DAWN S. MURRAY
Clinical Operations Director
Cincinnati,OH
Summary
Healthcare Executive in Clinical Operations and Practice Management
Clinical Business Development and Growth Strategies
Managed Care Contracting, Physician Coding and Billing, RCM
Physician Service with expertise in Emergency,Hospital Medicine and Women's Health .
Financial analytics and contract negotiation skills.
Dedicated to making a difference in patient care, clinical operations, and client relationships. Willing to work and travel as needed. Strong communication and presentation skills.
Overview
13
13
years of professional experience
Work History
Director, Clinical Operations, UC Health
University of Cincinnati Health
Cincinnati, Ohio
06.2021 - Current
- Directs Operational activities of the Ambulatory OBGYN Department in conjunction with the Inpatient L & D and Surgical Scheduling.Clinical Operations
- Leads clinical OBGYN Department with five subspecialities: Maternal Fetal Medicine, Uro Gyn, Gyn Onc, General OBGYN, and Infertility service lines.
- Oversees department strategies, operational success and financial objectives for over 350 employees and 75 physicians at an academic health system
- Improved Coding and Billing process for Department to enhance clinical representation and revenue generation for department
- Successfully built OR Surgical Strategy for block time utilization and revenue maximization
- Designed residency rotations in clinic with Attending Physician oversight modeling
- Leadership Member of the UC Health Women's Health Domain
- Led Growth Access Strategy and process rollout for entire department increasing visit volumes and RVU and revenue goals
- Collaborative Lead on program development with Emergency Medicine, Hospital Medicine, Family Medicine,Transitional Care supporting Medical Home Model and Population Health Initiatives
- Graduate of the UC Healthcare Leaders Academy
- elemedicine Planning and Rollout Experience, strong Post Acute Strategy skills to help physicians and hospitals place patients in the appropriate level of care locations and build clinical handoffs
- Physician Practice Management consulting to include evaluation of existing practices and defining new practices to improve efficiency and profitability
- Engages operations staff, Site Medical Directors and Client to achieve desired results
- Build and maintain relationships with client hospital personnel to evaluate and to improve patient flow and clinical modeling in the hospitalist and emergency medicine space of the hospital
- Includes preparation for client meetings; fully understands contractual requirements, current issues and client expectations
- Actively engages client management and communicates value added services; demonstrates a strong command of the business
- Drive key performance metrics and help client practices and hospitals define metrics for analysis and dashboarding
- Work with
- Clinical Services, Practice Improvement and Division Management to create and drive strategies and workflow processes
- Analyzes revenue cycle management processes and makes recommendations for improvements with billing, collections and denial management.
- Worked closely with organizational leadership and board of directors to guide operational strategy
Director
Anthem Blue Cross and Blue Shield
Independence, Ohio
01.2019 - 06.2021
- Provider Solutions and Analytics
- Health System and Provider Contracting and Client Solutions by using analytic tools to track both health risks and compliance, as well as leading the contract negotiation process
- Currently working with Ohio Health Systems and Providers: Cleveland Clinic Health System, University Hospitals, Summa
- Health System, Mercy Health System, Emergency Medicine, Anesthesia, Hospitalist Companies, ACO’s, Physician
- Organizations and ASC Contracting
- Responsible for: analyses include performing sophisticated retrospective data analytics, building new and modifying existing complex models to create predictive impact decision making tools, performing healthcare cost analysis to identify strategies to control costs;projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis; preparing pre-negotiation analysis to support the development of defensible pricing strategies; performing modeling to compare various contract scenarios based on member utilization patterns measuring and evaluating the cost impact of various negotiation
- Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures
- Educates provider contractors on contracting analytics from a financial impact perspective
- Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable
- Educate and sell value based care programs for shared savings reimbursement to hospitals and providers.
CEO & Owner
ANALYTICAL MEDICINE
Akron, OH
01.2018 - Current
- Consulting
- Business Development Planning and market analysis
- Expertise in Clinical Transitions of Care, technological support and population health management strategies
- Integrated physician services in Emergency Medicine, Hospital Medicine, Radiology and Anesthesiology
- Project work includes analyzing financial metrics, drilling down to identify and address critical issues, defining alternatives including cost, risk and benefits and develops and recommends solutions that support long term profit and growth in the healthcare environment.Strategic planning initiatives analyzed and defined, leading process improvement mapping process.
