Chair of the Advisory Board @ Goldring Center for Culinary Medicine
Chair of the Board of Directors @ Project Foundation
Illinois State University
Sixteen years of intense, progressive leadership experience and success in driving business growth in small business units and large matrix organizations. Has created and developed business strategies in marketing/sales, operations, and products which have increased revenue streams in existing and emerging markets and implemented process improvement strategies that increased profitability. Led significant organizational change, financial analysis, and
Sixteen years of intense, progressive leadership experience and success in driving business growth in small business units and large matrix organizations. Has created and developed business strategies in marketing/sales, operations, and products which have increased revenue streams in existing and emerging markets and implemented process improvement strategies that increased profitability. Led significant organizational change, financial analysis, and built highly energized result-oriented teams.
Director Corporate Strategy @ -Co-Led strategy sessions with Humana’s management team to define, communicate, measure, and design innovative solutions to achieve Humana’s long-term (2020) strategic goal.
-Using Human-Centered Design principles, developed a series of Population Health materials and Clinical Guidelines that aid leaders in developing a Community Health Profile aimed at identifying strategic focus areas.
-Responsible to equip 650+ market leaders across Medicare, Medicaid, and Commercial Group with tools and communication resources that connect Humana’s long term goal to associates’ roles and responsibilities.
-Built market based toolkits and training materials for market leaders to engage with and incorporate Humana’s long-term (2020) strategic goal into their annual business planning process.
-Led change management initiatives, process improvement, and cultural transformation from transactional health insurance to industry leading health care company focused on improving health outcomes.
-Led internal and external communication strategy associated to Humana’s long-term (2020) strategic goal, including the development of a comprehensive annual report and summary of activity across the enterprise.
-Serve as the key population health SME to advance the improvement of health outcomes within the enterprise. Consult directly with medical management, provider contracting, quality, case management, service operations, and community/public relations to develop an integrated market strategy that will align with Humana’s long-term (2020) strategic goal. From November 2014 to Present (1 year) Louisville, Kentucky AreaChairman Board of Directors @ I volunteer my skills in general management to oversee the day to day operation and launch of this nonprofit. Currently, we are working on the design and build of a medical clinic to be donated to a rural community in Malawi, Africa. For more information or to donate, please visit www.projectfoundation.org From 2011 to Present (4 years) Phoenix, AZ & Louisville, KYDirector Product Management & Strategy, Medicaid/Medicare-Dual Eligibles, LTSS, & Behavioral Health @ -Established strategic vision, goals and objectives for the Medicaid LTSS & BH Team, with a focus on implementing cost saving process improvement initiatives, securing partnership arrangements resulting in competitive positioning, and expansion of market presence.
-Influenced and defined vendor expectations and product roadmap for prioritized enhancements to an vended IT platform while integrating data feeds into Humana systems, and concurrently launched/sponsored a $3M IT project to build out enhancements to Humana’s current Clinical Platform, Clinical Guidance Exchange, to function based by State-by-State contracts and with the clinical procedures for Medicaid/LTSS.
-Developed robust process for clinical roles and responsibilities that relate to the strategic product development and implementation for Medicaid/Medicare medical management coordination within a matrix environment.
-Guide Sr. Leadership and/or market LTSS & BH clinical leadership with deployment of new LTSS & BH programs, RFPs and/or programmatic expansions of services and/or geographic regions.
Communicate diplomatically and collaborate with national market leadership and corporate cross-functional team contacts throughout Humana to provide technical assistance for market LTSS & BH program component implementation.
-Accountable for LTSS & BH costs within national awarded regions, including leadership for the medical unit cost plan, aggressive unit cost management and LTSS & BH action planning. Manage the execution of cost containment and medical expenses across all LTSS & BH products to ensure meeting budget targets.
-Responsible to coordinate and ensure consistent national medical management policies and clinical approach in multiple, simultaneous LTSS & BH market program implementations.
-Built and led clinical case auditing functions to drive quality improvement and NQCA certification. From January 2013 to November 2014 (1 year 11 months) Louisville, Kentucky AreaAdjunct Faculty @ Provides a quality learning experience for Graduate Level students on a semester basis. Performs instruction-related duties and responsibilities in a timely manner and in accordance with the mission, policies and procedures of the college. The relationship of the adjunct faculty member to the student is one of teacher and facilitator of learning, which is done out of passion for content and the experience within the profession.
At ASU, I have instructed Systems Thinking, Healthcare Finance, Communication, and Technology courses out of the Health Innovation programs through the College of Nursing. From January 2010 to May 2014 (4 years 5 months) Tempe, ArizonaIntegration Leader @ -Uses discipline and expertise to influence, lead and educate people and groups in order to optimize Market Operations results. Initiates, plans, and frames-up highly visible projects and establishes requirements while consulting and gaining commitment from key stakeholders.
-Serve as a management consultant to Market Presidents and key internal clients to identify and analyze medical trends and develop pilot actions to enhance current clinical programs.
-Responsible for integrating acquisition of an IT company that had private exchange functionality into our Humana systems, claims, and benefits platforms.
