Lead the charge in ensuring quality care through DRG clinical validation, assessing inpatient admissions and outpatient services. Collaborate with clinical teams to maintain compliance and optimize patient care across healthcare settings.

Manage payor contracts for specialty pharmacy services, ensuring compliance and optimizing reimbursement. Collaborate with finance and operations to analyze methodologies, resolve discrepancies, and support sustainable growth across various payor lines.

Manage and optimize payor contracts for specialty pharmacy services, ensuring compliance and maximizing reimbursement through effective analysis and operational implementation. Collaborate with finance and internal teams to support sustainable growth.

Lead the assessment and management of healthcare quality and efficiency, ensuring medically appropriate care through evaluations of service necessity, policy adherence, and provider collaboration, while optimizing patient care transitions across the continuum.

Optimize patient care quality by ensuring medical necessity through reviews of inpatient admissions and outpatient services, while collaborating with clinical teams and guiding members to appropriate providers and resources.