David Zona
Rochester,NY
Summary
Seasoned Managed Care Executive with extensive experience in health plan operations and quality improvement.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Senior Director, Managed Care Analytics
Island Peer Review Organization (IPRO)
12.2021 - Current
- Directs strategy and operations for organization's External Quality Review (EQR) Analytics Division.
- Responsible for ensuring client deliverables are produced on-schedule and with high quality.
- Drives strategic improvements to enhance operational and organizational efficiencies.
Director, Quality Management
Geisinger Health Plan
04.2021 - 12.2021
- Responsible for performance integrity of the organization's Medicare Stars Program.
- Worked closely with organizational leadership and board of directors to guide program strategy.
- Identified, recommended and implemented tactics to influence improvements to operational performance of Medicare Stars Program.
Senior Director, Strategic Initiatives
Centene Corporation
06.2020 - 07.2020
- Directed quality program strategy for organization's Marketplace line-of-business.
Director, Health Care Quality Improvement
Excellus Health Plan
10.2018 - 05.2020
- Directed strategy and operations for health plan's Medicaid Quality Improvement Program.
- Responsible for the design and implementation of a portfolio of Quality Improvement initiatives.
- Worked in matrix fashion with organizational leaders to address program performance opportunities and maximize associated incentive program revenue.
Senior Director, Quality Improvement Operations
Centene Corporation
01.2018 - 10.2018
- Directed the development and implementation of quality improvement initiatives for client's Medicaid Quality Program.
- Directed select health plan accreditation activities in support of compliance with NCQA Health Plan Accreditation standards.
Regional Director, Quality Improvement
Centene Corporation
07.2017 - 01.2018
- Facilitated quality program support for a portfolio of seven regional health plans.
- Reviewed monthly reports to identify potential opportunities for improvement in quality measures performance.
- Worked with health plans to develop strategies for addressing performance opportunities.
- Provided corporate support, resources and training to health plans to assist in their improvement strategies.
Director, Quality Improvement Operations
MVP Health Care
02.2015 - 11.2016
- Responsible for the performance excellence of the organization's enterprise Quality Improvement Program inclusive of Medicare, Medicaid, Commercial and Marketplace lines-of-business.
- Directed Quality Improvement data repository oversight and maintenance, analytics and reporting, Health Plan NCQA Accreditation and quality initiatives development and implementation activities.
Director, Health Services Operations
MVP Health Care
06.2012 - 02.2015
- Directed operational support for Medical Management division (Utilization and Care Management) of health plan inclusive of analytics and reporting, project management, process improvement, intake and compliance.
Manager, Population Health Analytics
MVP Health Care
08.2009 - 06.2012
- Responsible for oversight of Care Management analytics and reporting inclusive of monthly operational reporting and annual program evaluations.
- Directed Care Management intake functions.
Project Manager, Health Care Operations
MVP Health Care
09.2007 - 08.2009
- Directed the implementation of department and corporate projects commensurate to scope and schedule and in-line with allotted budget.
Program Manager, Quality Improvement
MVP Health Care
06.2004 - 09.2007
- Responsible for annual HEDIS audit operations and submissions.
- Provided analysis and reporting in support of health plan Quality Improvement Program.
- Managed annual HEDIS Medical Record Review operations.
- Worked across organization to identify and implement initiatives to address quality program performance opportunities.
Business Reporting Analyst
Rochester Individual Practice Association (RIPA)
07.2000 - 05.2004
- Prepared medical claims reports utilizing data extraction and manipulation tools.
- Produced reports formatted in compliance with data quality standards.
- Introduced efficiencies through the automation of manual reporting tasks.
Education
MBA - Health Care Management
University of Rochester
Rochester, NY05.2009
Bachelor of Arts - Economics, Psychology
University of Rochester
Rochester, NY05.2000
Skills
- Health Plan Quality Improvement
- Process Improvement
- Strategic Planning
- Analytics and Reporting
- Emotional Intelligence
- Critical Thinking
- Active Listening
Certification
Project Management Professional (PMP)
Lean Six Sigma Green Belt (LSSGB)
Certified SCRUM Master (CSM)
Timeline
Senior Director, Managed Care Analytics
Island Peer Review Organization (IPRO)
12.2021 - Current
Director, Quality Management
Geisinger Health Plan
04.2021 - 12.2021
Senior Director, Strategic Initiatives
Centene Corporation
06.2020 - 07.2020
Director, Health Care Quality Improvement
Excellus Health Plan
10.2018 - 05.2020
Senior Director, Quality Improvement Operations
Centene Corporation
01.2018 - 10.2018
Regional Director, Quality Improvement
Centene Corporation
07.2017 - 01.2018
Director, Quality Improvement Operations
MVP Health Care
02.2015 - 11.2016
Director, Health Services Operations
MVP Health Care
06.2012 - 02.2015
Manager, Population Health Analytics
MVP Health Care
08.2009 - 06.2012
Project Manager, Health Care Operations
MVP Health Care
09.2007 - 08.2009
Program Manager, Quality Improvement
MVP Health Care
06.2004 - 09.2007
Business Reporting Analyst
Rochester Individual Practice Association (RIPA)
07.2000 - 05.2004
MBA - Health Care Management
University of Rochester
Bachelor of Arts - Economics, Psychology
University of Rochester
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