MICHELLE T. BERIGAN
Aubrey,Texas
Summary
Healthcare Executive with twenty years of successful experience in operational leadership and consulting nationally and internationally across the all lines of businesses, including the healthcare spectrum supporting multi-billion dollar businesses. Strong emphasis on analytics, predictive modeling, strong financial over-site, quality, systems thinking, population analysis and lean six sigma and gap analysis. Extensive knowledge in the management of multiple lines of businesses, with successful history turning failed or stalled operations into high performing operations. Active member of the Risk Management Society (RIMS) and the American College of Healthcare Executives
Overview
28
28
years of professional experience
Work History
Executive Director of Operations
Gentevia/ Illumia
Plano, TX
11.2023 - Current
- Palliative care start-up program aligned with primary care Physicians on a dedicated account with private equity and Gentiva company
- Advanced Ilness management in the home and extension of the primary care Physicians
- Managed 48 team members: Nurse Practitioners, Call center, Registered Nurses, and support staff.
- Built the structure of the program to align and grow the program to 600 patient census within 8 months
- Managed Partner meetings monthly and quarterly rated the fastest growing palliative care branch in the country
- Hired 45 team members in 8 months with minimal turnover.
- Managed weekly interdisciplinary team members meetings with Medical Directors and Nurse practitioners to discuss new admissions and plans of care
Sr Regional Operational and Clinical Consultant
United HealthCare/Optum Consulting
Dallas, TX
06.2018 - 11.2024
- Developed a system of auditing/consulting with formal reporting and digital pictures to ensure compliance and understanding of gaps at all levels of the organization
- Introduced and instituted root-cause analysis /risk control assessments to understand operational gaps which increased productivity
- Initially, managed underperforming regional operations 60-70% compliance to higher-performing teams with a 98% average of compliance within 3 years.
- Instituted visual workplace deliverables in clinics with quality whiteboards, manuals to assist in adherence to quality audits, custom training, reengineering workflows, and physical changes to set up for patient and employee workflows.
Healthcare Business Strategist Principle Consultant /Owner
Boston Consulting
McKinney, TX
07.2017 - 06.2019
- Turned the outpatient clinics in under one year to an average of 97% quality compliance from an average of 70%
- Utilized Six Sigma methodology in operations and participated in joint commission onsite surveys
- A strategic member working on various projects with consulting groups and companies.
- Healthcare, business processes, operational efficiencies, operational budgeting, building high-performing teams.
- Subject matter expert on clinical and general operations and implementation of products and projects
Divisional Vice President
ACCENTCARE INC
McKinney, TX
05.2016 - 07.2017
- Managed shared service operation of a 165-employee division of registered nurses, social workers, and call center employees nationally, and prepared the operation for an audit in preparation for the sale of the company.
- Implemented first lean initiative within the company that resulted in a 45% reduction in work-force and $3.5 million dollars in salary wages with all processes and workflow streamlined and functioning 100%
- Decreased non-value added tasks through process re-engineering.
- Quarterly meetings onsite with the executive team and board of directors.
- Recruited to manage a division that was underperforming financially and operationally, to allow the company to pass an audit for the sale of the company within 16 months.
SR National Director
AMERISOURCE BERGEN
Carrollton, TX
05.2015 - 06.2016
- An International corporation partnering with healthcare providers and pharmaceutical manufacturers, strategic management and consulting with Sanofi/Genzyme.
- Strategic management and consulting with Sanofi/Genzyme on a $70 million dedicated account.
- Developing program and product mapping with architectural diagrams to outline present state and any future changes
- Managed a virtual national team of 135 nurses on a Telehealth program in all 50 states.
- Attended quarterly meetings with Genzyme onsite and traveled nationally to attend association meetings introduced new on-boarding training, quality scoring and mentoring program to increase retention of nurses
- Reporting directly to the national Senior Vice President of Strategic Accounts.
Sr National Operational Consultant
HEALTH CARE SERVICE CORPORATION, Insurance Company
Richardson, TX
03.2011 - 11.2015
- A member-owned national, in the US, comprised of Texas, Oklahoma, and New Mexico.
- Strategic management and integration of existing and all new programs and products
- Utilized lean operational principles and six sigma principles
- Utilized architectural mapping to document existing and new programs coupled with process engineering and reengineering principles, six sigma and lean principles
- Developed position papers for existing products and future products
- Developed and wrote managed care industry position papers for HCSC
- Partnered with brokers, consultants and product vendors for selection of products or programs to be utilized nationally
- A member of the team to develop and write; request for proposals and request for information
- Represented HCSC at the national Blue Cross and Blue Shield Association national meetings involving new program and product updates and new changes in insurance legislation
NATIONAL AND INTERNATIONAL ACCOUNT EXECUTIVE
ACE INSURANCE | ESIS | CIGNA
Dallas, Texas
05.2005 - 12.2011
- A FORTUNE 100 INTERNATIONAL INSURANCE COMPANY
- Consulting and sales with ACE/ESIS clients for improved effectiveness of risk mitigation and cost containment strategies including claims reporting lag time, large loss closure planning, auditing and loss control prevention programs
- Developed claim priority model (CPM), which established set parameters to flag high-risk cases.
