Tiffany Hendricks, RN, MSN, MHA
Frisco,TX
Summary
Dynamic, results-oriented healthcare executive with a proven track record of leading enterprise care management operations across commercial, Medicare, and Medicaid populations. Expertise in AI-enabled care models, data-driven performance optimization, and value-based care strategy. Known for transforming clinical operations into high-performing, scalable systems that improve outcomes, elevate member experience, and deliver measurable financial impact. Trusted leader to executive stakeholders, with deep experience in clinical quality, regulatory compliance (NCQA, HEDIS, CMS), and digital health innovation.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Assistant Vice President, Commercial Care Management & Specialty Operations
CVS Health (Aetna)
Frisco, TX
04.2025 - Current
- Lead enterprise-wide strategy and execution for commercial care management and specialty operations, impacting diverse populations across national markets
- Built and operationalized innovative care management workflows and digital solutions, reducing manual processes and improving care team efficiency and scalability
- Developed enterprise-level KPI dashboards and performance intelligence frameworks, transforming reporting into real-time, actionable insights for executive leadership
- Oversee large-scale, multidisciplinary teams (RNs, social workers, pharmacists, behavioral specialists, analysts), driving clinical excellence and operational performance
- Provide executive oversight of multidisciplinary teams across clinical, pharmacy, SW, dietician team, non-clinical engagement team, behavioral, maternity, transplant, 24-hour Nurse Line and specialty care domains, driving integrated, whole-person care delivery
- Designed and implemented AI-enabled member engagement strategies, increasing successful outreach rates and improving care plan adherence
- Developed advanced predictive analytics models to identify high-risk members, reducing avoidable ER visits and hospitalizations
- Built executive-level dashboards tracking engagement, productivity, clinical outcomes, and cost avoidance, enabling data-driven decision-making
- Delivered measurable improvements in total cost of care (TCOC) through value-based care initiatives and utilization management strategies
- Led transformation of care management workflows through automation, digital tools, and platform enhancements, improving efficiency and scalability
- Partner with internal and external stakeholders to ensure alignment with performance guarantees, regulatory requirements, and client expectations
Executive Director, Clinical Health Services
CVS Health
Frisco, TX
09.2024 - 04.2025
- Directed strategic operations across care management programs, achieving a 7.4% increase in engagement within five months
- Implemented data-driven operating models to enhance ACO performance, reporting accuracy, and clinical outcomes
- Led multidisciplinary teams across clinical and non-clinical functions, improving productivity and care coordination
- Spearheaded process standardization initiatives, reducing operational variability and improving service delivery consistency
- Strengthened provider and stakeholder partnerships to drive quality outcomes and shared savings performance
- Introduced enhanced analytics and reporting capabilities to improve performance transparency and accountability
Executive HRO Leader Coach (Contract)
ASM Research (Accenture Federal Services)
09.2024 - 02.2025
- Coached executive healthcare leaders on building high reliability organizations (HROs) and data-driven cultures
- Implemented systems leveraging data as a strategic asset to improve patient safety and organizational performance
- Guided leadership teams in reducing harm events through analytics-informed decision-making frameworks
- Promoted continuous improvement and psychological safety through structured learning and performance feedback systems
Senior Director, Care Management Oversight & Quality Assurance
Cityblock Health
01.2022 - 05.2024
- Led enterprise oversight of care management quality and compliance across Medicare, Medicaid, DSNP, and Commercial populations
- Designed and implemented end-to-end quality audit and compliance programs, ensuring success across CMS, NCQA, and state audits
- Built and operationalized enterprise CAP, QIP, and PIP frameworks, improving corrective action efficiency and regulatory performance
