James Coleman

• Oversee multiple lines of business across Inpatient and Outpatient Behavioral Health Utilization Management, ensuring compliance with regulatory requirements and optimizing operational efficiencies.
• Lead and develop high-performing teams across multiple states, driving engagement, retention, and professional growth while exceeding corporate performance benchmarks.
• Enhance organizational strategy by collaborating with executive leadership and cross-functional teams to implement innovative utilization management and quality improvement initiatives.
• Strengthen data-driven decision-making by analyzing utilization trends, cost-containment strategies, and clinical outcomes to improve service delivery and financial performance.
• Elevate stakeholder engagement through executive-level reporting and strategic presentations to Utilization Management Advisory Committees (UMAC), Quality Improvement Committees (QIC), and senior leadership, influencing policy and process enhancements.
• Expand process optimization initiatives by leading LEAN and workflow transformation projects, streamlining operations to improve efficiency, reduce costs, and enhance patient care outcomes.
• Spearhead compliance and accreditation readiness efforts, ensuring alignment with NCQA, CMS, and state-specific regulatory guidelines to uphold the highest standards of care and service.
• Mentor and develop future leaders by designing structured leadership training, preceptor programs, and professional development initiatives, fostering a strong pipeline of talent.

• Perform talent management such as, but not limited to, interviewing and hiring, training/onboarding, employee coaching & development, performance evaluations.
• Supervise daily activities of the behavioral health utilization management employees ensuring performance standards are met following NCQA, CMS, Corporate, and state & federal guidelines.
• Proactively monitor appropriate metrics and perform audits to drive efficiency.
• Develop and maintain business relationships internally and externally (providers, market leaders, vendors).
• Serve as subject matter expert and official department trainer for MCG.
• (Acquisition of WellCare Health Plans, Inc. by Centene Corporation finalized Jan 2020)

• Developed and provided departmental training on the MARx data system for the purpose of checking & understanding Medicare Benefit limits.
• Actively engaged in the department Preceptor program to facilitate training and on-boarding of new hires across the department.
• Active participant in the CareCentral/UAT testing and implementation for the BH department.
• Proven track record of consistently exceeding departmental and corporate operational standards and expectations.
• Provide direct clinical support to on-boarding staff, ensuring optimization of organizational and clinical processes.
• Engaged in collaborative efforts w/colleagues and management to develop and implement cohesive transitions for new programs, processes, and departments as a part of organizational growth.

Developed and delivered training on MARx data system for Medicare Benefit limits analysis.

Facilitated new hires' onboarding through active participation in the Preceptor program.

Participated in CareCentral/UAT testing and implementation for the Behavioral Health department.

Consistently surpassed departmental and corporate operational standards and expectations.

Provided clinical support to new staff, optimizing organizational processes.

Collaborated with colleagues and management to implement cohesive transitions for new programs.

• Facilitated communication between providers and multidisciplinary teams.
• Managed case documentation in electronic health records systems.
• Educate providers on healthcare resources and support services.
• Ensured that all documentation is completed accurately according to state regulations.
• Monitored and evaluated the effectiveness of care plans to meet members' evolving needs, while ensuring optimal utilization of benefits and services.