KRISTA M. WILLIAMS
Long Beach,CA
Summary
Experienced Program Manager with years of leading, designing, and evaluating youth development programs across schools, nonprofits, healthcare systems and community organizations. Skilled at building strong partnerships, managing multi-site program operations, and delivering evidence based strategies that support youth engagement, academic success, social-emotional learning, and overall well being. Recognized for improving program outcomes, training staff, and implementing strategies that promote safe, inclusive, and youth-centered environments. Proven track record of successfully overseeing complex projects from inception to completion.
Overview
10
10
years of professional experience
Work History
Grievance & Appeals Nurse Specialist
CalOptima Health
03.2024 - Current
- Expedited and standard nurse reviews for all lines of business
- Process appeals timely according to state regulations, compliance standard and department policies and procedures.
- Collect all necessary clinical information from providers, contact members for information and review cases based on benefits, regulations and plan policies for a fair and concise determination.
- Present case to medical directors for final review.
- Responsible for decision notifications to members via phone call and letter within the regulatory timelines.
- Discuss appeal process, medical decision and state fair hearing rights with members.
- Work with other Healthplans and medical groups for member effectuation (overturned authorizations) when appropriate.
President, Board of Directors
RACCS (Reaching Across Communities and Challenging Systems) Non Profit
01.2023 - Current
- Led strategic planning initiatives to enhance organizational effectiveness and community outreach.
- Oversaw budget development and financial management to ensure fiscal sustainability and accountability.
- Fostered partnerships with local agencies to expand service offerings and improve community impact.
- Guided board members in governance best practices, ensuring compliance with legal and ethical standards.
- Represent the organization at public events, media interviews, and stakeholder meetings to enhance visibility and partnerships.
Program Manager Consultant-Youth Programs
JW1
03.2024 - 03.2025
- Lead consulting projects supporting youth development initiatives for schools, nonprofits, and community agencies.
- Led cross-functional teams to implement strategic initiatives, enhancing program efficiency and stakeholder engagement.
- Developed comprehensive project plans, defining scope, objectives, and deliverables to align with organizational goals.
- Facilitated workshops and training sessions to improve team collaboration and skill development across departments.
- Analyzed program performance metrics, identifying areas for improvement and ensuring alignment with best practices.
- Maintain strong client relationships, serving as primary liaison with school districts, youth agencies, and partner organizations.
Supervisor, Utilization management
CalOptima Health
08.2023 - 03.2024
- Manage and oversee prior auth review nurses and coordinators to ensure compliance with applicable regulatory guidelines, policies and procedures.
- Collaborate with interdepartmental teams to resolve complex care member issues.
- Work with senior leadership to track UM resources to ensure adherence performance, compliance, quality, and efficiency standards.
- Meet with my team weekly to discuss successes and to identify opportunities for process and quality improvements.
- Develop and update UM workflows and policies for process improvement/functionality
- Spearhead as department lead/ representative for new system (JIVA) implementation.
- Provide testing and training lessons for new system (JIVA) implementation.
- Assisted in hiring, onboarding and training of new UM team members.
- Perform annual reviews and goal setting with direct reports.
Utilization Management Manager
Altais
04.2023 - 07.2023
- Delegate and assign daily task to the prior auth nurse review and coordinator team.
- Monitor review teams and support staff to meet performance and regulatory turn around targets.
- Manage policies and procedures of the outpatient services while tracking service outliers and any over utilization.
- Oversee clinical decision-making process based on regulatory guidelines, policy and procedures.
- Monitor KPIs, identify trends, and implement process improvements to reduce unnecessary utilization and denial rates.
- Manage call center coordinators for the virtual visit care team.
- Support with audit readiness, appeals, and regulatory reporting.
Internal Appeal Associate Manager
Oscar Health
07.2018 - 03.2023
- Lead and supervise the day-to-day operations for the denials and appeals team, ensuring productivity and quality standards are met.
- Develop and implement best practices for appeal reviews while remaining compliant based on regulatory guidelines and Healthplan policies and procedures.
- Oversee trainings, coaching and performance management of the appeals team while fostering a positive team culture.
- Support with audit readiness, appeals, and regulatory reporting.
- Review complex cases and work with interdisciplinary teams to provide fair and quality case reviews.
- Collaborate with Independent Review Organizations (IROs) for same/similar specialty reviews.
- Analyze denial trends, reimbursement issues and provider disputes to develop process improvements.
Utilization Review Manager
Altamed Health Services
02.2016 - 03.2018
- Led utilization review processes to ensure compliance with regulatory standards and organizational policies.
- Developed training programs for staff on best practices in utilization management and documentation requirements.
- Oversaw the evaluation of clinical data to optimize patient care and resource allocation across services.
- Collaborated with interdisciplinary teams to enhance care coordination and streamline service delivery workflows.
- Implemented strategies to identify opportunities for cost savings while maintaining high-quality patient outcomes.
Education
Licensed Practical Nursing Program -
Pacific College
Costa Mesa, CA07.2013
Bachelor of Arts - Communication Studies
California State University Long Beach
Long Beach, CA05.2009
Skills
- Written and interpersonal skills
- Scope management
- Team supervision
- Business analysis
- Budget management
- Service coordination
- Excellent communication
- Excellent organization skills
- Ability to manage and prioritize the daily work effectively
- Conflict management
- Problem solving skills
- MS Office (Word, excel, PowerPoint, Outlook, Teams)
- Power BI (spreadsheets, reports, data entry)
- Google Dashboards (Slack, Workday, Okta)
- Project management
- Strategic planning
- Critical thinking
Personal Information
- LVN CA License- 279231, CM Certified
Timeline
Program Manager Consultant-Youth Programs
JW1
03.2024 - 03.2025
Grievance & Appeals Nurse Specialist
CalOptima Health
03.2024 - Current
Supervisor, Utilization management
CalOptima Health
08.2023 - 03.2024
Utilization Management Manager
Altais
04.2023 - 07.2023
President, Board of Directors
RACCS (Reaching Across Communities and Challenging Systems) Non Profit
01.2023 - Current
Internal Appeal Associate Manager
Oscar Health
07.2018 - 03.2023
Utilization Review Manager
Altamed Health Services
02.2016 - 03.2018
Bachelor of Arts - Communication Studies
California State University Long Beach
Licensed Practical Nursing Program -
Pacific College