-Strategically led a portfolio of pilot activity between Humana and Walmart to integrate value-based offerings between the two organizations for a Tele-Health Clinics within the Walmart store footprint. Initial concept was transitioned and launched in San Antonio, Texas in 2013. From October 2012 to January 2013 (4 months) Louisville, Kentucky AreaBoard of Directors for Arizona Chapter @ Determine the Organization's Mission and Purpose
Select the Directors for the Non-Profit and Succession Planning
Support the Executive and Review His or Her Performance
Ensure Effective Organizational Planning
Ensure Adequate Resources
Manage Resources Effectively
Determine and Monitor the Organization's Products, Services and Programs
Enhance the Organization's Public Image From May 2008 to November 2012 (4 years 7 months) Phoenix, Arizona AreaDirector Clinical Operations @ Business development of a multidisciplinary team responsible for coordinating and collaborating with the
provider network of a highly complex membership. Utilize the principles of continuous quality improvement;
provide leadership, administrative and management support, strategic planning and overall direction of the
Create a culture that embraces change and seeks high accountable performance which grew the business from
97 to 138 accounts in four years. Known as a ‘best in class’ operational site in which over one hundred sales
presentations occurred under my counsel.
Promote a positive public image, facilitate the establishment of effective and efficient internal and external
customer interfaces and ensure development of staff through the implementation of logically developed goals,
objectives and business plans.
Managerial oversight of 100 plus team members to include senior level professionals, RN Case Managers,
Social Work Care Coordinators, Pharmacists, and paraprofessional staff.
Achieve and maintain quality of care and medical efficiency standards and expectations as impacted by trends
for program responsibilities; NCQA/URAC accreditation standards, HEDIS measures, and Utilization targets.
Work collaboratively with providers, sister segments, consultants as well as internal plan management.
Develop, implement and monitor action plans to modify care delivery patterns and reduce expenses.
Foster innovative problem solving techniques and critical thinking skills to uphold principles of continuous
quality improvement while increasing efficiencies and decreasing costs.
Guide development of multiple levels of professional staff while serving as a role model, teacher, coach and
leader. Provide staff with opportunities that lead to enhancement of their individual management and
Communicate department goals and team-specific goals and engages everyone in their achievement. From February 2008 to October 2012 (4 years 9 months) Phoenix, Arizona AreaClinical Integration Manager @ Collaborate with senior executives within all business segments to define corporate strategies, bridging the
gap between online technology solutions and our business growth plan.
Responsible for the analysis efforts, including user requirements, user flows, business rules and product
strategies for consumer facing online products utilized by 1.1M registered users.
Design, Develop, and Deployed an enterprise-wide Secure Messaging application that allows 1400+
internal users the ability to communicate to 24M members annually.
Lead a team in charge of the creation of a transformational product offering. Team strategies include
business case development and conceptual design review based on the results of numerous Focus Group
and Pilot tests in targeted markets.
Manage the Marketing and Sales teams for web issues, knowledge, and product enhancements. Web site
creation for B-B, sales and RFP support, and define overall solution and strategy to support the business
Lead cross – functional, highly successful product development teams basing delivery on analysis and
understanding of corporate strategies, market dynamics, and technology assessments.
Develop and implement annual business plans for multiple product lines, which support strategic corporate
sales, profit and product development goals and objectives.
Provide a deep understanding of business strategies and core applications within our corporate culture
resulting in the management of several cross functional teams driving long term product positioning with
the support of executive leadership.
Project Management Professional with numerous on time/budget successes in a dynamic, cross-functional
matrix corporation. Provided leadership to business/project teams by directing, managing, and aligning
staff to appropriate tasks based on priority, skills, knowledge, and workload. From 2007 to 2008 (1 year) Golden Valley, MinnesotaProduct Manager @ Performed product management activities for Personal Health Support ($58.5M annual revenue) including
RFP, Exception Review, Marketing Collateral, Technical Updates to Systems, and Project Management.
Responsible for product analysis, requirement definition, design, quality assurance, detail documentation,
and reporting of performance metrics.
Organized and led inter-departmental teams through all stages of product/project management.
Managed multiple and/or complex project plans to ensure that development initiatives stay on course and
on time. (PacifiCare Integration & Case Management Transformation)
Supported business growth/client services and channel partner training and sales efforts.
Utilized by sales and account management staff in the specifics of the product, and kept them informed of
new developments and enhancements. From 2006 to 2007 (1 year) Golden Valley, Minnesota
MHI, Healthcare Innovation - Master's @ Arizona State University From 2008 to 2010 Master's, Business Communication and Organizational Development @ Illinois State University From 1999 to 2009 BS, Business Administration, Management and Operations @ University of Wisconsin-River Falls From 1995 to 1999 Tony Mollica is skilled in: Management, Non-profits, Healthcare, Managed Care, Healthcare Management, Medicaid, Disease Management, Medicare, Utilization Management, Nursing, Hospitals, Healthcare Information..., Nonprofits, Case Managment, Process Improvement, Leadership, Health Insurance, Strategy, HIPAA, Healthcare Industry, EMR, Cross-functional Team..., Team Building, Strategic Planning, Team Leadership, Program Management, Six Sigma, Healthcare Consulting, Training, Health Policy, Project Management, Change Management, Case Management