T. Monica Hong
Palm Coast,FL
Summary
Dynamic professional with extensive experience poised to lead impactful change. Demonstrated success in implementing strategic initiatives and optimizing operational performance. Recognized for fostering collaborative team leadership and adapting to evolving business demands. Skilled in executive leadership, strategic planning, and utilizing innovative methods to drive business growth and operational excellence. Proven track record of effective team collaboration and consistently achieving results.
Overview
21
21
years of professional experience
Work History
Vice President, Clinical Consulting
Claro Healthcare / Kaufman Hall
01.2025 - Current
- Promoted to Vice President in recognition of leadership in clinical performance improvement, revenue cycle optimization, and measurable client impact.
- Led comprehensive staffing analyses and operational assessments across Case Management and Utilization Review to optimize resource allocation and performance.
- Spearheaded the redesign and implementation of a Physician Advisor Program, including escalation workflows, performance metrics, and role clarity.
- Developed and deployed enhanced workflows for Utilization Management, Patient Access, Registration, and Authorization, improving denial rates and throughput.
- Directed denials and appeals management strategies, including root cause analysis, payer-specific interventions, and appeal letter development.
- Designed and delivered training programs for Case Management, Utilization Review, and nursing teams on best practices in patient status determination and medical necessity documentation.
- Established and chaired UM, LOS, and Denials Management Committees to drive cross-functional accountability and continuous improvement.
- Created comprehensive education materials and toolkits to support Care Management and Physician Advisor engagement and compliance.
- Led performance improvement initiatives for two large hospital systems, delivering a combined $40 million in annual gross benefit through targeted interventions.
- Conducted initial process improvement assessments to identify operational inefficiencies and prioritize high-impact opportunities.
- Collaborated with senior management to develop strategic initiatives and long term goals.
- Implemented advanced data analytics tools to drive data-driven decision-making across all levels of the organization, leading to better business outcomes.
- Cultivated strong relationships with key stakeholders, including customers, vendors, regulators, and community leaders to promote collaboration and long-term success.
- Delivered strong financial performance despite challenging economic conditions by executing prudent risk management strategies throughout all aspects of business operations.
- Led cross-functional teams for the successful completion of major projects, resulting in increased efficiency and client satisfaction.
- Spearheaded organizational restructuring initiatives, streamlining operations and reducing overhead costs.
- Developed new revenue streams by identifying growth opportunities and forging strategic partnerships with key industry players.
- Established a culture of continuous improvement, fostering innovation and driving sustainable growth across the organization.
Enterprise Quality Improvement Advisor
CareSource
03.2020 - 05.2022
- Led enterprise-wide quality improvement and process optimization initiatives across multiple lines of business, including Case Management, Grievance & Appeals, and Quality Measures, ensuring alignment with NCQA, HEDIS, and CMS Star Ratings.
- Collaborated with Care Coordination and Utilization Management teams to align clinical operations with quality improvement strategies, resulting in measurable gains in performance metrics and member satisfaction.
- Facilitated internal workgroups focused on improving HEDIS and CAHPS measures, including Well-Child Visits, Immunizations, Cancer Screenings, Medication Adherence, and overall member experience.
- Oversaw the development and maintenance of the Quality Improvement Work Plan, Program Evaluation, and Program Description templates for all lines of business, ensuring regulatory compliance and strategic alignment.
- Conducted root cause analyses and performance reviews to identify gaps, evaluate intervention effectiveness, and recommend new or revised process measures to drive outcomes.
- Established and standardized quality reporting protocols, communicating trends, strengths, and opportunities for improvement to market leaders across the enterprise.
- Analyzed complex data sets related to quality of care inquiries, producing actionable reports and strategic recommendations to support continuous improvement.
- Presented market-level quality performance updates to the Chief Operating Officer and executive leadership during Performance Steering Committee meetings, influencing enterprise-level decision-making and resource allocation.
- Maintained up-to-date knowledge on industry trends and regulations, ensuring accurate advice was provided to clients at all times.
- Mentored junior advisors, fostering a supportive team environment focused on growth and learning.
- Developed long-lasting relationships with clients to ensure consistent retention and loyalty.
- Improved client retention rates by developing and implementing comprehensive advisory plans tailored to individual needs.
- Fostered culture of innovation within advisory team, encouraging adoption of new technologies and methodologies.
- Enhanced team productivity with introduction of streamlined processes for client assessments and follow-ups.
Manager, Care Management
Devoted Health
10.2021 - 02.2022
- Directed daily operations for a team of 35 clinical and non-clinical staff within the Medicaid and Medicare Advantage plans, overseeing the delivery of longitudinal case management services and ensuring alignment with CMS regulations and the plan’s Model of Care.
