Kimberly W. Webb
United States
Summary
Accomplished Nurse executive leader with 15+ years of managed care experience and key responsibility for clinical operations; passionate about leading multidisciplinary teams to transform health delivery and improve outcomes. Proven ability to analyze business needs, lead the delivery of value- added solutions and identify population health opportunities. Record of initiating and maintaining cross-team relationships with providers, community organizations, health systems, and operational teams; resulting in measurable improvements in value-based care and quality. Demonstrated success in curating a culture that fosters high team engagement, authenticity, integrity and retention. Enthused to continue to develop and implement value based care initiatives that push the boundaries of what is possible in healthcare by changing the lives of individuals and communities.
Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Nurse Executive with a Master of Science in Population Health Management.
Overview
20
20
years of professional experience
2
2
Certification
Work History
Vice President Health Strategy Consultant
Siftwell Analytics
08.2024 - Current
- Advises Business Development, Marketing, Data Analytics, Product Development and Customer Success on Population Health and Medical Management Strageties and Operations
- Designs proprietary tools for Medicaid and Marketplace populations leveraging Artificial Intelligence
- Provides thought leadership on key healthcare initiatives, participates in the design of analytical studies
- Presents the functions and features of Analytical tools and methodology through marketing activities, publications, webinars, events and conferences regionally and nationally
- Develops and maintains external relationships and partnerships that advances Siftwell in the health insurance marketplace and favorable positive for new and prospective markets and clients
- Partners with Product Management and Data Analytics to customize AI models to identify emerging risk cohorts, gaps in care, health-related social needs, provider network congruency and aide in deploying personalized, targeted outreach interventions and campaigns
- Collaborates with Customer Success team to drive successful client implementations for measurable results and provides consultative services to support implementing the analytical solution and leverage technology to optimize cost per unit/case measures and reports on the impact of targeted clinical, quality, and marketing campaigns
- Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills.
Vice President Population Health Clinical Operation
AmeriHealth
10.2021 - 07.2024
- Provided leadership, direction and oversight on a multi-state, multi-product (Marketplace, Medicaid, Medicare) clinical and population health division. Consisting of 8 direct reports 1,000+ indirect multidisciplinary team who supported 17 contracts addressing physical, mental and social care needs of 3+ million members.
- Integrated and streamlined Physical health, Behavioral health and Social Health processes and teams for improved quality outcomes, access, and positive member experience.
- Key responsibility for Marketplace (ACA), Medicaid (Foster), and Medicare (DSNP and MMP)
- Partnered with cross-functional and P&L leaders to develop and implement strategic population health operational plans across the enterprise to ensure compliance with contract and regulatory standards for all local markets.
- Developed annual initiatives, and prepared, monitored, and analyzed variances of departmental, market, and vendor budgets, in order to, control and appropriately allocate resources; Delivered operational administrative savings of $18.5 million
- Oversight and execution of strategic plan(s) in compliance with relevant accreditation, regulatory and contractual requirements.
- HRA/ HOS revisions and improvements, automation, and aggregation of responses into the Medical Management platform resulting in improved efficiency and end-user/ member increased satisfaction exceeding market Performance metrics.
- Audit/Accreditation coordination and execution- Develop and implement a strong process that delivers achievement of appropriate NCQA accreditation and annual External Quality Audits across all lines of business as required by contractual language to achieve service excellence
- Develop proposed responses for six (6) State requests for proposals (RFPs) for population health
- Cultivated strong relationships with key stakeholders, including customers, vendors, regulators, and community leaders to promote collaboration and long-term success.
Associate Vice President, – Strategy & Integration, Clinical Operations
Cardinal Innovations Healthcare
08.2020 - 09.2021
- Company Overview: (Company acquired)
- Astute program and strategic business solutions leader who thrived in a collaborative environment driving program management, portfolio management and business analysis strategies to optimize the performance of the organization’s population health and clinical operational teams
- Designed and developed programs and products that integrated clinical and community/member organizations.
- Partnered with Vice Presidents of Network, Population Health, Quality & Community Operations on design, implementation, and outcomes evaluation of services and programs.
- Streamlined utilization management (UM) program for Foster, Intellectual development and disability (I/DD).
- Monitored utilization patterns such as demographics of service, revenue, and expenditures.
- Presented status of key performance indicators and made recommendations of continuous improvement opportunities to Executive leadership team.
- Developed behavioral and mental health programs that integrated programs and population segments.
- Created new initiatives with vendors and provider partners to ensure programs complied with state contract requirements.
- Designed educational programs for external stakeholders (health systems, community-based organizations and Consumer/Family Advocacy Committee).
- Championed diversity and inclusion efforts within the organization, successfully implementing policies and programs that promoted equal opportunities for all employees, regardless of background or identity.
Executive Director – Clinical Center of Excellence
Magellan Health, Inc.
01.2016 - 01.2020
- Directed the strategy and operational activities of 200+ indirect reports that provided case management, and utilization management for Medicaid, Medicare, and commercial populations.
- Developed and implemented plans and objectives for the division to align with overall, corporate level goals and priorities.
