Alexis is an executive with enterprise-wide quality management, operations, software development, and program management expertise in the Health Care, Managed Care, Insurance and Financial Services industries. Alexis has a keen ability to successfully transform and build high-performing teams / organizations to support rapid growth and innovative company products. She excels at continuous process improvement, simplifying complex system,
Alexis is an executive with enterprise-wide quality management, operations, software development, and program management expertise in the Health Care, Managed Care, Insurance and Financial Services industries. Alexis has a keen ability to successfully transform and build high-performing teams / organizations to support rapid growth and innovative company products. She excels at continuous process improvement, simplifying complex system, infrastructure and business processes resulting in strategies that make a difference to the company's bottom-line and the quality of services delivered. Known for turning-around struggling departments, programs and strategic initiatives. Strong quality and process improvement, financial & resource management discipline. Alexis thrives in fast-paced organizations and quickly learns /develops an in-depth understanding of the inner workings of companies and their corporate cultures.
•Managed care quality management
•HEDIS, versight of National QM Medicaid programs
•CXO relationship management
•$300M+ budget/program management
•CPHQ, PMP & Six Sigma Green Belt Certified
•Consultant & leader of strategic quality improvement and technology enterprise initiatives
•Global contract Negotiations, On/Off Shore Resourcing
•International Management & Product Development
•Mentoring & Staff Development (150+)
•Industries: Insurance, Financial Services, Healthcare
SEO: Healthcare Quality Management, HEDIS, NCQA, Quality, CPHQ, Operations, Application Development, Project Management, Testing, Requirements, Agile, Scrum, PMP, PMI Green Belt, Six Sigma, Portfolio Management, Relationship Management, CBA, Contract Negotiations, RFP, RFI, Vendor Management,. On or Off-shore management, global product development, e-commerce, insurance, health care, financial services, strategy, total cost of ownership, performance improvement, COO, managed care, Medicaid, Medicare, hospital, re-engineering
Vice President Quality Operations @ From November 2014 to Present (1 year) Scottsdale, AZSr. Director of National Medicaid Quality Management @ Accountable for the Aetna Medicaid's Quality, HEDIS and Continuous Quality Improvement programs and services (including Dual Eligible products and Long Term Care).
- Establish innovative strategies to improve health outcomes and quality results
- Partner with technology, business intelligence, and operations organizations to design new tools/processes to improve member/provider engagement and overall performance.
- Provide NCQA accreditation support/leadership for Aetna Medicaid plan's throughout the USA.
- Accountable for managing Aetna's annual HEDIS audits and CAPHS/HOS Surveys on behalf of 11 Health Plans and over 28 product lines across the USA.
- Implement and deliver corporate-wide intervention programs (Well Care, EPSDT, Diabetes)
- Complete outcome evaluations for Medicaid intervention programs.
- Deliver Medicaid-wide oversight of Health Plan's quality management policies, procedures and health care quality results.
- Accountable for writing RFP responses relating to Aetna Medicaid's quality assessment and performance improvement programs.
- Provide quality management expertise and support in starting-up new Health Plans, including pre-delegation credentialing audits, creation of plan policies, procedures and systems to enable adherence to state and regulatory requirements.
- Support merger and acquisition analysis and recommendations relating to medical management and quality management systems, processes and programs.
- Accountable for budgeting and contract management for all NCQA certified vendors used to enable the Medicaid division to successful complete their annual HEDIS Audits (HEDIS Software, Auditor and Survey Vendors). From 2011 to December 2014 (3 years) Aetna MedicaidVP APPLICATION DEVELOPMENT (Provider and Claim Processing Systems) @ VP Information Technology – Accountable for end-to-end strategy, relationship management, system/product development, maintenance, and support of Provider, Contract, Client management & Claim pricing systems for Workers Compensation, Network Rental, Coventry National Managed Care and associated EDI transactions. 160+ employees; Budget: $20-30M. From 2010 to 2011 (1 year) VP PROGRAMS @ Board member of the AZ Society of Information Management organization.
