Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

Khalisha Wilson

Healthcare Consultant
Philadelphia,PA

Summary

Versatile and strategic value-driven healthcare professional and consultant with experience in creating and providing quality care for 100+ Medicare/Medicaid participants. Firm understanding and intermediate efficiency of business applications for data analysis and implementing business solutions aimed at setting a standardized process for interdepartmental teams and cross- functionally collaborating with internal and external stakeholders.

Overview

5
years of professional experience

Work History

Guidehouse
Philadelphia, PA

Healthcare Strategy Consultant
12.2022 - 10.2023

Job overview

  • Contributed to assessments of current and future state Veterans Health Administration programs, strategize improvement action plans.
  • Collaborated with project team members on existing initiatives or the development initiation and execution of new Network adequacy projects, deviations and deliverables.
  • Reconciled conflicting healthcare network adequacy data to obtain clear measures of operational performance for the Department of Veterans Affairs.
  • Iterated and created standard operating procedures to ensure efficiency of VHA processes, policies and procedures
  • Supported the Veterans Health Administration with the implementation of contractual performance improvement initiatives to increase operational efficiencies and improve, reduce risk and improve patient experience within the community care network

AmeriHealth Caritas
Philadelphia, PA

Service Coordinator of Managed Care
05.2019 - 12.2022

Job overview

  • Managed, coordinated, and provided care consultation to 100+ Medicare and Medicaid recipients
  • Developed the facilitation of person-centered team meetings to improve plan of care for recipients through business applications and data analysis
  • Relationship management with 20 care management team members and 50+ healthcare providers to implement comprehensive needs assessments for all participants to address barriers related to social determinants of health.
  • Responsible for daily monitoring of authorization management, utilization management and claims processing within ELTSS to ensure accurate and quality delivery of waiver services.
  • Created customized care plans, collaborating with participants to assess and meet individual needs.


Cedarwoods Care Management
Philadelphia, PA

Senior Service Coordinator
08.2018 - 04.2019

Job overview

  • Provided consultation and implemented long term care management for 40 + Medicare and Medicaid participants.
  • Reduced participant incidents by 20% by conducting root cause analysis and creating recovery action steps and initiatives with care team.
  • Monitored and analyzed key metric reports and processes to ensure all critical incident reports aligned with state contractual obligations.
  • Performed detailed analysis on multiple cases, reccomend potential business solutions, and ensure successful implementations


Education

Holy Family University
Philadelphia, PA

MBA from Healthcare Administration
05.2019

Indiana University of Pennsylvania
Indiana, PA

Bachelor of Science from Human Resources Management
05.2015

Skills

  • Process Improvement
  • Project Management
  • Trend Analysis
  • Healthcare & Business Administration
  • Regulatory Compliance
  • Stakeholder Interviews
  • Business Analysis
  • Managed Care
  • Social Determinants of Health
  • Performance Management
  • Strategic Direction
  • Strong Problem Solving
  • Relationship Management
  • Leadership

Timeline

Healthcare Strategy Consultant

Guidehouse
12.2022 - 10.2023

Service Coordinator of Managed Care

AmeriHealth Caritas
05.2019 - 12.2022

Senior Service Coordinator

Cedarwoods Care Management
08.2018 - 04.2019

Holy Family University

MBA from Healthcare Administration

Indiana University of Pennsylvania

Bachelor of Science from Human Resources Management

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Khalisha WilsonHealthcare Consultant