- Effectively worked with client’s brokers to establish loss prevention plans including large loss indicator’s, pre and post claim plans and location-specific needs
- Managed at risk clients with 100% retention
- Produced $5.4 million ROI for client over two-year period
- Collaborated with Brokers and underwriting for account penetration opportunities and managed product liability risk proposals from underwriting
- National and International travel, including participation in a joint venture with a Chinese Insurance company.
- Served as a subject matter expert on well-being programs, benefits, policies, and resources for business partners, consulting with other disciplines internationally.
- Reported directly to the Executive Vice President of National Operations.
VICE PRESIDENT OF NATIONAL OPERATIONS
Sedgwick Claims Management Services Inc.
Irving, TX
03.2000 - 11.2005
- The largest flagship operations multi-site program for SBC with 240,000 lives at that time; program consisted of STD, LTD, FMLA and WC programs with a dedicated call center
- Managed $50-80 million in revenue, a $6.2 million operations budget, and maintained 19%-23% profit margin
- Implemented a national call center with Cisco software; call monitoring, score cards and productivity measures
- Developed a corporate team for national consulting for all national enterprise operations
- Introduced six sigma and lean principles with all operations resulting in increased productivity by 31% and decrease expenses by 37%
- Introduced and instituted root-cause analysis /risk control assessments to understand operational gaps which increased productivity
- Responsible for 50 million dollar budget, re-writing the original budget to support a successful operation with increased productivity through productivity metrics and balanced scorecard
- Developed nationally recorded training modules for the branches
Participated in M &A acquisitions with the executive team on two acquisitions - Largest flagship operation for this company, participated in sales presentations and meetings with existing and potential clients
- Developed weekly calls for the business units for intense case management with clients via conference calls to manage open WC, STD, and LTD claims with high net incurred to obtain file closure
- Assisted clients with accelerating claim closure through co-morbidity identification, fraud utilization, litigation strategies, and claim audits
NATIONALACCOUNT EXECUTIVE /CONSULTANT
KEMPER NATIONAL SERVICES, FORTUNE 100 INSURANCE COMPANY
05.1997 - 04.2000
- Managed national workers' compensation, general liability and product liability accounts with fortune 500 companies 89% case closure rate within 90-120 days on open cases savings exceeded 25 million
- Claim closure expertise through medical case management, physician consults and monthly client claim reviews
- Member of the executive team working with CCO, CFO and executive risk management teams
- Assisted clients with reserve setting, return-to-work strategies and fraud identification
- Flagged co-morbidity cases including psychiatric and drug addition to address and develop treatment plan for faster return-to-work
- Member of claims process improvement team, new product development team and regional leader
- Member of the national audit team completing; safety, Pre-OSHA and corporate audits with clinical and operational challenges
- National travel to Kemper accounts for quarterly meetings
- Product liability audits and reporting to underwriters for determination on Insurability of companies and products
Education
Six Sigma Black Belt Program -
Villanova University
Pennsylvania 01-2025
MBA - International Business Administration
University of Texas
Bachelors of Science - Nursing
University of Massachusetts
Skills
- Business Analysis
- Risk Assessment
- Client Relationship Management
- Problem Resolution
- Leadership and Mentoring
- Team Building
- Market Research
- Systems Thinking
- Six Sigma/Root Cause Analysis
- Financial Acumen
- Developing High performing Teams
- Logistics Management
- Planning and execution
- Listening to internal and external customers
Additional Information
- Awards: Colleen Maxwell Award for Outstanding Community Service in Boston
- Nursing experience: Cardiac Care Unit (CCU), Inpatient and outpatient medical, psychiatric, addiction, rehabilitation, corporate occupational health management, national clinical consulting on wellness programs, home health, healthcare claims management and operations.
Timeline
Executive Director of Operations
Gentevia/ Illumia
11.2023 - Current
Sr Regional Operational and Clinical Consultant
United HealthCare/Optum Consulting
06.2018 - 11.2024
Healthcare Business Strategist Principle Consultant /Owner
Boston Consulting
07.2017 - 06.2019
Divisional Vice President
ACCENTCARE INC
05.2016 - 07.2017
SR National Director
AMERISOURCE BERGEN
05.2015 - 06.2016
Sr National Operational Consultant
HEALTH CARE SERVICE CORPORATION, Insurance Company
03.2011 - 11.2015
NATIONAL AND INTERNATIONAL ACCOUNT EXECUTIVE
ACE INSURANCE | ESIS | CIGNA
05.2005 - 12.2011
VICE PRESIDENT OF NATIONAL OPERATIONS
Sedgwick Claims Management Services Inc.
03.2000 - 11.2005
NATIONALACCOUNT EXECUTIVE /CONSULTANT
KEMPER NATIONAL SERVICES, FORTUNE 100 INSURANCE COMPANY
05.1997 - 04.2000
Six Sigma Black Belt Program -
Villanova University
MBA - International Business Administration
University of Texas
Bachelors of Science - Nursing
University of Massachusetts
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