Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Iris Vela

Houston,TX

Summary

Growth-oriented healthcare professional with a clinical background and a passion for shaping strategy, driving innovation, and building collaborative partnerships. Known for bridging clinical expertise with business goals to inform decision-making, enhance service delivery, and support scalable, patient-centered solutions. Skilled in cross-functional collaboration, strategic planning, and delivering clinical insights that align with organizational growth and impact.

Overview

7
7
years of professional experience
1
1
Certification

Work History

Provider Partnerships Manager

Delfina
01.2025 - Current
  • Identify, recruit, and onboard new provider partners in alignment with network expansion goals.
  • Develop and maintain strong, collaborative relationships with existing providers to ensure satisfaction and retention.
  • Negotiate and manage provider contracts, pricing structures, and service level agreements.
  • Monitor provider performance metrics (e.g. quality, cost, satisfaction) and implement improvement initiatives as needed.
  • Coordinate with cross-functional teams to ensure provider needs and compliance requirements are met.
  • Stay updated on industry regulations, trends, and competitive activity to inform strategic decisions.

Clinical Assessment Specialist

The Menninger Clinic
Houston, TX
09.2023 - 12.2024
  • Conducted clinical intake and screening to identify gaps in care and help prospective clients understand the real-world impact of integrated behavioral health services.
  • Informed commercial strategy with clinical insights, helping shape product positioning, employer education campaigns, and sales enablement materials.
  • Served as a strategic liaison between clinical operations and business development to ensure alignment across service delivery, client expectations, and scalability.
  • Contributed to post-sale implementation and partner success by advising on care navigation, engagement best practices, and integration within existing benefits ecosystems.

Clinical Nurse Consultant

EPIC Brokers & Insurance Consultants
05.2023 - 02.2024
  • Managed clinical case reviews and care coordination for members under self-funded employer health plans, ensuring timely access to appropriate, cost-effective care.
  • Collaborated with third-party administrators (TPAs), stop-loss carriers, and provider networks to implement care strategies that reduced high-cost claims, and improved member outcomes.
  • Conducted needs assessments, developed care plans, and coordinated services for complex, chronic, and high-risk cases across medical and behavioral health domains.
  • Advised employer clients and brokers on clinical trends, utilization patterns, and opportunities for early intervention or cost containment.
  • Served as a liaison between members, providers, and plan administrators to resolve escalated issues and navigate benefits, prior authorizations, and treatment plans.
  • Analyzed claims and population health data to identify candidates for case management and flag potential large-loss exposures.
  • Ensured documentation met HIPAA, URAC, and ERISA compliance standards; maintained accurate and timely records in case management platforms.
  • Supported health plan strategy by contributing to clinical reporting, vendor performance reviews, and program design recommendations.

Quality Letter Auditor

United Healthcare
06.2018 - 05.2023
  • Audited member and provider correspondence (e.g., denial, approval, and appeal letters) to ensure compliance with CMS, NCQA, and internal policy standards.
  • Reviewed outbound communications for accuracy, completeness, clinical appropriateness, and adherence to federal and state regulatory guidelines.
  • Identified quality and process gaps in letter generation, recommending corrective actions, and participating in root cause analysis to improve compliance rates.
  • Tracked audit outcomes and trends to support continuous quality improvement (CQI) initiatives, reporting findings to leadership and compliance teams.
  • Maintained detailed documentation of audit results and corrective actions in compliance with HIPAA and internal record-keeping policies.

Education

Bachelor of Science - Nursing

The University of Texas At Arlington
Arlington, TX

Skills

  • Nurse-Led Sales Strategy
  • Healthcare Market Insight
  • Account Management
  • Persuasive Communication
  • Clinical Consultative Selling
  • Program Development & Implementation
  • Interdisciplinary Team Leadership
  • Negotiation & Conflict Resolution
  • Training & Education
  • Operational Efficiency
  • Utilization Review & Cost Containment
  • Emotional Intelligence & Empathy
  • KPI & Outcome Reporting
  • Time & Territory Management
  • Product Knowledge Development
  • Strategic Communication
  • Client Relationship Management
  • Problem Solving & Critical Thinking
  • Cross-Functional Collaboration
  • EMR & CRM Proficiency

Certification

  • Registered Nurse (Compact) - Texas Board of Nursing
  • Registered Nurse - California Board of Registered Nursing
  • Lifestyle Wellness Certification - University of Texas at El Paso

Timeline

Provider Partnerships Manager

Delfina
01.2025 - Current

Clinical Assessment Specialist

The Menninger Clinic
09.2023 - 12.2024

Clinical Nurse Consultant

EPIC Brokers & Insurance Consultants
05.2023 - 02.2024

Quality Letter Auditor

United Healthcare
06.2018 - 05.2023

Bachelor of Science - Nursing

The University of Texas At Arlington

Similar Profiles

CREATE PROFILE