Maryanne Alalade
Columbus,OH
Summary
Dynamic leader with excellent communication skills, quality improvement strategies and experience in project management. Diligent in directing and improving operations through outcome driven and customer satisfaction focus. Proficient in best practices, market trends and regulatory requirements of industry operations. Talented leader with analytical approach to business planning and day-to-day problem-solving.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Manager, Pre-Service Operations
Optum Home & Community Care
09.2021 - Current
- Goal oriented people leader focused on team effectiveness, organizational culture, leading change, and engaging and developing employees.
- Analyze, track, and interpret data informatics to drive execution of clinical strategy and achieve market objectives.
- Utilization of analytical and statistical software with proficiency in Microsoft office suite to guide complex decision making and competing priorities.
- High level understanding of CMS, NCQA, stated, federal, and payor regulatory guidelines with development and maintenance of clinical policy and day to day operations.
- Project management in numerous process improvement initiatives within highly matrixed environment working towards one common goal.
- Partner with Compliance team to prepare for and participate in CMS, NCQA, and health plan audits to ensure regulatory standards are met.
- 100% to goal with performance and market objectives in both 202, 2022 and 2023.
Clinical Review Coordinator
Optum Home & Community Care
12.2019 - 09.2021
- Proficient in Medicare Advantage, Medicare, and Medicaid plans to complete prior authorization reviews for Inpatient Rehabilitation and Skilled Nursing level of care.
- Improved team productivity and quality through onboarding new colleagues and mentoring existing colleagues daily.
- Enhanced operational workflows by completing daily audits, data analysis and providing recommendations for daily strategy in partnership with management team.
Physical Therapist
Kindred At Home
11.2017 - 05.2019
- Provide in-home physical therapy to patients of various diagnoses, ages, complexities, and socioeconomic status.
- Demonstrate excellence in customer service and patient care earning achievement of Clinician of the Year.
- Excel in communication between patient payer sources, durable medical supply companies, and provider offices for patient specific needs.
- Participate in innovative process improvement initiatives to improve workflow for clinicians, satisfaction in patient care, and improved branch outcomes.
Physical Therapist II
Vanderbilt University Medical Center
10.2016 - 11.2017
- Excel in providing individualized inpatient rehabilitation primarily to orthopedic and trauma patients of various acuity, age, and complexity in level 1 trauma acute care hospital.
- Assist in development of Orthopedic Trauma bundled payments that are currently being utilized for all patients admitted to Vanderbilt Hospital who are within that diagnostic category.
- Participate in process improvement initiatives through interdisciplinary work groups, individual projects, and organized discussions with clinical team leads, floor staff, and managers.
- Assist in orientation of new staff members with role of Preceptor for new employees.
Physical Therapist
Beth Israel Deaconess Medical Center
02.2016 - 04.2017
- Provide inpatient rehabilitation to orthopedic trauma patients, of various ages and complexity, in level 1 trauma Acute Care Hospital.
- Complete thorough evaluations and treatments to establish a plan of care in collaboration with patients, families, social supports and multi-disciplinary medical team in order to achieve patient’s goals, optimize function and ensure appropriate discharge dispositions.
- Participate in teaching and continuing education opportunities including patient / caregiver education, orienting support staff, and attending clinical in-service presentations and monthly, evidence-based journal reviews.
Education
Doctor of Physical Therapy -
MGH Institute of Health Professions
Charlestown, MA01.2016
Bachelor of Science - Kinesiology
Indiana University
Bloomington, IN05.2012
Skills
Outcome driven
Self motivated
Analytical
Quality Improvement
Leadership
Communication
Utilization Management
Value Based Care
Detail oriented
Innovative
Microsoft Suite
Tableau
Certification
M&R Level 1 Certification
M&R Level 2 Certification
Lean Six Sigma Green Belt
Timeline
Manager, Pre-Service Operations
Optum Home & Community Care
09.2021 - Current
Clinical Review Coordinator
Optum Home & Community Care
12.2019 - 09.2021
Physical Therapist
Kindred At Home
11.2017 - 05.2019
Physical Therapist II
Vanderbilt University Medical Center
10.2016 - 11.2017
Physical Therapist
Beth Israel Deaconess Medical Center
02.2016 - 04.2017
Doctor of Physical Therapy -
MGH Institute of Health Professions
Bachelor of Science - Kinesiology
Indiana University