Dana Carbo-Bryant
Summary
A clinical healthcare executive with over 20 years of clinical expertise and responsibility in the Medicaid line of business including managed care, non-profit health care delivery, and private practice. Experience clinical leader in quality performance, utilization management and affordability Experienced in utilization review, particularly around pre-service benefit and coverage determination Expertise in clinical mentoring and coaching, particularly of those involved in the care of children Strong teambuilding skills Effective communication and presentation skills Creative, non-pressured approach to problem solving
Healthcare professional prepared for leadership role with extensive experience in medical administration and clinical oversight. Known for driving impactful healthcare initiatives and fostering culture of excellence. Committed to collaborative team environments and adaptable to evolving healthcare needs, with strengths in strategic decision-making and patient care optimization.
Overview
30
30
years of professional experience
1
1
Certification
Work History
Chief Medical Officer
UnitedHealthcare Community Plan
- Responsible for quality and affordability goals that affect total cost of care for MississippiCAN and CHIP program membership.
- Provide clinical oversight for the end-to-end clinical model within the health plan along with HEDIS and CMS Star rating data collection process, local performance strategy, and CAHPS Improvement Strategy
- Actively engage with internal clinical partners and external constituents, such as members, physicians, medical and specialty societies, hospitals and hospital associations, federal regulators, and market-based collaboratives
- Develop strategies to identify clinical areas that indicate disparities in health outcomes across groups and an approach to closing identified gaps in health outcomes
- Drive quality improvement and provider incentive models through identification of appropriate practices; initial contact and target setting, implementation, and ongoing leadership during Joint Operating Committee meetings
- Liaison with appeals and grievances managers responsible for representing the health plan at State-level Fair Hearings.
Clinical Advocacy and Support Medical Director Manager
UnitedHealthcare Community & State
01.2020 - Current
- Provided clinical management for Medical Directors whose responsibilities involve clinical case and effective health care aimed at improving overall health status.
- Managed clinical case reviews, peer-to-peer interactions, and member advisement comparable to those under my supervision.
- Responsible for clinical collaboration with and advisement to Operations leadership and clinicians consulting on members' health care, clinical policies, and processes.
Clinical Advocacy and Support Medical Director, Team Lead
UnitedHealthcare Community & State
11.2018 - 12.2019
- Provided senior leadership and accountability for the performance and direction of medical directors in the department.
- Managed outpatient and inpatient utilization through pre-service coverage determination and medical necessity review.
- Provided physician support to clinical coverage review operations, primarily through the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity and communication with requesting providers as needed in peer-to-peer telephone calls.
- Supervised clinical staff, providing continuous professional development opportunities and training to maintain and strengthen competencies.
- Managed multidisciplinary teams, fostering collaboration between various healthcare professionals for optimal patient care.
- Enhanced operational performance by identifying areas of improvement and implementing change management strategies.
- Mentored physicians and other medical staff, facilitating professional development through training programs.
- Maintained compliance with local, national and federal requirements for staff education and certifications.
Associate Medical Director
UnitedHealthcare Community & State
06.2018 - 11.2018
- Provide clinical support to health plan Chief Medical Officers (CMO) in Louisiana and Mississippi in the areas of quality, affordability, and utilization management.
- Louisiana-Responsible for clinical oversight of the health plan administered specialty programs (Personal Cares Services, Private Duty Nursing, Pediatric Day Health Care, Transportation and Department of Corrections), worked closely with clinical staff on affordability initiatives, in particular private duty nursing, and serving as a liaison between the health plan and United Clinical Services.
- Mississippi-Responsibilities included participation in continuum rounds, supporting CMO in quality oversight, affordability initiatives, including private duty nursing and speech therapy, and serving as a liaison between the health plan and United Clinical Services.
Clinical Coverage Review Medical Director
UnitedHealthcare Community & State
01.2015 - 01.2018
- Provided physician support to clinical coverage review operations, primarily through the application of clinical knowledge in various utilization management activities with a focus on pre-service coverage determination or medical necessity and communication with requesting providers as needed in peer-to-peer telephone calls.
- State Lead, Mississippi- Responsibilities included serving as liaison between the Health Plan and team of medical directors that review for Mississippi, drafting and updates of standard denial letter language to reflect state and federal regulations as well as current UnitedHealthcare policies
- State Lead, Louisiana-In addition to responsibilities listed above for state lead in Mississippi, collaborated with regulatory adherence, the national letter team, and the Health Plan to bring denial letter language into compliance with stipulations of the Wells lawsuit in Louisiana
- Collaborated with nurse leadership to develop tools to use in conjunction with reviews that minimize errors and increase efficiency
Quality/Peer Reviewer
eQHealth Solutions
01.2013 - 01.2015
- Performed utilization review with a focus on inpatient utilization and outpatient therapies
Staff Pediatrician
Jackson Pediatric Associates
01.2004 - 01.2015
- Responsible for the provision of well and sick primary care for infants and children from birth to 18 years of age.
- Tobacco Champion, for exemplary service in tobacco cessation screening and treatment by the MS Chapter of the American Academy of Pediatrics and the MS Department of Health
Staff Pediatrician
Jackson-Hinds Comprehensive Health Center
01.1995 - 01.2004
- Responsible for the provision of well and sick primary care for infants and children from birth to 18 years of age. These services were provided in various inner city and rural settings throughout Central Mississippi.
- Established the first Reach Out and Read Early Literacy Program in state of Mississippi
- Grand Rounds Presenter, “Establishing a Reach Out and Read Program,” Department of Pediatrics, University of Mississippi Medical Center
- Presenter, “Childhood Obesity,” Annual Meeting, Mississippi Medical and Surgical Association
Education
B.A. - Biology
Hampton University
Hampton, VA01.1987
Internship, Residency - undefined
Boston City Hospital
Boston, MA01.1995
Doctor of Medicine - undefined
Boston University
Boston, MA01.1992
Skills
- Patient safety advocacy
- Clinical expertise
- Strategic leadership
- Healthcare management
- Quality improvement
- Improving clinical quality outcomes
- Clinical data analysis
- Teamwork and collaboration
- Critical thinking
- Clinical quality improvement
Accomplishments
- Collaborated with team of [Number] in the development of [Project name].
Certification
- American Board of Pediatrics
- Mississippi, active
- Florida, pending
- Tennessee, pending
Affiliations
- Fellow, American Academy of Pediatrics
- Mississippi Chapter, American Academy of Pediatrics
- Member, Mississippi Medical and Surgical Association
- Member, Mississippi State Medical Association
Timeline
Clinical Advocacy and Support Medical Director Manager
UnitedHealthcare Community & State
01.2020 - Current
Clinical Advocacy and Support Medical Director, Team Lead
UnitedHealthcare Community & State
11.2018 - 12.2019
Associate Medical Director
UnitedHealthcare Community & State
06.2018 - 11.2018
Clinical Coverage Review Medical Director
UnitedHealthcare Community & State
01.2015 - 01.2018
Quality/Peer Reviewer
eQHealth Solutions
01.2013 - 01.2015
Staff Pediatrician
Jackson Pediatric Associates
01.2004 - 01.2015
Staff Pediatrician
Jackson-Hinds Comprehensive Health Center
01.1995 - 01.2004
Chief Medical Officer
UnitedHealthcare Community Plan
Internship, Residency - undefined
Boston City Hospital
Doctor of Medicine - undefined
Boston University
B.A. - Biology
Hampton University
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