Edna Dudley
Dallas
Summary
Strategic and results-driven healthcare executive with 12+ years of experience leading clinical operations, population health initiatives, and enterprise-wide care management programs. Proven expertise in operational transformation, regulatory compliance (NCQA, CMS), and performance optimization across Medicaid, Medicare, Marketplace, and Commercial lines of business. Skilled in driving multimillion-dollar cost containment, enhancing clinical quality, and aligning strategic objectives with organizational growth. Recognized for launching scalable, data-driven programs to reduce high-cost utilization and improve patient outcomes. Adept at cross-functional leadership, vendor governance, KPI development, and stakeholder engagement within complex, matrixed environments.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Associate Vice President, Healthcare Services
Molina Healthcare, Inc.
09.2020 - 05.2025
- Led comprehensive population health operations encompassing case management, disease management, quality improvement, and care transitions across Medicaid, Medicare, and Marketplace lines of business.
- Managed enterprise-wide initiatives to enhance health outcomes, meet regulatory benchmarks, and deliver cost-effective care solutions.
- Orchestrated creating and deploying a unified operational roadmap, integrating clinical priorities with financial goals and organizational growth strategies.
- Strengthened cross-functional accountability in clinical, quality, and financial areas by instituting robust performance metrics.
- Increased regulatory compliance for members with special healthcare needs by 94% by executing strategic workflow enhancements.
- Engineered a targeted intervention initiative focused on process optimization achieved over $7M in cost avoidance within six months.
- Decreased avoidable emergency room visits by 40% and inpatient admissions by 45% by launching a statewide community paramedicine program.
- Maximized program impact and investment returns by partnering with finance and vendor teams to align workforce planning, funding, and ROI metrics.
- Enhanced cost containment and outreach precision by designing a comprehensive enterprise dashboard to monitor high-utilization trends in ER and inpatient settings.
- Recognized with the 2023 Molina Excellence Award for demonstrating leadership in clinical innovation and delivering measurable improvements in population health outcomes.
Senior Director, Care Coordination
Healthcare Highways
09.2019 - 09.2020
- Oversaw enterprise-wide implementation of care coordination and care management strategies, ensuring effective alignment with service delivery and operational objectives.
- Launched an integrated clinical care management system encompassing standardized assessments, care plans, and process-driven workflows.
- Harmonized and streamlined workflows across care models to enhance efficiency and scalability.
- Delivered expert consultation as a recognized subject matter expert on care coordination for vulnerable populations.
- Collaborated with ACOs and community-based organizations to strengthen access to care and reduce preventable expenditures.
- Achieved scalable care coordination outcomes by deploying operational playbooks to guide management models.
- Secured top-tier performance recognition by consistently achieving strategic goals and sustaining high-impact results.
- Advanced national strategy execution by forging and nurturing collaborative relationships with regional stakeholders.
- Ensured regulatory and clinical compliance by verifying consistent, high-quality care service delivery for HCH clients.
- Delivered measurable innovation and operational efficiency improvements by orchestrating complex, high-impact clinical initiatives.
- Closed workforce capability gaps by evaluating staffing needs and spearheading targeted recruitment, onboarding, and skill-building programs.
- Expanded member access to essential community support services by leveraging partnerships with ACOs, healthcare systems, and post-acute providers.
- Surpassed organizational benchmarks and expectations by establishing and institutionalizing a comprehensive care management program.
Director, Healthcare Services
Molina Healthcare
09.2016 - 09.2019
- Directed daily service operations and evaluated program performance to identify areas for enhancement.
- Executed strategic modifications and development initiatives to ensure alignment with federal and state regulatory frameworks.
- Functioned as clinical operations authority, contributing expertise across cross-functional corporate committees to advance procedural efficiencies.
- Integrated operational workflows with clinical care models to fulfill compliance mandates.
- Achieved top-tier performance ratings for three consecutive years by exceeding annual evaluation benchmarks.
- Improved 30% regulatory compliance and eliminated financial penalty risks by introducing targeted process enhancements.
- Strengthened organizational readiness and operational consistency by developing training programs, standard operating procedures, and policy frameworks.
- Maintained high productivity levels and exceeded satisfaction benchmarks by sustaining optimal staffing ratios and consistent service delivery standards.
Supervisor, Case Management & Disease Management
BlueCross BlueShield
01.2012 - 09.2016
- Administered managed care operations across multiple clinical disciplines, including Case Management and Disease Management.
- Formulated and instituted comprehensive policies and procedures to ensure regulatory compliance and operational efficiency.
- Established scalable workflows, documentation protocols, and communication frameworks to streamline managed care activities.
- Coordinated cross-functional initiatives to enhance collaboration and deliver cost-effective healthcare solutions.
- Achieved over $5M in cost savings by driving strategic process improvements and leading system overhauls.
- Recognized with Spirit Award in 2013, 2015, and 2016 by fostering team excellence and delivering high-impact contributions.
- Exceeded performance benchmarks for four consecutive years by optimizing operational workflows and aligning team output with corporate goals.
RN Case Management Specialist
Cigna
10.2010 - 12.2011
- Conducted comprehensive assessments of members’ physical, psychological, and social needs to determine appropriate care plans.
- Developed and coordinated individualized case management plans in collaboration with providers, ensuring alignment with clinical guidelines and member goals.
- Monitored utilization of medical services to promote cost-effective care while maintaining quality standards.
- Analyzed clinical documentation/health plan benefits to determine medical necessity and service eligibility.
- Surpassed performance benchmarks through consistent achievement of service excellence and compliance standards.
- Oriented/equipped new team members with practical skills in integrated personal healthcare systems and operational procedures.
- Facilitated positive health outcomes by applying motivational interviewing, behavior modification strategies, and shared decision-making frameworks.
- Advanced organizational objectives by fostering cross-functional collaboration to deliver high-quality, safe, customer-focused services.
- Delivered individualized coaching and evidence-based guidance to support informed medical decisions and address care gaps among health plan members.
Education
Master of Science - Nursing
Oklahoma Baptist University
Shawnee, OKBachelor of Science - Nursing
Oklahoma Baptist University
Shawnee, OKAssociate of Applied Science - Nursing
Trinity Valley Community College
Athens, TXSkills
- Healthcare Operations Leadership
- Strategic Planning & Execution
- Population Health Management
- Cost Containment & Utilization Review
- Value-Based Care Models
- Cross-Functional Team Leadership
- Performance & Process Improvement
- Care Management Optimization
- Regulatory Compliance (CMS, NCQA)
- Clinical Program Development
- Data-Driven Decision Making
- Change Management & Transformation
- Vendor & Stakeholder Management
- Quality & Risk Management
Certification
- Registered Nurse (RN), Texas Board of Nursing, 785641
- Certified Case Manager, Commission for Case Manager, 4208726
- Licensed Vocational Nurse (LVN), Texas Board of Nursing, 212620
Timeline
Associate Vice President, Healthcare Services
Molina Healthcare, Inc.
09.2020 - 05.2025
Senior Director, Care Coordination
Healthcare Highways
09.2019 - 09.2020
Director, Healthcare Services
Molina Healthcare
09.2016 - 09.2019
Supervisor, Case Management & Disease Management
BlueCross BlueShield
01.2012 - 09.2016
RN Case Management Specialist
Cigna
10.2010 - 12.2011
Bachelor of Science - Nursing
Oklahoma Baptist University
Associate of Applied Science - Nursing
Trinity Valley Community College
Master of Science - Nursing
Oklahoma Baptist University
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