Jua'Nese Williams
Pine Castle,FL
Summary
Senior leader with extensive experience in care management and population health within the health plan managed care industry. Proven expertise in Medicare, Medicaid, CEGs, and healthcare population health care management software systems, along with a deep understanding of regulatory compliance. Highly skilled communicator with a talent for cultivating relationships and developing people, resulting in the creation of high-functioning performance teams. Committed to delivering excellence in service, quality, and care. Recognized as an expert in care management and population health improvement initiatives, consistently identifying optimization and operational opportunities for innovation and performance improvement. Adept at maximizing technology and innovation to drive strategic direction and achieve business and financial success. Demonstrates exceptional project management skills, effectively managing multiple projects and priorities. Known for strong operational management, negotiation, and problem-solving abilities, all while utilizing a high degree of emotional intelligence.
Overview
19
19
years of professional experience
1
1
Certification
Work History
LEAD CONSULTANT
Zircon Consulting, LLC
01.2022 - Current
- Provide strategic consultation to multiple healthcare organizations across the US providing oversight for operations, vendor partners to ensure compliance with federal and state regulatory standards, issue notice of action to health plans, vendors and providers identifying processes for improvement and recommendations
- Establish Centers of Excellence that ensure continuous optimization of system integration that enhance processes and organizational efficiencies
- Oversee Business Requirement Gathering, Gap Analysis Design and Built future-state workflows to ensure 'best practices' industry standards
- Proactively uses data analysis to identify opportunities for quality improvement and designs program enhancements to positively influence the effective delivery of quality care and the leadership teams that serve the population
- Analyze trends and metrics to develop solutions, provide coaching, feedback and education to the leadership network and associates, and build capability, improve performance, and resolve skills gaps through leadership development
- Negotiated new contracts with specific vendors that drove the delivery of services and reorganization of operations, creating efficiencies and improving profitability
SVP/ EXECUTIVE CONSULTANT
Wilreign Group
03.2017 - 12.2022
- Provide strategic consultation to multi-location business units/ operations and partner with the organization's leaders and teams to ensure compliance with standards, identify processes for improvement, and implement and facilitate custom training that incorporates the optimized processes, improving the overall health of the business!
- Act as Trusted Advisor, manage internal and external (such as vendor relations) stakeholders, drive completion of milestones, define the organization and departmental KPIs
- Serves as an organizational change agent, and oversight expert for care delivery operations, population health initiatives, and implementation across the organization
- Optimized and created new processes, policies, procedures, and leaders and teams within the organization that ensure compliance, improve metrics and care outcomes
- Responsible for setting up a Center of Excellence for sustainable growth, success, and outcomes, which cultivates a culture of quality and integrity and conducts ongoing oversight audits to evaluate new processes and programs making necessary changes as needed to achieve target
- Negotiate new contracts for services and conduct a business Analysis Assessment to identify root causes, and gaps within the business administration, operations, and financials to include business and resource needs, identify immediate and long-term appropriate solutions
- Prepare and present oversight audit results and assessment findings to business unit, senior management, and compliance teams
- Create an implementation plan for corrective action, that includes education, coaching, meetings, job aides, and initiation of onsite oversight visits; analyze the data to measure impact and metrics post-implementation
- Provide executive coaching to Senior Leadership Teams and utilize many 360-degree psychometric assessments for their professional and team development that fosters high-performance teams and drive organizational transformation
- Provide 1:1 coaching, feedback, and education to the organization's network and associates, build capability, improve performance, and resolve skills gaps through leadership development
CM/PH CONSULTANT & SME/CARE MANAGEMENT SYSTEM IMPLEMENTATION/TRAINER
Anoteros, LLC
03.2017 - 12.2022
- Trusted Advisor, manages internal and external (such as vendor relations) stakeholders, drives completion of CM/UM/AG specific milestones that would define the overall success of the overall operational effectiveness and system implementation that manages the task and records performed
- System implementation of Guiding Care
- Development of newly established business unit for care delivery such as Utilization Management, Appeals and Grievances based on federal and state regulatory guidelines and standards
- Develop standards of practice, administrative operating procedures and oversight committees and programs
- Created Job Aide step actions, quick reference guides, specific workflow teaching videos, and policy reference guides
- Gathered client business requirement, designed future state workflows ensuring 'best practices' industry standard and preparing for Leadership review and approval for specific functions within the population health modules within platform
- Created Visio for current and future state design to prepare for AH Kickoff and Requirement Gathering
- Led configuration and design sessions based on adoption of future state workflows industry best practices, and standard of practice
- Established training step module for Pop Health Module to incorporate full clinical end to end process
- Create job descriptions and roles for specific business units i.e., UM /AG staff
- Created SWOT analysis for newly established unit, rollout, and deployment plans
- Implement InterQual Connect, including custom client specific medical policy and conducting organization wide training on appropriateness and correct use of application
SENIOR DIRECTOR, CONSULTING
Highpoint Solutions
06.2013 - 03.2017
- Act as Trusted Advisor to multiple healthcare organizations across the US, manages internal and external (such as vendor relations) stakeholders, drives completion of milestones, defines organizational KPIs, and ensure all business units support overarching goal and efficiencies