Accountable for monthly programs/presentations for the AZ SIM meetings. Developed relationships with key industry players within AZ to ensure programs delivered innovative and informative presentations/sessions to further the IT profession for leaders in the community. From January 2010 to December 2010 (1 year) AVP IT APPLICATION DEVELOPMENT, TESTING, PROJECT MANAGEMENT & ENGINEERING @ Hired to transform the IT organization by leading the Application Development, Testing, Network/Systems Engineering, Project Management and Computer Education Services (new development, production support and maintenance). Accountable for partnering with the business to align on yearly IT priorities/strategies and budget to evolve claims, policy, operations, agent portals/web services systems. Direct/Indirect reports: 65+. Budget management responsibilities: $10-$20M.
•Turned around a failing, mission critical $25M imaging and workflow program (FileNet/J2EE/.NET /Oracle)
•Implemented Virtual Test Servers using VMware Lab Manager
•Instituted an IT Portfolio Management Council to enable prioritization of projects/infrastructure upgrades.
•Provided 1st, 2nd and 3rd level production support of applications and engineering / infrastructure. From February 2007 to August 2009 (2 years 7 months) Scottsdale, ArizonaSR IT DIRECTOR - APPLICATION DEVELOPMENT, PRODUCT DEVELOPMENT, PROGRAM MANAGEMENT @ Last Position: Responsible for $100M+ global portfolio & leading the $320M program and development effort to re-engineering the global Card Acceptance and Global Network systems within American Express, including card authorizations, global clearing & settlement, point of sale, accounts receivables/payables.
Key results: •Drove the creation of a technology long-range plan which identified $400M+ in benefits by re-engineering core customer servicing and financial processes/systems (600+ development work streams.)
•Managed yearly multi-million dollar budgets within 1% of forecast
•Delivered executive level presentations/dashboards on programs/IT development progress
•Directed 7+ development organizations to successfully deliver core system enhancements and SOA (C++, J2EE, Linux, Tumbleweed Communications, Oracle, etc.),
•Created a new Program Office and Release Management organization to support the delivery of the program initiatives.
IT Director - E-Commerce / Advanced Payments. Responsible for all AmEx Latin America and Global Network Services (GNS) projects, development and business relationship management of e-commerce and emerging technology for non-traditional payment solutions (e.g. smart card applications such as EMV/Loyalty and related POS capabilities.
IT Director of Development / Infrastructure, Alliance & Partnerships - E-commerce COE. Accountable for partnering with the business to identify entrepreneurial payment products/services and establishing key alliances and partnerships to develop e-commerce & smart card (EMV) solutions.
Project Manager / IT Director, New Business Development & E-Commerce
Operations Manager / Project Manager - HR Benefits and Salary Call Center
Business Operations Industrial / Performance Engineer From October 1989 to February 2007 (17 years 5 months) MANAGEMENT ENGINEER (INDUSTRIAL ENGINEER) @ Accountable for leading all process improvement activities at hospitals (e.g. McKay Dee Hospital) throughout Utah. Areas of focus - billing/accounting, doctor practice patterns, laboratory services and nursing practices. Assessed patient room utilization to support growth and maximize utilization. Supported requirements gathering and implementation of EMR system. From March 1986 to October 1989 (3 years 8 months)
BS @ University of Utah Alexis CPHQ is skilled in: Project Portfolio..., Streamline Processes, American Express, Six Sigma, SPC, Pareto Analysis, Technology Strategy..., Technology Alignment, Global Leadership, Department Budgeting, Global Deployment, Process Improvement, Expense Reduction, IT Financial Management, Availability Management, Capacity Management, Healthcare IT, HEDIS, Pay For Performance, Certified Scrum Master..., HIPPA, Siebel, CPHQ, Strategic Planning, HIPAA, Business Process, Healthcare Information..., Insurance, Management, Program Management, IT Management, Expenses, PMO, Project Management, Technology Product..., CRM, Leadership, Pay for Performance, Business Process..., Vendor Management, Quality Assurance, Strategy, Enterprise Software, Analysis, Requirements Gathering, PMP, Executive Management, Team Leadership, IT Strategy, Testing
Looking for a different
Get an email address for anyone on LinkedIn with the ContactOut Chrome extension