Kristi L. Byrd
New Albany,IN
Summary
Experienced in clinical operations with a comprehensive background in optimizing processes, enhancing operational efficiency, and leading cross-functional teams. Demonstrated ability to drive impactful results through strategic planning and resource management. Valued for collaboration and adaptability in dynamic environments. Highly skilled in project management and process improvement.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Associate Director Clinical Services Delivery
Optum Home & Community Care Transitions
02.2022 - Current
- Enterprise partnership clinical lead for largest national external client (~3.6 million Medicare lives)
- Clinical and business process oversight and improvement across highly complex and matrixed organizations to ensure success
- Drive and monitor financial and operational KPIs
- Operationally accountable for seamless processes to achieve operational and client outcomes
- Experience managing complex initiatives across the entire lifecycle - from initial requirements gathering through release, rollout, and measurement
- Transition from naviHealth to Optum Home and Community
- Successfully navigating rebranding, leadership changes, negative press, and client transitions
- Strategic planning and project management including CMS compliance, NCQA compliance, managed care, Humana Health Plan Medicare Advantage
Senior Market Development Professional, Senior Products
Humana Inc.
01.2018 - 01.2022
- National Medicare market post-acute clinical operations oversight
- Clinical and business process oversight and improvement across highly complex and matrixed organizations to ensure success
- Vendor client relationship management
- Implementation and optimization of post-acute utilization management vendor in 36 states
- Project and initiative management of Post-Acute Strategy
- Post-acute subject matter expert
Clinical Policy Consultant
Humana Inc.
01.2017 - 01.2018
- Synthesized complex medical literature and distill findings into simplified deliverables able to be shared with a broad range of stakeholders both with and without clinical experience
- Analyze healthcare data
- Researched and synthesized complex healthcare regulatory landscapes, providing expertise on federal agency regulations and market access barriers
- Worked with senior leadership on drafting policy thought-pieces on a variety of Congressional and Administrative subject matter areas pertinent to Market Access and Regulatory clients
Clinical Consultant, Senior Products
Humana Inc.
02.2016 - 01.2017
- Education and mentorship among post-acute teams and external post-acute providers to facilitate successful implementation of pilot programs
- Relationship building and single point of contact for regional post-acute providers
- Provider facing market liaison
Front Line Leader, Senior Products
Humana Inc.
03.2013 - 02.2016
- Led and managed day-to-day clinical operations to ensure efficiency and alignment with organizational objectives
- Collaborated with senior leadership to define business priorities and set actionable goals
- Analyzed operational metrics and generate reports to identify trends and opportunities for improvement
- Served as primary point of contact for internal stakeholders on operational matters
- Ensured compliance with company policies, industry regulations, CMS & NCQA guidelines, and best practices
Clinical Advisor, Commercial/Senior Products
Humana Inc.
08.2006 - 03.2013
- Complex Case Management
- Utilization Management
- Claims and Benefit Review
- Adherence to NCQA and CMS guidelines
Education
Master of Science - Organizational Leadership
Northcentral University
Bachelor of Science - Health Services
University of Southern Indiana
Associate of Science - Nursing
University of Southern Indiana
Skills
- Client Relationship Management
- Medicare/Medicaid/Commercial Business
- Client & Business Strategy
- Financial and Operational Metrics
- Managed Care
- Utilization Management
- Strategic Planning & Innovation
- Clinical Operations Management
- Microsoft 365 Office Suite
- Change Management
- Process Oversight & Improvement
- Cross-functional collaboration
- CMS and NCQA Regulatory & Quality Compliance
- Project management
- Strategic leadership
- Analytical thinking
- Coaching and mentoring
- Relationship building
Certification
Certified Case Manager (CCM), Commission for Case Manager Certification
Timeline
Associate Director Clinical Services Delivery
Optum Home & Community Care Transitions
02.2022 - Current
Senior Market Development Professional, Senior Products
Humana Inc.
01.2018 - 01.2022
Clinical Policy Consultant
Humana Inc.
01.2017 - 01.2018
Clinical Consultant, Senior Products
Humana Inc.
02.2016 - 01.2017
Front Line Leader, Senior Products
Humana Inc.
03.2013 - 02.2016
Clinical Advisor, Commercial/Senior Products
Humana Inc.
08.2006 - 03.2013
Bachelor of Science - Health Services
University of Southern Indiana
Associate of Science - Nursing
University of Southern Indiana
Master of Science - Organizational Leadership
Northcentral University
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