- Serves as organizational change agent, oversight expert for care delivery operations, population health initiatives, and implementations across the organization including state and federal programs (New York State MLTC, FIDA and SNPs), Massachusetts Dual Health Plans (Mass Health, Medicare, Dual Eligible), and high Utilization Reduction Programs
- Expert Care Management optimized and created new processes, policies, procedures, and leaders and teams within organization that ensures compliance, improve metrics and care outcomes and Implementation of Care Management Solutions for Medicare and Medicaid health plans in NY and MA
- Optimize Medical Management programs and operations, deploying KPIs, implemented integrated care team that improved the quality of care and reduced LOS by 40% within 1st quarter of implementation
- Designed and built future-state workflows to ensure 'best practices' industry standards
SENIOR VICE PRESIDENT /LEAD CONSULTANT
iCoach&co, subsidiary of ICEA, Inc
11.2010 - 06.2013
- Provide strategic consultation to multiple healthcare organizations across the US providing oversight for operations, vendor partners to ensure compliance with federal and state regulatory standards, issue notice of action to health plans, vendors and providers identifying processes for improvement and recommendations
- Work with teams, providers and vendors in formularizing corrective actions plans and implementing training to correct the non-compliance
- Negotiated new contracts with specific vendors that drove the delivery of services and reorganization of operations, creating efficiencies and improving profitability
- Lead Business Requirement Gathering and Gap Analysis Design and Built future-state workflows to ensure 'best practices' industry standards
- Proactively uses data analysis to identify opportunities for quality improvement and designs program enhancements to positively influence the effective delivery of quality care and the leadership teams that serve the population
- Analyze trends and metrics to develop solutions, provide coaching, feedback and education to the leadership network and associates, and build capability, improve performance, and resolve skills gaps through leadership development
Manager, Consulting – CareAdvance Practice
The Trizetto Group
01.2009 - 11.2010
- Manage CareAdvance Enterprise client implementation, training and support software development life cycle (SDLC) enhancement
- Provide delivery leadership and manage teams to execute business strategy through establishing and facilitating effective care bridges between clinical and technical teams
- This includes leading business requirements sessions, determining and communicating gaps in product features/functionality and what is required for successful operations
- Business lead for client innovations specific to care management technology enabled
- Key Responsibilities: Product/Project Management, Setting engagement objectives and scope, Oversee work plans for multiple components of an engagement
- SDLC/Manage activities between product management workstreams
- Conduct client interviews and facilitate client meetings
- Resource Forecast and Demand, Performance Review and Appraisal, Coaching and Mentoring of Staff, Implementation and Training, Organization Change Management Lead
- Business Requirement Gathering and Gap Analysis, Design and Build future-state workflows to ensure industry 'best practices' and standards
- Configure Environment to support future state business and 3rd party integration and/or data feeds
- User Acceptance Testing, Product Training Delivery and Curriculum Development and End User Training Delivery and Curriculum Design by future state workflows
CLINICAL EDUCATION CONSULTANT
McKesson Health Solutions
01.2006 - 11.2008
- SME for InterQual Products and CERME, taught over 150 healthcare organizations and institutions including hospitals, managed care organizations, medical groups and physician practices, long term care and home health for appropriateness of care
- Trained InterQual Products and facilitated Regional Programs Delivery and development of Courseware for InterQual Medical Necessity and Certification Programs
- InterQual Certified Instructor for all McKesson InterQual Products and McKesson software programs including CERME, CCMS, STAR, Horizon, and Alliance partners
- Taught over 300 healthcare organizations and institutions including hospitals, managed care organizations, medical groups and physician practices, long term care and home health for appropriateness of care
- Clinical Auditor with focus on medical necessity and appropriateness of care for Target MS-DRG and short stay admission identified by Federal Government Program Integrity Contractors
- Instructor and Co- Author of Certified Professional in Utilization Review Programs (CPUR)
- Instructor and Co-Author of Certified Professional in Healthcare Management (CPHM)
Education
MBA - Health Administration
Kennedy Western University
Cheyenne, WY01.2003
Associate of Applied Science - Nursing
Valencia Community College,
Orlando, FL01.1989
Skills
- Strategic Partner and Trusted Advisor
- Change Agent Process Improvement
- Expert Regulatory Compliance
- Critical Thinking & Interpersonal Skills
- Improve Clinical Operations & Outcomes
- Mediation Skills, Negotiation Skills
- Cultivate Relationships, Build Relationships Internal and external
- Leadership & Oversight & Team Development
- Exceptional Communication Skills
- Digital transformation /Innovation management
- Organizational Management Team building
- Leadership Development
- Client relationship management
- Workflow Optimization/ Policy Development
- Vendor Management /Corporate Governance
Accomplishments
- Collaborated with team of over 500 in the development and system -wide implementations with various Health Plan, Providers, and Compliance.
- Achieved 100% provider engagement by introducing Authorization/ UM portal within Care Management systems and programs for requesting tasks.
- Resolved product issue through consumer testing.
Certification
- Certified Professional Coach w/ Accredit Coaching Model and Educator
- Myers – Brigg Level 3 Practitioner and Trainer
- FIRO-B Practitioner
- Strong Inventory Practitioner
Timeline
LEAD CONSULTANT
Zircon Consulting, LLC
01.2022 - Current
SVP/ EXECUTIVE CONSULTANT
Wilreign Group
03.2017 - 12.2022
CM/PH CONSULTANT & SME/CARE MANAGEMENT SYSTEM IMPLEMENTATION/TRAINER
Anoteros, LLC
03.2017 - 12.2022
SENIOR DIRECTOR, CONSULTING
Highpoint Solutions
06.2013 - 03.2017
SENIOR VICE PRESIDENT /LEAD CONSULTANT
iCoach&co, subsidiary of ICEA, Inc
11.2010 - 06.2013
Manager, Consulting – CareAdvance Practice
The Trizetto Group
01.2009 - 11.2010
CLINICAL EDUCATION CONSULTANT
McKesson Health Solutions
01.2006 - 11.2008
- Certified Professional Coach w/ Accredit Coaching Model and Educator
- Myers – Brigg Level 3 Practitioner and Trainer
- FIRO-B Practitioner
- Strong Inventory Practitioner
MBA - Health Administration
Kennedy Western University
Associate of Applied Science - Nursing
Valencia Community College,
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