Melanie Nevala

• Strategic Leadership: Oversee Utilization Management (UM) operations, ensuring regulatory compliance and alignment with organizational goals.
• Operational Efficiency: Implement process improvements to enhance workflow, reduce delays, and optimize cost-effective care delivery.
• Regulatory Compliance: Ensure adherence to Medicare, Medicaid, and state-specific UM regulations, mitigating risks and maintaining accreditation standards.
• Performance Optimization: Monitor key performance indicators (KPIs), driving improvements in service level agreements (SLAs) and turnaround times (TATs).
• Cross-Functional Collaboration: Partner with medical directors, clinical teams, and external stakeholders to enhance patient outcomes and streamline UM processes.
• Team Leadership & Development: Mentor and develop high-performing teams, fostering a culture of accountability, innovation, and continuous improvement.

• Needs Assessment & Strategy: Evaluated client needs, set clear objectives, and identified operational improvement opportunities.
• Process Optimization: Advised on efficiency solutions, cost savings, and centralization efforts.
• Project & Vendor Management: Managed multiple projects, reviewed contracts, and secured favorable vendor agreements.
• Stakeholder Engagement: Facilitated workshops to align priorities and drive consensus on strategic initiatives.

• Provided strategic guidance to executive leadership on customer service trends, market insights, and competitive analysis.
• Customer-Centric Culture: Championed a customer-centric culture emphasizing empathy, responsiveness, and accountability.

• Strategic Leadership: Led cross-functional teams of 150+ in Utilization Management and Specialty Services, driving operational excellence.
• Client & Business Growth: Successfully launched 23 client implementations across Medicare, Medicaid, Exchange, and Commercial lines, ensuring 100% client retention.
• Training & Performance: Developed Oncology & Cardiology intake training programs, exceeding SLA/TAT goals and achieving 97% audit scores.
• Business Transformation: Optimized performance and cost efficiency, hiring 50+ staff in 2022 and implementing IVR system savings of $600K annually.
• Culture & Innovation: Fostered collaboration, boosting morale, reducing turnover, and enhancing service delivery.