Misha Lehman
San Antonio,Texas
Summary
Cultivated a results-driven environment by implementing effective strategies that improved healthcare delivery and encouraged cross-departmental collaboration and staff development.
Overview
19
19
years of professional experience
Work History
Director, HCS Marketplace
Molina Healthcare
01.2021 - 02.2026
- Developed and executed policies and operational procedures aligning with organizational goals and regulatory requirements (state, CMS, NCQA, etc.).
- Successfully launched the Corporate centralization of 14 states (TX, NM, FL, ID, IL, OH, SC, WA, NV, KY, MI, MS, UT, WI) for the Marketplace LOB.
- Collaborated with IT to develop and roll out a new UM platform to leverage technology to enhance operational efficiency.
- Collaborated with Compliance to ensure KPIs were successfully achieved monthly.
Director, Healthcare Services (TX Medicaid, MKP, MCR)
Molina Healthcare
08.2015 - 01.2021
- Analyzed operational data to identify areas of improvement in processes and practices and executed improvement plans.
- Mentored and coached staff to build a high performing, multidisciplinary team culture that focused on accountability and professional development.
- Audited files to ensure accurate, compliant documentation for inpatient and outpatient services, reviewed appeals and correspondence letters.
Manager, HCS
Molina Healthcare Washington
03.2007 - 08.2015
- Started role in 2007 as Inpatient UM nurse reviewing 25 auths/day
- Promoted to Interim Supervisor of IP UM in September 2007
- Promoted to Prior Authorization Supervisor in 2009 over both clinical and non-clinical teams.
- Promoted to Prior Authorization Manager 2012 over all clinical and non-clinical for Medicaid and Marketplace.
- Streamlined workflows by identifying bottlenecks and existing systems and implementing appropriate solutions.
- Reviewed prior auth files for accuracy and compliance.
Education
Bachelor of Nursing - undefined
University of Texas at Arlington
05.2019
Associates of Nursing - undefined
Del Mar College
12.2001
Skills
- Office Suite software
- Interqual and Milliman
- Organizational and time management skills
- Corporate communications
- Problem solving
- Customer service
- Attention to details
- CMS, NCQA, HEDIS
- Auditing and research
Timeline
Director, HCS Marketplace
Molina Healthcare
01.2021 - 02.2026
Director, Healthcare Services (TX Medicaid, MKP, MCR)
Molina Healthcare
08.2015 - 01.2021
Manager, HCS
Molina Healthcare Washington
03.2007 - 08.2015
Bachelor of Nursing - undefined
University of Texas at Arlington
Associates of Nursing - undefined
Del Mar College