Dara Fowler

Performance-driven Vice President with 18 years of experience aligning systems with business requirements, policies and regulatory requirements. Passionate about applying excellent organization and communication skills to manage and lead teams. Results-oriented individual well-versed in interfacing and consulting on business processes to drive results based on sound overall business judgment. Strong experience in business unit and clinical services management at steadily increasing levels of operational responsibility and bottom-line impact. Offering a complementary combination of clinical, business and market analysis, strategic planning, and operational management. As RN/BSN, with 25-plus years in healthcare, possess full knowledge and skills in clinical processes, clinical operations, and the provider-payer relationship. As MBA/business analyst/director, skilled in researching and analyzing such issues as ROI, cost–benefit, value-proposition of client services and products, business and market trends, financial and process auditing, design of tracking and reporting systems, program design and implementation, regulatory compliance, staff training, and operations performance measurement and analysis.

• Optum, a subsidiary of UnitedHealth Group, Rochester, New York, 06/2006, 05/2024, Market Vice President, Upstate NY, Maine, and New Hampshire, Reporting to the Regional President, managed the delivery of Medicare Special Needs Programs (MCSNP) and services across multiple markets in both the Upstate New York, Maine, and New Hampshire regions. Responsible for developing and delivering a compelling forward-looking vision and strategy that guided the business and aligned to enterprise goals and objectives. Create and execute an operational annual plan to accomplish strategy. Setting the tone and bringing culture to life through aligned strategy. Attracting and selecting staff and structuring roles and responsibilities; deploying aligned staff whose capabilities enable the organization to achieve goals. The aligned resources included business development, clinical, client management, network and medical. Obtain and distribute all resources needed for priorities, goals, and strategy; deploying resources that best enable the team to do their work. Ability to work cross functionally with key partners to drive strategy. Monitor and measure progress against plans; provide real time supportive and corrective feedback and assistance.
• Optum, a subsidiary of UnitedHealth Group, Rochester, New York, 06/2006, 05/2024, Market Vice President, Prepare and deliver presentations to and fostering relationships with critical stakeholders, recognizing, and responding to the diverse needs of key inside and outside. Manage multi-market profit and loss statements, adjusting process as needed to improve outcomes.
• Optum, a subsidiary of UnitedHealth Group, Rochester, New York, 03/2015, 11/2019, Senior Director of Clinical Operations, Initiate and build partnerships with long term care facilities (LTCFs) as their clinical vendor for MSNCP, with significant and measurable success in keeping patients out of hospitals. Support the complex LTCF inception and on-boarding process which involves client site business meetings with Optum’s clinical and sales staff to prepare Optum staff appropriately, through clinical orientation, ensuring a seamless transition for each individual facility. Recruit, hire and oversee the training, deployment and support of a clinical team of advanced practice clinicians (NPs and PAs) to sustain and grow operations in seven submarkets, each of which is unique in terms of socio-economic and host/LTCF expectations; currently 85 staff deployed in approximately 70 LTCFs. Collaborate with sales to manage relationships with facilities to ensure appropriate coaching and support of LTCF staff to continue generating patient interest and enrollment in MSNCP. Report to Vice President; two direct reports: Director of Clinical Operations and Senior Manager of Clinical Operations. Began as Health Services Director; job title changed as responsibilities increased and market broadened.
• Excellus Blue Cross & Blue Shield, Rochester, NY, 10/1998, 06/2006, Director: Medicare Compliance – Corporate Compliance, Successfully orchestrated the complete roll-out of the company’s first Medicare Compliance Program: Performed extensive research of federal guidelines to develop policy and protocol. Presented to board of directors. Designed and delivered accompanying staff training. Monitored and reported on organizational compliance with Medicare regulations. Implemented tracking system for regulator inquiries. Coordinated all activities for Medicare and New York State site surveys.
• Excellus Blue Cross & Blue Shield, Rochester, NY, 04/2003, 06/2004, Corporate Director: Utilization Management – Healthcare Affairs, Developed and implemented new and innovative corporate strategies for Utilization Management for all lines of business to include Medical Audit, Medical Claim Review, Regulatory Compliance, and Clinical Code Auditing functions for Health Plan: Provided support to contracting team as it related to provider contracting. Developed performance analysis and management reporting re: savings, return on investment, inventory management and productivity.
• Excellus Blue Cross & Blue Shield, Rochester, NY, 04/2001, 04/2003, Director: Medical Audit – Healthcare Affairs, Developed, trained and deployed a claims audit team that was successful in revenue recovery, claims process review, and root cause analysis: Reviewed/audited claims, billing, DRG methodology, and patient medical records. Implemented corrective provider training. Implemented a process for Emergency Department claims sampling. Team identified and recovered over $1 million in overpayments.
• Excellus Blue Cross & Blue Shield, Rochester, NY, 10/1998, 04/2001, Manager: Medical Audit – Provider Contracting, Implemented the tracking and monitoring of all Medical Audit Activities: Developed department policies and procedures. Participated in developing/executing provider operating and financial agreements.