Director of Hospitalist Operations
ENVISION PHYSICIAN SERVICES
Parsippany, NJ
01.2017 - 01.2018
- Provide consultative oversight to a new $12M contract with RWJUH System for emergency and hospital medicine
- Oversee 30 direct reports successfully providing clinical services in 25+ hospitals, LTACHs, and SNFs
- Manage profitability of assigned hospital/system contracts, including client retention and price negotiations
- Analyze financial and clinical metrics to identify and address critical issues
- Streamlined clinical hand off and enhanced patient throughput by creating innovative clinical care model for emergency and hospitalist medicine; researching competitive market analysis on reimbursement methodologies and clinical care models; and leading strategic planning sessions with senior medical leadership
- Improved billing and revenue cycle 40% in 1 year over baseline in hospitalist service line by restructuring charge capture and coding process and educating clinicians on current documentation criteria
- Led hospitalist operational rollout of 9 new programs within a tight 12 month deadline, meeting RWJBH
- System contract obligations by recruiting, hiring, negotiating contracts for 70+ physicians and support staff
- Ensured accurate clinical metric tracking to meet Medicare guidelines by analyzing 2018 MIPS criteria
- Identified key performance metric analytics and development of integrated scorecard for RWJBH Emergency
- Medicine and Hospital Medicine program, accomplishing risk-based metric achievement at 97.5% for first year
- Investigated literature and quantified hospital medicine quality and financial measures for Envision NE
- Operating Unit Hospitalist Service Line, defining operational report metrics and dashboard
- Maximized effectiveness and productivity of hospital support staff by redesigning and restructuring roles and responsibilities for 30+ Envision employees at 20+ hospital facilities
- Formulated strategic plan for roll out of key clinical initiatives across RWJBH system through facilitating and collaborating with regional and site medical directors and at system-wide meetings
- Led project management for ED/HM clinical handoff tool and protocol development which improved ED flow metrics below CMS national average, patient throughput, and denied days for medical necessity
- Designed and implemented patient throughput plan for RWJBH by looking at ED patient admission and discharge process, delays in discharge, bed placement, case management role, and throughput committee startups at client hospitals
- Partnered with clinical leadership to roll out telemedicine initiatives with managed care payers, boosting covered lives in New Jersey’s program to 80K with 24/7 clinical coverage through BCBS program
- Decreased medical observation length of stay (OBS LOS) 14.75 hours on average for all client hospitals and provided cost savings by analyzing and creating rapid-decision unit (RDU)/observation and hospital medicine playbooks for operating units
- Reduced denied days 23% in the first 3 months by successfully rolling out an observation unit at Hamilton Medical
- Center with 12 beds.
Director
US ACUTE CARE SERVICES
Canton, OH
01.2015 - 01.2017
- Integrated Acute Care Operations and Performance
- Executed development of startup hospitalist service line to existing national emergency medicine company
- Supported RFP process with CEO to build contracts nationally for integrated physician services
- Worked with the Hospitalist VP of
- Operations to establish service goals and objectives for the new division
- Defined company roles and policies for startup
- Defined USACS hospitalist strategic analysis and implemented national strategy for integrated emergency and hospital medicine services
- Defined value statement for new organization to include branding, mission statement, marketing, and RFP and proposal content by building job descriptions, designing hospitalist service line model to scale for national growth, creating the outline for advanced practice practitioners model, and identifying key performance indicators and business intelligence tools for tracking quality measures
- Crafted business development plan and supported effective RFP process with CEO and CMO
- Successfully showcased an integrated clinical model and won a contract with Allegany Health System
- Presented to Carolinas Health System, Catholic
- Health Initiatives Health System, and Mercy Health System
- Outlined quality measures and key performance indicators effectively for collection and reporting to NCQA and CMS
- Successfully negotiated risk-based contracts with clients based on collaborative KPI’s and reimbursement models
- Secured additional contracts for service within Allegany Health System by spearheading strategy for build out of post-acute care as part of continuum-of-care service line and helping define staffing models and clinical handoff tools
- Established onboarding and educational curriculum for integrated acute-care physicians and extenders, resulting in hiring new providers with an effective training process
- Hired and negotiated physician and extender contracts, job descriptions, and hospital assignments, providing startup clinicians for Allegany Health System and building out hospitalist programs where existing emergency medicine services existed.
Vice President
INPATIENT MEDICAL SERVICES
Fairlawn, OH
01.2010 - 01.2015
- Business Development and Operations
- Acted as senior member with physician owners providing analytical and business development skills to set company strategic plans for growth and lead operational efficiencies for hospitalist services in client hospitals
- Supported service line development for financial growth and client interface to build business and to assure contracted deliverables
- Senior
- Management Leader 100+ physicians in 14 hospitals and 30 post-acute facilities
- Drove process for establishing annual success measures for each strategic initiative, building revenue and EBITDA year over year
- Launched strategic growth roadmap for a multi-year strategic initiative that increased profit from $8M to $11M at time of private equity purchase
- Achieved significant growth with physician and hospitalist contracts in NE Ohio and Great Lakes region during 5-year leadership, hiring 39 physicians and adding 22 contracts for service
- Negotiated and executed value-based contracts with hospitals, post-acute facilities, and managed-care payers including
- Anthem, BCBS, United, and Medical Mutual
- Offered coding and billing expertise for fee-for-service and value-based care reimbursement, increasing revenue and educating clinicians to accurately code, bill, and collect
- Implemented Clinical RN Patient Call Center, handling 200 patient discharge calls per day
- Established pre-admission testing program for Summa Health System, lowering surgical cancelations.
Education
Master of Business Administration (MBA) - HealthCare Administration
Akron University
Bachelor of Science (BS) - Business Administration/Chemistry
Ashland University
Skills
Healthcare Strategy, Business Development, Clinical Revenue Generation, Patient Throughput Strategies, Data Analysis, Outcomes Performance, Clinical Co Medical Management, Physician Oversight, RVU Modeling, Surgical Optimization, Contract Negotiation Skills for Physicians and Payers, EPIC, RCM expertise
undefinedTimeline
Director, Clinical Operations, UC Health
University of Cincinnati Health
06.2021 - Current
Director
Anthem Blue Cross and Blue Shield
01.2019 - 06.2021
CEO & Owner
ANALYTICAL MEDICINE
01.2018 - Current
Director of Hospitalist Operations
ENVISION PHYSICIAN SERVICES
01.2017 - 01.2018
Director
US ACUTE CARE SERVICES
01.2015 - 01.2017
Vice President
INPATIENT MEDICAL SERVICES
01.2010 - 01.2015
Master of Business Administration (MBA) - HealthCare Administration
Akron University
Bachelor of Science (BS) - Business Administration/Chemistry
Ashland University
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