Kay Small

Background

About Kay Small

MANAGED CARE CLINICAL AND OPERATIONAL LEADER Select Skills & Accomplishments • Effectively leads a department with onsite and work-at-home staff; manages departmental and project performance objectives for state contract pay-for-performance and liquidated damages totaling $21 million. Monitors and tracks operational performance noting policy and procedure adherence. Evaluates services for benefit appropriateness and quality of care • NCQA experience and knowledge provides ability to direct efforts that resulted in Full Health Plan accreditation and a perfect score in 2016 including file reviews for medical necessity and benefits appeals, member and provider grievances/complaints, and state fair hearings • Develops management tools, presentations and platforms to simplify executive reporting and drive actionable results • Directed a major health plan medical management restructure and in-sourcing to establish integrated health management department including policy, procedure and performance metrics for UM, UR, CM, and DM. Project was delivered ahead of plan and under budget. • Lead corrective actions resulting in greater 98+% consistency between delivery room records and maternal child data base in warehouse and its source information to determine preterm births data quality. • Using a depth of experience in Health Care payer claims systems and their implementation, created a parallel testing process for claims validation that included reviews for UM/CM edit functionality. This was accomplished by identifying absent or missing adjudication rules that defaulted to inappropriate claims payment. • Achieves consistently high employee satisfaction scores resulting in greater associate engagement and team performance for its annual review. Focus • Executive Management/Senior Leadership • Governmental and commercial managed care experience and management • Buyer and provider engagement • Project and process management • Staff development and performance management