Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Nahder Pajoohi

Livingston,NJ

Summary

Experienced Health Management practitioner and subject matter expert with a proven track record in enhancing payer and provider operations. Expert in deploying and managing health management operations, including technology solutions and process improvements that enhance physician and patient experiences, as well as quality and cost to serve. Skilled in fostering strong relationships to solve complex business challenges, demonstrating exceptional program management and interpersonal abilities.

Overview

32
32
years of professional experience

Work History

Health Management BPS Senior Manager

Accenture
Florham Park, NJ
02.2010 - 10.2024
  • Develop sourcing and technology solutions for payer and provider clients during sales pursuits.
  • Design impactful client-facing communications to showcase the benefits and value of proposed solutions, emphasizing cost efficiency and improved member/provider experiences.
  • Craft and present robust business cases to internal and client stakeholders.
  • Lead client discussions, showcasing differentiated capabilities, exceptional client experiences, and unique value delivered.
  • Develop contracting language, Service Level Agreements (SLAs), and Key Performance Indicators (KPIs).
  • Oversee transition process, including, but not limited to, recruiting/hiring, training, ramp-up, and stabilization phases.
  • Deliver operational excellence through data analysis, innovative technology solutions, and process improvements.
  • Responsible for account financials, with a focus on tracking key cost and revenue drivers to ensure precise forecasting.
  • Instrumental in delivering improved financials via strategic revenue improvement and cost reduction drivers.
  • Build and nurture strong relationships to effectively address and resolve complex business challenges.

Care Management Consultant

Willis Towers Watson (WTW)
Parsippany, NJ
07.2006 - 11.2009
  • Participated in complex consulting engagements to evaluate, develop, and implement employer healthcare strategies and programs that control cost trends, improve health outcomes, promote employee wellness, and encourage health management program participation.
  • Projects include: Development of culture of health strategies; care management vendor selection and procurements; audits of case management, wellness, & disease management programs; measurement and evaluation of return on investment (ROI) for wellness and disease management programs; Health Advocacy Program development; feasibility, design, and implementation of on-site health centers.
  • Supported the sales and marketing efforts of the Care Management practice, including developing proposals, conducting market research and leading sales presentations.

Manager, Disease Management

AmeriChoice – UnitedHealth Group
Newark, NJ
07.2001 - 07.2006
  • Developed and deployed Disease Management Programs targeting Asthma, Diabetes, CHF, COPD, and Influenza/Pneumonia populations.
  • Implemented corporate medical management workflows for optimal clinical outcomes.
  • Deployed technology-based capabilities, including Telemedicine Program, Electronic Medical Records Systems, and Predictive Modeling Programs.

Emergency Room Technician

Passaic General Hospital
Passaic, NJ
08.1992 - 12.1999
  • Provided patient care by taking vital signs, inserting IVs, drawing blood, and providing first aid treatments.
  • Assisted physicians with emergency procedures, such as CPR and suturing.
  • Transported patients from the ER to other departments or units throughout the hospital as needed.

Education

Master of Public Health -

New York University
New York
05-2001

Bachelor of Arts - Psychology

The George Washington University
Washington, DC
06-1996

Skills

  • Health Management
  • Healthcare Payer and Provider Operations and Processes
  • Clinical Acumen and Processes
  • Account Management
  • Solution Development
  • Sourcing Strategy
  • Operating Model Design
  • Process Design Mapping
  • Delivery Excellence and Operational Improvement
  • Technology Solutions
  • Financial Management / Analysis
  • Strategic Cost Reduction
  • Program and Project Management
  • Commercial, Medicaid and Medicare Lines of Business

Accomplishments

  • Successfully transitioned 1000+ FTEs Care Management Business Process Outsourcing engagement across 23 processes for 4 sites located in the Philippines and India
  • Instrumental in delivering significant revenue improvements and cost reductions across accounts managed.

Timeline

Health Management BPS Senior Manager

Accenture
02.2010 - 10.2024

Care Management Consultant

Willis Towers Watson (WTW)
07.2006 - 11.2009

Manager, Disease Management

AmeriChoice – UnitedHealth Group
07.2001 - 07.2006

Emergency Room Technician

Passaic General Hospital
08.1992 - 12.1999

Master of Public Health -

New York University

Bachelor of Arts - Psychology

The George Washington University

Similar Profiles

CREATE PROFILE
Nahder Pajoohi