- Oversight of utilization management and prior authorization functions, optimizing workflows to support timely, evidence-based decisions and reduce unnecessary utilization.
- Oversaw end-to-end medical management activities, including case management, utilization review, denials mitigation, and care coordination, with a focus on operational efficiency and member satisfaction.
- Developed and implemented standard operating procedures (SOPs) and performance protocols to ensure consistency, compliance, and high-quality service delivery across clinical teams.
- Partnered with IT and engineering teams to enhance the clinical documentation platform, improving workflow efficiency, data integrity, and reporting capabilities.
- Designed and deployed auditing and monitoring tools to track key performance indicators (KPIs), support regulatory readiness, and drive continuous quality improvement.
- Conducted variance analysis to evaluate operational performance, identify trends, and implement targeted interventions to improve utilization outcomes and reduce administrative denials.
- Collaborated cross-functionally with Care Coordination, Quality, and Utilization Review teams to ensure appropriate resource utilization and safe, timely transitions of care.
- Provided strategic leadership and coaching to RN Care Managers and support staff, ensuring achievement of service level agreements (SLAs), quality benchmarks, and member engagement goals.
- Accomplished multiple tasks within established timeframes.
- Managed and motivated employees to be productive and engaged in work.
- Maximized performance by monitoring daily activities and mentoring team members.
- Maintained professional, organized, and safe environment for employees and patrons.
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
- Managed budgets effectively, ensuring optimal financial performance while investing in necessary resources for business growth.
- Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
Director of Affordability and Solutions / Service Delivery Lead
United Health Group (Optum)
10.2018 - 01.2020
- Directed service delivery and performance oversight for a portfolio of 84+ Medicare Advantage clients, ensuring alignment with contractual obligations, clinical goals, and member satisfaction.
- Monitored and ensured achievement of Performance Guarantees, developing and executing corrective action plans and presenting Comprehensive Clinical Analyses and Program Overviews to internal and external stakeholders.
- Acted as the primary client advocate, coordinating across internal departments to implement systems, resolve escalations, and address evolving service needs.
- Analyzed client performance data and reporting requirements to design and implement innovative, data-driven solutions that improved efficiency, outcomes, and client satisfaction.
- Led complex, cross-functional projects—including reporting redesign, referral routing optimization, and performance strategy development—to support key business objectives and operational excellence.
- Played a key role in business strategy development, contributing clinical insights and operational recommendations to support growth and innovation.
- Influenced senior leadership to adopt new approaches to care management, patient engagement, and utilization management, driving improvements in affordability and quality of care.
- Authored and led responses to complex Requests for Proposals (RFPs) for clinical programs, supporting both new business acquisition and contract renewals.
- Actively participated in new client implementations, ensuring seamless onboarding and alignment of service delivery with client expectations and regulatory requirements.
- Proactively identified potential risks and implemented mitigation strategies to minimize negative impacts on projects or business operations.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas.
- Improved project efficiency with strategic planning, resource allocation, and time management practices.
- Facilitated cross-functional collaboration for improved decision-making processes within the organization.
- Managed budgets effectively to ensure optimal use of resources while maintaining financial stability.
- Boosted client satisfaction rates through exceptional relationship management and prompt resolution of issues.
- Pioneered adoption of sustainable practices, leading to industry recognition and awards.
- Enhanced data-driven decision-making by implementing advanced analytics and reporting tools.
- Transformed organizational culture to embrace continuous improvement, leading by example and mentoring teams.
Clinical Program Consultant
United Health Group (Optum)
02.2016 - 10.2018
- Developed and implemented workflow improvements for Utilization Management and referral processes, enhancing operational efficiency, reducing member abrasion, and improving turnaround times.
- Provided strategic oversight of Care Management, Disease Management (CMDM), and Utilization Review programs, ensuring compliance with CMS regulations, accreditation standards, and client contracts.
- Collaborated with internal partners—including Care Coordination, Quality, and Member Engagement—to streamline processes, improve performance metrics, and enhance patient satisfaction and program efficiency.
- Developed and implemented standardized process documents for clinical programs, ensuring alignment with regulatory requirements and member experience goals.
- Led the Medicare Plan of Care deployment as project lead, overseeing system automation and serving as process owner for clinical referral workflows.
- Facilitated quarterly Model of Care training for new hires and partnered with Optum Training to revise and maintain CMDM program curricula.
- Conducted internal and external clinical and business audits, developed corrective action plans, and led ISO audit readiness for Medicare Advantage programs.
