Senior Director Of Clinical Operations Resume Example Evolent Health

SENIOR DIRECTOR OF CLINICAL OPERATIONS

Professional Summary

Accomplished healthcare leader with demonstrated ability to deliver mission-critical results. Experienced nurse with many years of case management and providing services to an elderly population and commercial insured. High-performing with 30 years of healthcare experience and sophisticated knowledge of healthcare operations at all levels including managed care. Development of clinical programs and implementation, evaluate for program effectiveness, quality, claims, financial and network management. Demonstrated proficiency in staffing, training and development. Excellent relationships internally and influence change within another organization. Ability to understand the client's process in order to create and implement policies, procedures, work plans and remain curious when evaluating problems while allowing out of the box thinking in order to implement integrated policies. Many years of experience working with project managers and proven track record creating and executing on a client's clinical program implementation. Ability to manage multiple projects and completion on or before deadline. Project and Operations Management: Initiated Six Sigma team to analyze length of stay in skilled nursing facilities which resulted in savings estimated at 5 million. Developed and implemented training for nurses to manage complex cases and health coach. Consolidated Medicare team from multiple locations down to two locations. Managed over 30 direct reports consisting of nurses and non-clinical support. Staff turnover rate less than 1%. Administered staff audits, performance reviews and when needed corrective action plans. Managed a Chronic Care Pilot in NC for members with an AARP Medicare Supplement. Responsible for all functions related to planning, hiring, training and implementation for the pilot. Collaboration with all the key stakeholders internal and external. Process improvement to allow for model changes when needed and evaluated impact of the change. Expanded NC pilot to four additional markets in 2008. Successfully planned, hired, trained and launched expansion by developing a strong team. Developed a customized model of care for the client resulting in a return on investment. Identify target opportunities utilizing population analytics.

Experience

Senior Director of Clinical OperationsEvolent Health

Responsible for growth and working with clients to realize targeted engagement, clinical and economic outcomes.
Oversee the implementation of ongoing management of the client's tailored population health model.
Participating in developing and driving an annual clinical initiative plan, monitoring key program and population metrics, participating in quality improvement efforts and working directly with the care management staff including RN care managers, case, health coaches, behavioral health specialists, social workers, dieticians and pharmacists, in delivering optimal results.
Responsible for ongoing development of clinical guidelines and protocols used in delivery of population health services, as well as the ongoing design and commercialization of the company's integrated population analytics and care management workflow technology platform.
Experience with Accountable Care Organization and Medicare Shared Savings Program.
The Population Health model embedded care managers within Primary Care Practices to manage high risk for Fee for Service Medicare and Commercial patients.
Hospital transition program similar to the Eric Coleman model.
Moderate risk patients managed telephonically and outreach to patients who frequently use the Emergency Department.
Responsible for communicating policies and procedures that integrate the work of all positions within the care management organization, and ensures that they are known and followed.

Clinical DirectorDec 2008 to Sep 2013
United Healthcare

AARP My Care Path Oversee and direct the health management team managing high risk members with chronic medical and behavioral conditions.
Excellent collaboration between business segments to ensure a successful integrated program.
Responsibilities include reporting, program budget and analyzing profit and loss statements.
Also responsible for identifying areas for process improvement and developing action plan for implementation.
Day to day oversight includes managing conflict and finding resolution within the team and constant monitoring pilot for project risks.
Mentor and develop managers through formal channels, one on one interaction and continuing education support.
Responsible for audit preparation and presentation with internal and external customers.

UnitedHealth Care - Clinical Program ManagerNov 2003 to Dec 2008
AARP Chronic Care － Cleveland, North Carolina Florida New York California

Responsibilities included pilot program design for Medicare and Commercial memberships, implementation and strategies for contingency planning, risk mitigation, program goals, milestones and deliverables.
Activities included hiring, managing, training and evaluating direct reports.
Developed pilot work flows and standard operating procedures.
Collaborated with internal divisions functioning as a Subject Matter Expert for process improvement and system migrations.
Developed innovative ideas which resulted in segment roll out for process improvement.
Collaborated on the development of RFP's for external customers.
Participated in presentations in finalist consideration of RFPs.

Clinical Manager Medicare TeamDec 2002 to Nov 2004
UnitedHealth Care

Responsible for managing a large team of nurses and non-clinical staff who delivered inpatient monitoring and case management when Medicare Advantage members were discharged from an inpatient setting.
Successful decrease of custodial spends for admissions to Skilled Nursing Facilities.
Successful outcomes for Fast Track Appeals process with Centers for Medicare and Medicaid Services.
Collaborated with Compliance staff to develop process for Fast Track Appeals which resulted in successful launch.
Developed solid working relationships with the Quality Improvement Organizations.
Trained staff at the St Louis site to successfully implement a Medicare Team using the infrastructure implemented in North Carolina.

Education

Certification Chronic Care Professionals

Associate Degree, ScienceUniversity of Arkansas at Little Rock － Little Rock, ArkansasScience

Skills

budget, client, clients, delivery, driving, Fast, hiring, managing, Mentor, Nursing, policies, presentations, process improvement, profit and loss, program design, protocols, Quality Improvement, reporting, RFP, workflow

Resume Overview

Companies Worked For:

Evolent Health
United Healthcare
AARP Chronic Care
UnitedHealth Care

School Attended

University of Arkansas at Little Rock

Job Titles Held:

Senior Director of Clinical Operations
Clinical Director
UnitedHealth Care - Clinical Program Manager
Clinical Manager Medicare Team

Degrees

Certification Chronic Care Professionals
Associate Degree , Science

Senior Director of Clinical Operations Resume Example

Resume Score: 90%

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