- Created data-driven strategies to optimize care delivery and drive cost savings and improved clinical outcomes
- Developed advanced analytics and reporting tools, enhancing KPI tracking, performance visibility, and operational insights
- Partnered with health plans and clients to align strategy, ensuring contract performance and long-term partnerships
- Led cross-functional initiatives improving technology platforms, reporting capabilities, and workforce performance
Lead Operations Director
UnitedHealthcare
09.2020 - 01.2022
- Oversaw national care management operations delivering clinical, behavioral, and SDOH services across large employer accounts
- Improved operational efficiency through process redesign and performance optimization strategies
- Partnered with Clinical Affordability teams to implement medical cost reduction initiatives
- Delivered executive-level reporting on operational performance, outcomes, and client satisfaction
- Enhanced member experience through consumer-centric concierge care models
Director, Clinical Quality & Care Management
UnitedHealthcare (Optum)
11.2010 - 09.2020
- Led enterprise clinical quality programs supporting 5,000+ staff and $2M+ budget oversight
- Developed and implemented data-driven quality monitoring systems, improving audit performance and compliance outcomes
- Created enterprise reporting tools and dashboards to track clinical, operational, and financial performance
- Served as SME for care management product development and regulatory compliance
- Improved client retention and contract performance through enhanced quality and audit outcomes
Education
Master of Science - Nursing & Healthcare Administration
Loyola University New Orleans
Bachelor of Science - Nursing
Baylor University
Core Executive Competencies
- Care Management Strategy
- AI & Predictive Analytics in Healthcare
- Value-Based Care
- Population Health
- Clinical & Operational Transformation
- Digital Health Platforms
- Healthcare Financial Performance (ROI, Cost Avoidance)
- Regulatory Compliance (NCQA, HEDIS, CMS)
- Enterprise KPI Development
- Workforce Optimization
- Client & Stakeholder Engagement
Executive Impact Snapshot
- Delivered multi-million-dollar cost avoidance through ER diversion, readmission reduction, and care optimization strategies
- Increased member engagement through data-driven outreach and AI-informed segmentation strategies
- Led operations supporting 5,000+ clinical and non-clinical staff across national care management programs
- Built enterprise KPI dashboards improving real-time performance visibility and executive decision-making
- Spearheaded AI-driven workflow optimization and predictive analytics integration into care management models
- Improved audit performance and compliance outcomes across NCQA, CMS, and state regulatory bodies
Earlier Leadership Experience
- Director, Inpatient Division - Craig Ranch Hospital, Led hospital operations, accreditation readiness, and clinical performance improvements, Improved patient satisfaction to 96%+ and significantly increased operational efficiency, Managed large clinical teams, budgets, and regulatory compliance initiatives
- Interim Chief Nursing Officer - Select Specialty Hospital, Led hospital operations, accreditation readiness, and clinical performance improvements, Improved patient satisfaction to 96%+ and significantly increased operational efficiency, Managed large clinical teams, budgets, and regulatory compliance initiatives
Certification
- Registered Nurse, Texas
- ISO 9001 Lead Auditor, Bureau Veritas
Technology And Analytics
- Tableau
- Salesforce
- EMR/EHR Systems
- Data Visualization
- AI-Driven Analytics (Predictive Modeling, Risk Stratification)
- Microsoft Office Suite (Excel, PowerPoint - Advanced)
Affiliations
- Delta Sigma Theta Sorority, Inc.
- Sigma Theta Tau International Honor Society of Nursing
Timeline
Assistant Vice President, Commercial Care Management & Specialty Operations
CVS Health (Aetna)
04.2025 - Current
Executive Director, Clinical Health Services
CVS Health
09.2024 - 04.2025
Executive HRO Leader Coach (Contract)
ASM Research (Accenture Federal Services)
09.2024 - 02.2025
Senior Director, Care Management Oversight & Quality Assurance
Cityblock Health
01.2022 - 05.2024
Lead Operations Director
UnitedHealthcare
09.2020 - 01.2022
Director, Clinical Quality & Care Management
UnitedHealthcare (Optum)
11.2010 - 09.2020
Master of Science - Nursing & Healthcare Administration
Loyola University New Orleans
Bachelor of Science - Nursing
Baylor University