Michelle Higgins
Healthcare Management
Odessa,USA
Summary
Masters prepared registered nurse searching for the opportunity to work with an innovative company to apply my people management, project management, and process implementation experience.
Health services management professional with demonstrated expertise in optimizing healthcare operations and leading multidisciplinary teams. Adept at strategic planning, regulatory compliance, and resource allocation to drive organizational success. Strong focus on team collaboration and achieving measurable outcomes, adapting seamlessly to evolving needs. Skilled in process development, patient care coordination, and implementing quality improvement initiatives.
Overview
29
29
years of professional experience
Work History
Health Services Director
Elevance (formerly Anthem)
10.2020 - Current
- Responsibilities include implementing cost of care initiatives, workstream business lead for AI predictive analytics, oversight of system migration testing and the 5-person team, UM SME for Availity provider portal training, Health Plan UM support, UM operational report oversight, MCG quarterly/annual update testing, and Chair of 2 governance committees.
- Implemented standard documentation across Medicare, Medicaid, and Commercial which led to a 4% increase in staff productivity.
- Created/implemented the system testing playbook and oversaw all testing efforts which led to 15 health plans successfully migrating to a new platform.
Director Outpatient Services
CareSource
02.2020 - 10.2020
- Oversaw physical health outpatient utilization management (UM) process development, Health Plan UM support, cost of care implementations. Led meetings and work groups to facilitate new and revised processes.
- Implemented prior authorization list which led to 5% increase in timely turn around.
- Lay Off
Director II Medical Management
Elevance (formerly Anthem)
02.2014 - 02.2020
- Promoted to Director II Medical Management to lead physical health UM process development, provided business input for implementation of a new company UM platform, medical policy implementation, Health Plan UM support, NCQA adherence, cost of care implementations, policy and procedure creation/business owner, chair of 2 governance committees, report business logic, participated in state readiness reviews and lead implementation of new business and system migrations for business process.
- Implemented the short length of stay process which led to yearly savings of over $3million.
- Worked with the reporting team to create a report on the top 10 authorization issues which cause a claim to fail. Held monthly meetings with the health plan to ensure authorizations were corrected before claims adjudication resulting in a 3% increase in timely claims payment.
Manager II Inpatient
Elevance (formerly Amerigroup)
06.2011 - 02.2014
- Progressed to Manager II Inpatient position and charged with physical health UM inpatient process flow, maintaining contractual turnaround times, engaging facilities to foster a good working relationship, report monitoring and report business logic. Participated in NCQA and State reviews.
- Implemented standardized documentation templates which led to a 10% increase in staff productivity.
- Implemented new single case agreement process which decreased turnaround time by 13% and increased provider/member satisfaction.
Manager I Outpatient
Elevance (formerly Amerigroup)
03.2009 - 06.2011
- Managed physical health UM outpatient process flow, maintaining contractual turnaround times, ensured NCQA adherence, report monitoring and report business logic.
Education
Masters in Business (MBA) - Healthcare Management
WGU
Salt Lake City, UTBachelor of Arts (B.A.) - Healthcare Management with Concentration in Communication
SNHU
Manchester, NHAssociate of Arts (A.A.) - Business / Corporate Communications
SNHU
Manchester, NHRegistered Nurse Diploma - undefined
The Miss AJ. McMasters School of Nursing
Moncton, New BrunswickSkills
- Healthcare management
- Workforce coaching
- Collaborative teamwork
- Analytical problem-solving
- Effective time management
- Streamlined process management
- Critical thinking
- Excellent communication
Languages
French
Professional Working
Timeline
Health Services Director
Elevance (formerly Anthem)
10.2020 - Current
Director Outpatient Services
CareSource
02.2020 - 10.2020
Director II Medical Management
Elevance (formerly Anthem)
02.2014 - 02.2020
Manager II Inpatient
Elevance (formerly Amerigroup)
06.2011 - 02.2014
Manager I Outpatient
Elevance (formerly Amerigroup)
03.2009 - 06.2011
Bachelor of Arts (B.A.) - Healthcare Management with Concentration in Communication
SNHU
Associate of Arts (A.A.) - Business / Corporate Communications
SNHU
Registered Nurse Diploma - undefined
The Miss AJ. McMasters School of Nursing
Masters in Business (MBA) - Healthcare Management
WGU
Similar Profiles
Sean OBrienSean OBrien
Strategic Consulting Senior Director at Elevance Health (Anthem Inc.)Strategic Consulting Senior Director at Elevance Health (Anthem Inc.)
Valerie ShephardValerie Shephard
Utilization Management Representative at Elevance Health Anthem BCBSUtilization Management Representative at Elevance Health Anthem BCBS
Shayla TurnerShayla Turner
CALL CENTER CUSTOMER SERVICE AGENT at Elevance Health - Anthem FHPSCALL CENTER CUSTOMER SERVICE AGENT at Elevance Health - Anthem FHPS
Farzana ShaikFarzana Shaik
RIO SPECIALIST & MEDICAL RECORDS AUDIT PROCESSER at VALERION HEALTHRIO SPECIALIST & MEDICAL RECORDS AUDIT PROCESSER at VALERION HEALTH
Neleigh CrossNeleigh Cross
Outpatient Mental Health Care Coordinator at Midland Memorial HospitalOutpatient Mental Health Care Coordinator at Midland Memorial Hospital