Summary
Overview
Work History
Education
Skills
Hobbies and Interests
Awards
Affiliations
Accomplishments
Certification
References
Timeline
Generic
Paige Kearns

Paige Kearns

Brighton,CO

Summary

Regional Vice President with a proven record of exceeding KPIs and enhancing affordability performance. Expertise in developing innovative solutions for complex challenges, supported by Lean Six Sigma certification. Skilled in data analytics, team building, and strategic planning, driving teams to achieve optimal collaboration and deliver high-quality, value-based healthcare.

Overview

10
10
years of professional experience
2
2

Advanced Degrees

Work History

Regional Vice President of Inpatient Utilization Management

Optum
08.2024 - Current
  • Regional executive leader of 400+ member team responsible for the operational efficiency and affordability commitments of 9 states.
  • Supporting nearly 2 million members from over 20 health plans, including Medicare, Medicaid, and commercial lines of business.
  • Analyzed market trends to inform strategic planning and decision-making processes.
  • Monitored regulatory requirements to ensure adherence across all regional operations.

Regional Senior Director of Utilization Management

Optum
07.2023 - 08.2024
  • Collaborate with analytics, finance, innovation, contracting, and operations to guarantee best-in-class quality, cost management, and compliant performance.
  • Execute affordability commitments while spearheading innovation and deployment of efficient standardized processes.
  • Led strategic initiatives to enhance patient care and operational efficiency.

Senior Director of Medical Management Operations

Optum
09.2020 - 07.2023
  • Oversee Utilization Management, Case Management, Prior-Authorizations, referrals, transitions of care, and behavioral health programs.
  • Facilitating support for 100+ facility locations, 500+ physicians, and 50,000 Medicare/Medicaid members across various health plans
  • Oversaw budget management to align resources with organizational goals.

Education

MBA -

Capella University
Denver
02.2023

Master of Science - Nursing Leadership And Management

University of Phoenix
Denver, CO
03.2012

Skills

  • Utilization Management
  • Prior-Authorization
  • Appeals & Grievances
  • Regulatory Program compliance
  • Innovation
  • CMS
  • NCQA
  • Medicaid management
  • Medicare management
  • SNP management
  • Commercial plan management
  • Data analysis
  • Change Management
  • Team-Building
  • Collaboration
  • Networking
  • Process Improvement
  • Managed care
  • Affordability strategy
  • Budget management

Hobbies and Interests

  • Fly-Fishing
  • Self-Reliance Homesteading
  • Cooking
  • Volunteering

Awards

  • Optum Mountain West 500 - Most Innovative and Most Impactful Idea award, 02/2022
  • Optum Colorado Market Performance Award, 01/2021

Affiliations

  • Clinical Leadership Executive Program Graduate, 02/2022

Accomplishments

2024 Exceeded annual affordability target of $35 Million by 35% for an annual savings of $54.6 Million

2024 Developed regionalized program descriptions and policies for UM department

2024 Decreased authorization processing turn around time from 85 hour average in 2023 to 51 hours in 2024.

2023 Successfully combined 8 individually managed states into one cohesive UM team supporting the West Region

Certification

  • Lean Six Sigma Geen Belt-2021
  • CO Nursing License 190515

References

References available upon request.

Timeline

Regional Vice President of Inpatient Utilization Management

Optum
08.2024 - Current

Regional Senior Director of Utilization Management

Optum
07.2023 - 08.2024

Senior Director of Medical Management Operations

Optum
09.2020 - 07.2023

MBA -

Capella University

Master of Science - Nursing Leadership And Management

University of Phoenix

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