- Acted as subject matter expert and process owner for the Onsite Readmission Prevention Program, including the development and implementation of performance metrics for Transitional Case Managers.
- Provided consultation and guidance during new program launches, ensuring process design supported clinical effectiveness and operational scalability.
- Delivered executive-level reporting and insights to support strategic decision-making and continuous improvement across clinical operations.
- Facilitated training sessions for staff members to enhance their skills in delivering effective clinical programs.
- Collaborated with healthcare professionals to ensure seamless coordination of services within multidisciplinary teams.
- Served as a subject matter expert, advising colleagues on current trends in evidence-based practice relevant to targeted disease states or conditions.
- Promoted regulatory compliance processes and changed management on assigned programs initiatives.
- Designed customized interventions tailored to meet the unique needs of diverse patient populations.
- Contributed to the development of organizational policies and procedures, ensuring alignment with regulatory standards and best practices within the field.
- Developed policy recommendations that led to significant improvements in organizational practices related to clinical programming.
- Streamlined clinical processes for increased efficiency and improved patient experience.
- Reduced staff turnover rates by creating supportive work environments that foster professional growth and development opportunities.
- Promoted a culture of continuous improvement through regular feedback loops, engaging stakeholders in conversations around best practices.
- Resolved highly complex business problems affecting clinical processes and functional requirements.
- Assisted with regulatory issues such as compliance.
- Consulted with healthcare professionals on business decisions.
- Formulated and implemented 4 innovative medical strategies in the managed healthcare field.
- Reviewed internal systems and organized training plans to address areas in need of improvement.
- Restructured procedures through coordination with compliance director to create and execute projects.
- Recommended 8 operational improvements based on tracking and analysis of readmission and performance data.
- Leveraged on-site observation and personal interviews to identify team and individual strengths.
Clinical Operations Manager – Readmission Prevention Case Management Program
United Health Group (Optum)
07.2015 - 02.2016
- Directed daily operations and performance oversight for a multidisciplinary team of facility-based RN Case Managers across multiple hospital sites, ensuring alignment with program goals and quality standards.
- Oversaw assignment and reassignment of case managers based on patient acuity, hospital census, and staffing needs to ensure optimal coverage and continuity of care.
- Managed clinical operations across the continuum of care, including case management, care coordination, and medical management consulting, with a focus on reducing hospital readmissions.
- Provided strategic leadership and mentorship to professional staff, including coaching, performance feedback, and workflow optimization to meet daily, weekly, and monthly program metrics.
- Conducted medical record reviews to assess medical necessity and ensure compliance with case management protocols and regulatory standards.
- Adapted departmental plans and priorities in response to evolving business needs, operational challenges, and healthcare regulations.
- Allocated resources effectively to meet fluctuating demands, ensuring high-quality patient care and efficient use of staff and clinical assets.
- Analyzed performance data and variances to identify trends, drive continuous improvement, and ensure achievement of key performance indicators (KPIs) aligned with RAP (Readmission Avoidance Program) objectives.
- Developed strategic partnerships with external stakeholders such as pharmaceutical companies or other healthcare providers to expand services offered.
- Reduced operational expenses by optimizing resource allocation and managing budgets prudently.
- Spearheaded process improvement initiatives that resulted in increased efficiency and improved patient care quality.
- Implemented innovative technologies to enhance data-driven decision making in clinical operations management.
- Championed continuous learning opportunities for staff through workshops or seminars resulting in higher competency levels among employees.
- Recruited trained, and mentored new employees, fostering their professional development within the organization.
- Established effective communication channels between departments, fostering a collaborative work environment.
- Led the implementation of electronic medical records systems which streamlined documentation processes while maintaining high standards of patient privacy.
- Improved patient satisfaction by streamlining clinical operations and implementing efficient processes.
- Developed key performance indicators to monitor departmental progress and identify areas for improvement.
- Enhanced staff productivity through effective training programs and performance management strategies.
- Conducted performance evaluations for staff members, identifying strengths as well as areas for growth and improvement opportunities.
Team Lead – Readmission Prevention Program
United Health Group (Optum)
10.2014 - 07.2015
- Served as Process Owner for the Onsite Readmission Prevention Care Management Program, overseeing implementation, performance monitoring, and continuous improvement efforts.
- Facilitated new hire and up-training for case management staff, with a focus on telephonic triage, care coordination, and readmission prevention strategies.
- Developed and implemented standardized workflows to support safe transitions from hospital to home, ensuring alignment with contracted facility requirements and best practices.
- Collaborated with internal Utilization Management teams and hospital-based Utilization Review staff to ensure appropriate resource utilization, timely discharge planning, and reduced readmission risk.
