Marissa Crawhorn
Willow Springs,IL
Summary
Accomplished operations leader with over ten years of experience in Managed Care. Results oriented with proven success in the development and implementation of large-scale initiatives, driving quality and financial performance.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Vice President, Utilization Management
Centene Corporation
09.2021 - Current
- Over ten years of experience working in a Shared Services model, partnering with Health Plan Executives to achieve common quality and financial goals.
- Identified opportunities to improve business process flows and productivity.
- Identified clinical best practices across Health Plans and lines of business.
- Oversaw processes used to assess quality and manage risk, partnering with Medical Economics on trend mitigation.
- Maintained compliance with the National Committee for Quality Assurance (NCQA) standards for UM functions.
- Promoted and executed on company and business unit goals.
- Responsible for team of over 300 FTE's, 10 Medicaid markets, the National ABA program, and the National Partnerships in Care program.
- Achieved 35.1M in QAI savings to a target of 27.2M in 2023.
- Led ABA HBR Initiative in GA and IN in 2024, generating over 7.8M in QAI savings.
- Achieved 14.3M in Q1 2025 QAI savings to a 19.4M 2025 goal.
- Designed and implemented the Partnerships in Care program in 7 states within 6 months.
Director, Clinical Operations
Centene Corporation
01.2019 - 09.2021
- Responsible for the IP and OP Behavioral Health UM teams for five Health Plans in the Central Region.
- Partnered cross-functionally with Health Plan Case Management, Network, and ELT teams on trend mitigation and strategic solutions.
- Led monthly Value Story meetings, focusing on key performance indicators and QAI commitments.
- Supported Iowa Total Care and the State of IA in the formation of a new Behavioral Health Service, Psychiatric Intensive Care.
Clinical Manager, Ambetter
Centene Corporation
03.2017 - 01.2019
- Responsible for monthly reporting to Health Plans on IP UM metrics for all Ambetter markets.
- Promotion of clinical excellence and standardization across all lines of business.
- Development of new methods for clinical reviews.
- Provider outreach and education to promote best clinical practices.
- Participation in Parity Review process.
Clinical Supervisor, Ambetter
Centene Corporation
01.2016 - 03.2017
- Supervised the Utilization and Case Management teams for the Ambetter product.
- Built relationships with 12 Health Plans and the provider community.
- Maintained TAT compliance at 100% for IP UM.
- Led the day to day operations of a team sitting in multiple states, across three time zones.
Intensive Case Manager
Cenpatico Behavioral Health
09.2014 - 01.2016
- Managed caseload of up to 150 High Acuity/Moderate Acuity members.
- Telephonic Case Management- completed assessments, care plans, and linked members to community resources.
- Volunteered for the Substance Abuse team and met with members in hospitals for coordination of care.
- Participated in on-going communication between case management staff, utilization management staff, health plan partners and contracted providers.
- Maintained HIPAA compliance.
Aftercare Specialist
Timberline Knolls
09.2008 - 09.2014
- Provided residents with clinically appropriate aftercare treatment plans under strict time constraints.
- Educated patients and family members on proper discharge procedures, including treatment team recommendations for ongoing care.
- Managed caseload of 35 patients by coordinating individualized discharge plans, consulting with referring professionals, and collaborating with the resident's clinical team.
Education
Bachelor of Arts - Psychology
The George Washington University
Washington, DCMaster of Science - Clinical Psychology
Benedictine University
Lisle, ILMBA - Business Administration
Quantic
Washington, DCSkills
- Physical Health and Behavioral Health Integration
- Healthcare Business Operations
- Clinical Analytics
- Quality Improvement Initiatives
- Clinical Strategy and Leadership
- Cross-functional Communication
Certification
- Licensed Clinical Professional Counselor- IL- No. 180.010053
Timeline
Vice President, Utilization Management
Centene Corporation
09.2021 - Current
Director, Clinical Operations
Centene Corporation
01.2019 - 09.2021
Clinical Manager, Ambetter
Centene Corporation
03.2017 - 01.2019
Clinical Supervisor, Ambetter
Centene Corporation
01.2016 - 03.2017
Intensive Case Manager
Cenpatico Behavioral Health
09.2014 - 01.2016
Aftercare Specialist
Timberline Knolls
09.2008 - 09.2014
Bachelor of Arts - Psychology
The George Washington University
Master of Science - Clinical Psychology
Benedictine University
MBA - Business Administration
Quantic
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