitor status, roadblocks, resource capacity, projected and actualized ROI and value delivery which extended to deliver automated reporting
• Lead a cross-functional work group of business and IT partners (32 internal employees) to develop a web-based software intended to streamline the organizations project management and intake process
• Managed portfolio of Claims Operations projects estimated to generate $80 million dollars in health plan savings and revenue annually
• Devise Product roadmaps to identify product vision, goals, strategy, features, capabilities and release timelines
• Create Test Cases and conduct Pre and Post implementation assessments to validate Project actual outcomes against intended outcomes
• Developed SOPs to support implementation and ongoing quality refinement for intake strategy and project management Quest Diagnostics
Client Engagement Manager II Health & Wellness Division Aug. 15 – Oct. 17 Novi, MI
• Managed Health & Wellness Projects for 82 employer groups belonging to the organizations large key account portfolio (Cigna, BCBSCA and Self- Insured 50,000+ member health plans)
• Managed over 300 Wellness Campaigns Nationwide for Chronic Disease Prevention & Maintenance
• Executed 6.2 million dollars in Health & Wellness Benefit Projects in Q4 2016
• Onboarded and managed a team of 5 Project Coordinators employed to service and support the entire Health & Wellness division project portfolio
• Conducted Coaching Evaluations of Non-Compliant Medical Providers
• Enforced State Regulated Medical Guidelines
• Created custom marketing material for Strategic Accounts
• Utilized Salesforce to Generate Client Profiles, Business Workflows and Document Libraries
• Maintained accessibility permissions and licensing for key business platforms
• Composed and Managed Department SOPs and Training Model to align with Best Practices adopted by the organization
• Prepared Critical business data to support successful migration between company operating systems Program Director
South Redford School District
Sep. 14 – Aug. 15 Redford, MI
• Served as a program director for the district’s business development division
• Managed Performance, Training, Payroll, Scheduling and Compliance for 22 Direct Reports Participated in recruiting, interviewing and hiring new talent
• Wrote business proposal for program reconstruction and obtained 100% board approval
• Participated in bidding selection and approval
• Managed contract, performance and relationship for 6 vendors
• Managed end to end Rebranded of the district’s elementary education enrichment program
• Successfully launched Program, achieving 150% of target enrollment goal
• Generated a 60% increase in revenue YOY following the implementation of 5 new enrichment programs
• Performed all required State Licensing and Regulatory Functions Initiated and Organized inclusive enabled enrichment activities Utilization Management Lead
Meridian Health Plan
Apr. 14 – Sep. 14 Detroit, MI
• Managed health plan authorizations for commercial & Medicaid (state-funded) members
• Ensured accurate and timely processing of all requests as mandated by quality standards
• Verified credentials for existing providers & initiated enrollment of prospective ones
• Reviewed and assessed patient medical records to determine eligibility for services
• Engaged with providers to obtain all required documentation
• Served as a member of the executive review committee for member/provider appeals Durable Medical Equipment Intake Team Lead
J&B Medical Supply
Mar. 12 – Oct. 13 Wixom, MI
• Responsible for leading and developing a team of 13 inbound – member facing intake reps
• Developed & performed training for departmental quality standards
• Conducted needs analysis with new and prospective clients
• Assessed medical history to determine eligibility for specific products and services
• Compiled required medical documentation to satisfy requirements for insurance authorizations Verified and coordinated medical benefits
• Established knowledge of medical terminology; CPT, HCPC and ICD-10 Diagnosis codes
• Coordinated reviews for member appeals to substantiate medical necessity
• Developed & performed training for departmental quality standards Sales Manager (Licensed Life, Health & Accidental Insurance Producer) Western & Southern Financial Group
Jan. 11 – Mar. 12 East Lansing MI
• Recognized as top Sales Agent –District wide
• Managed life, supplemental health and accidental policies for new and existing clients
• Evaluated & Trained other licensed agents
CORE WORK EXPERIENCE
KEY ACHIEVEMENTS
Organization Transformation
Developed and implemented a strategic business model that included transitioning a district composed of four elementary schools with more than 200 employees and 1500 students from a multi-unit, isolated operating business into a fully integrated one. This business model included transforming the district’s culture, rebranding, instituting new programs and resources, recruiting new talent, developing stronger parent and community bonds and closing major financial and operational performance gaps. Project Management & Innovation
Lead development and successful launch of three (3) Virtual (In-Home) Patient Preventative Health Projects in a 90-day timeline using the critical path method. The project included onboarding 2 vendors and managing deliverables for 6 cross-functional workstreams encompassing 58 internal employees. In total this initiative was estimated to generate a combined, $4.6 B in healthcare savings and revenue annually Leadership
Instilled a sense of purpose, integrity, focus and excellence within a dismantled team of twenty-two employees that consistently missed performance standards and showed no progress in aligning as a department. After ten months of assessing the current and intended state of the department’s performance and employing new coaching strategies and performance incentive techniques, the team increased their productivity by 28% and showed a significantly lower turn-over rate.
Contact this candidate