- Conducted onsite visits, case audits, and one-on-one coaching for both new and tenured nurses to reinforce clinical standards and improve care delivery.
- Identified performance gaps and partnered with clients and key stakeholders to implement targeted interventions that improved patient outcomes and operational efficiency.
- Tracked, analyzed, and reported program performance metrics using Tableau, driving data-informed decision-making and accountability across teams.
- Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
- Established clear performance metrics for the team which helped in tracking progress towards set targets effectively.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Conducted regular progress reviews with individual team members to identify areas for improvement and provide guidance on career development opportunities.
- Coached team members in techniques necessary to complete job tasks.
Enterprise Clinical Trainer
United Health Group (Optum)
07.2009 - 10.2014
- Developed, facilitated, and evaluated new hire onboarding and ongoing training programs for Care Management, Utilization Management, and other clinical teams across the enterprise.
- Trained and mentored case management staff on telephonic triage protocols, equipping them with the skills to assess, prioritize, and respond to member needs effectively and in compliance with clinical guidelines.
- Delivered targeted training on utilization management workflows, documentation standards, and clinical decision-making tools to ensure consistency and regulatory compliance.
- Served as a subject matter expert (SME) for clinical platforms including VCC, CareOne, Community Care Platform, and ICUE, supporting both training and system optimization.
- Collaborated with clinical leadership to assess training needs, design customized learning solutions, and align training delivery with evolving program goals and regulatory requirements.
- Managed and prioritized training requests across multiple clinical programs, ensuring timely and effective delivery of content.
- Supported the rollout of new clinical initiatives by developing training materials, conducting system walk-throughs, and providing hands-on coaching to frontline staff.
- Promoted a culture of continuous learning and professional development, contributing to improved staff confidence, workflow efficiency, and member satisfaction.
Registered Nurse – Cardiac Telemetry and Women’s Surgery Unit
Kettering Medical Center
05.2005 - 12.2011
- Assessed and monitored patients who required IV cardiac medication, pre and post cardiac catheterization care, EKG strip interpretation, chart audits, preceptor for second year nursing students, analyzing patient data including lab work, and status of access.
- Timely and accurate documentation of clinical notes in the EMR (EPIC).
- Educated and coached patients on managing their health status; worked with a healthcare team to develop care plans and regimens for patients.
Registered Nurse – Telephonic Triage Nurse
United Health Group (Optum)
01.2005 - 07.2009
- Delivered high-quality telephonic triage by assessing members' current health status through inbound and outbound calls, determining appropriate care dispositions.
- Identified gaps or barriers in treatment plans and implemented timely interventions to support optimal patient outcomes.
- Provided comprehensive patient education to promote self-management of chronic conditions and ensure medication adherence.
- Collaborated closely with the Medical Director and case management team on complex cases requiring urgent care coordination.
- Recognized by the leadership team for outstanding performance and clinical excellence; selected to lead onboarding and mentorship of new team members, ensuring a smooth transition and consistent quality of care.
Education
Bachelor of Science - Nursing
Capella University
Minneapolis Minnesota10-2021
Associate of Science - Nursing
Kettering College of Medical Arts
Kettering, Ohio07-2005
Skills
- Risk management
- Data analysis
- Performance monitoring
- Process improvement
- Resource allocation
- Client relationship building
- Industry best practices
- Performance monitoring and evaluation
- Operational leadership
- Operations oversight
Timeline
Vice President, Clinical Consulting
Claro Healthcare / Kaufman Hall
01.2025 - Current
Manager, Care Management
Devoted Health
10.2021 - 02.2022
Enterprise Quality Improvement Advisor
CareSource
03.2020 - 05.2022
Director of Affordability and Solutions / Service Delivery Lead
United Health Group (Optum)
10.2018 - 01.2020
Clinical Program Consultant
United Health Group (Optum)
02.2016 - 10.2018
Clinical Operations Manager – Readmission Prevention Case Management Program
United Health Group (Optum)
07.2015 - 02.2016
Team Lead – Readmission Prevention Program
United Health Group (Optum)
10.2014 - 07.2015
Enterprise Clinical Trainer
United Health Group (Optum)
07.2009 - 10.2014
Registered Nurse – Cardiac Telemetry and Women’s Surgery Unit
Kettering Medical Center
05.2005 - 12.2011
Registered Nurse – Telephonic Triage Nurse
United Health Group (Optum)
01.2005 - 07.2009
Bachelor of Science - Nursing
Capella University
Associate of Science - Nursing
Kettering College of Medical Arts
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