- Restructured cost-of-care initiative and redefined measures to analyze clinical, financial, and quality outcomes.
- Developed, Monitored, Analyzed variances, key performance indicators, service level agreements, and objective key results.
- Ensured integrated clinical models for care and utilization management were medically appropriate and reflected federal and state requirements for Marketplace, Medicaid, and Medicare population.
- Oversaw initiatives for quality improvement and NCQA & URAC accreditation.
- Decreased ALOS by 1.5 days, readmission rates by 7%, and AHT by 32 to 21 minutes within six months.
- Restructured underperforming team by implementing an evidence-based medical necessity framework, Milliman Care Guideline.
- Designed, enhanced, and implemented clinical programs that served a diverse population across multiple health plans and markets.
- CDC Diabetes Prevention Program, a digital platform for Complex Case management, and Employer Health & wellness programs.
Senior Director – Central Care Management Operations
Evolent Health
01.2013 - 01.2016
- Key responsibility for operations of the Department, including coaching and guiding individuals and teams in order to implement department, divisional and organizational mission/goal.
- A multi-disciplinary team, clinical and non-clinical, to deliver population health in six regional markets with a $10.6M annual budget.
- Served as clinical SME for continuity of care
- Lead presenter for NCQA accreditation and certification activities.
- Increased disease management enrollment by 15% and decreased emergency utilization by 10%.
- Turned around an underperforming team reassigning members into geo-pods, redesigning case management programs, and hiring/training new staff.
- Received 'Excellence in All' award for amending value-based contracts with payors, improving performance of central operations, increased patient satisfaction by 12%, and decreasing medically inappropriate utilization.
Regional Director
CareFirst Blue Cross Blue Shield, Patient-Centered Medical Home
01.2010 - 01.2013
- Executive leader with a budget of $250M, consisting of 350+ primary providers with 34 direct reports (nurses and provider network) serving Federal Employee Plan (FEP), Commercial, and Medigap Populations on population health analysis and trends
- Led, managed, and implemented effective standards, protocols processes and decisions supports to improve and promote quality and clinical outcomes by identifying preventable factors to reduce preventable hospitalizations, readmissions, and ER visits.
- Hired, trained, coached, counseled, and evaluated the performance of 34 direct reports.
- Cost share savings within the region of $22M by providing physician groups with population health analysis and monthly, quarterly and annual cost trends for their attributed and identifying opportunities for care coordination, access, cost, and quality.
- Supported Care Management / Coordination Providers; ensured thorough understanding of Care First programs and performance expectations.
Previous Tenures
- Medstar, Clinical Resource Management, per diem, 2013 – 2017
- Home Health & Emergency Room RN (2007-2010)
- Cardio-Metabolic Consultant at Novartis Pharmaceuticals (2004-2007)
- Captain, United States Air Force- Nurse, (2000-2004)
Education
Bachelor of Science - Registered Nurse (cum laude)
Tennessee State University
Nashville, TNMaster Science - Population Health Management
The Johns Hopkins University
Baltimore, MD05-2023
Skills
- Healthcare Operations
- Program Development
- Physical, Behavioral and Social Integration
- Leadership
- Care Coordination/Management
- Process Improvement
- Utilization Management
- Change Management
- Provider Engagement
- Value-Based Care
- CAHPS/HEDIS
- Managed Care Contracts
- Vendor Relationships
- Regulatory Compliance
- Accreditation
- Problem-solving
- Teamwork and collaboration
Certification
- Active, unrestricted Compact Registered Nurse license, Maryland, 2000-2024
- Certified Case Manager, Commission for Case Management Certification, 2016-2026
- Health Care Strategy, Harvard Business Online, 09/01/24
Affiliations
- National Honor Society of Nursing, Sigma Theta Tau, Pi Upsilon
- Case Management Society of America
- Coordinator for Institute of Exceptional Care (IEC) Policy Group
- National Association of Health Services Executives (NAHSE)
- American Health Information Management Association (AHIMA)
Previous tenures
- Clinical Resource Management, Medstar, 01/01/13 -12/31/18
- Home Health & Emergency Room RN, 01/01/07 -12/31/10
- Cardio-Metabolic Consultant, Novartis Pharmaceuticals, 01/01/04 - 12/31/07
- Captain, United States Air Force- Nurse, 01/01/00 - 12/31/04
Timeline
Vice President Health Strategy Consultant
Siftwell Analytics
08.2024 - Current
Vice President Population Health Clinical Operation
AmeriHealth
10.2021 - 07.2024
Associate Vice President, – Strategy & Integration, Clinical Operations
Cardinal Innovations Healthcare
08.2020 - 09.2021
Executive Director – Clinical Center of Excellence
Magellan Health, Inc.
01.2016 - 01.2020
Senior Director – Central Care Management Operations
Evolent Health
01.2013 - 01.2016
Regional Director
CareFirst Blue Cross Blue Shield, Patient-Centered Medical Home
01.2010 - 01.2013
Previous Tenures
Bachelor of Science - Registered Nurse (cum laude)
Tennessee State University
Master Science - Population Health Management
The Johns Hopkins University
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