Lauren Simpson
Lancaster
Summary
Results-driven healthcare management professional with proven ability to lead teams to success through effective employee motivational strategies. Strong focus on team collaboration, operational efficiency, and achieving measurable outcomes. Adept at strategic planning, process improvement, and fostering culture of accountability and excellence. Known for adaptability and consistently meeting changing organizational needs.
Overview
13
13
years of professional experience
Work History
Manager of Authorizations - Utilization Management
Fidelis Care
10.2022 - Current
- Oversees and manages a team of 6 Supervisors and 117 indirect reports to ensure accurate daily Utilization Operations including timeliness, quality and performance outcomes, provider interactions and associated regulatory compliance measures.
- Creates utilization management team policies and procedures to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards.
- Reviews, analyzes, and reports on trends, patterns, and impacts to deliver a cost-effective utilization program and present results to senior leadership.
Supervisor of Clinical Services – Transitional Care
Fidelis Care
07.2019 - 10.2022
- Supervised 17 administrative staff in multiple state regions
- Maintained accurate knowledge of State regulations & provided training to effectively communicate these changes to our employees.
- Lead my team to reduce hospital readmission rates for our membership.
- Motivated my team to increase productivity by 22% through a transitional period of working-from-home.
- Active Participant in the MOSAIC Employee inclusion group (Diversity & Multicultural awareness) and the INSPIRE Employee inclusion group (Women Empowerment)
Managed Long Term Care Trainer
Fidelis Care
05.2017 - 07.2019
- Developed and trained desk level procedures for a team of over 500 clinical and administrative staff
- Took a lead role in the 438 DOH initiative development & training across the organization
- Lead a 6-month development plan of building a Utilization Management team within the MLTC organization chart.
- Revamped the department New Hire Orientation into a detailed 4-6 week training class with a mapped learning plan and graduation segment which helped guide our new hires to success in their new roles.
Managed Long Term Care Trainer
Fidelis Care
11.2014 - 05.2017
- Supervised 19 administrative staff that provided care management to individuals that qualify for Long Term Services and Supports under Medicaid Managed Care.
- Worked directly with providers to ensure their authorization requests are completed within compliance of all state and federal deadlines and regulations.
- Lead a medication management project which saved the company over $130,000 on a monthly basis
Quality Assurance Supervisor
Univera Healthcare
01.2013 - 07.2014
- Researched, and responded to inquiries from internal and external customers, business partners and special groups concerning our products, services and policies in accordance with MTM, NCQA, HIPAA, NYSDOH and other legislative requirements.
- Worked directly with providers to ensure their authorization requests are completed in compliance with all state and federal deadlines and regulations.
Education
Masters of Public Health - Concentration in Health Policy, Management & Behavior
University at Albany
Albany, NY01.2020
Bachelors Degree - Health And Wellness
Buffalo State College
Buffalo, NY01.2012
Skills
- Over a decade of leadership experience
- Quality Assurance and Operations management
- Care Management & Utilization management processes
- Proficient in MS Word, Excel, and PowerPoint to create and analyze data
- Staff training and development
- Complex Problem-solving
Timeline
Manager of Authorizations - Utilization Management
Fidelis Care
10.2022 - Current
Supervisor of Clinical Services – Transitional Care
Fidelis Care
07.2019 - 10.2022
Managed Long Term Care Trainer
Fidelis Care
05.2017 - 07.2019
Managed Long Term Care Trainer
Fidelis Care
11.2014 - 05.2017
Quality Assurance Supervisor
Univera Healthcare
01.2013 - 07.2014
Bachelors Degree - Health And Wellness
Buffalo State College
Masters of Public Health - Concentration in Health Policy, Management & Behavior
University at Albany
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