Ebony Washington

About Ebony Washington

Results-driven Clinical Care Leader with a proven track record of optimizing clinical operations, achieving 100% NCQA accreditation and spearheading major initiatives such as high-risk member assessments and a $50 million cost-of-care recovery project. Expert in strategic planning, budget management, and compliance, with notable achievements in improving care transition metrics and driving efficiency through digital transformation and training programs. Demonstrated success in leading diverse teams, managing complex cases, and enhancing patient care outcomes across various healthcare networks•Strategic Leadership: Co-led strategic planning with co-directors for Care Management and Utilization Management, overseeing a network serving +11,500 patients•Business Continuity Planning: Directed high-risk member assessments during the pandemic, achieving an 8,900-assessment completion rate. Spearheaded a Cost-of-Care Initiative, transitioning over members to MLTSS•Budget Management: Participated in annual budget planning, benchmarking, and addressing year-over-year variances in services and costs; managed clinical initiatives that directly impacted revenue generation•Audit Compliance & Accreditation: Achieved 100% NCQA accreditation; developed corrective actions that improved audit scores across internal, DMAHS, IPRO, and NJ Choice audits, completing eight audits within two years•Risk Management: Managed state complaints, conducting thorough investigations and reporting back to the state and senior leadership on findings•Operational Leadership: Managed eight Clinical leaders, overseeing day-to-day operations and adhering to timely resolution of escalated issues while optimizing member care across multiple departments•Quality Reporting: Successfully maintained compliance with audit elements, coordinated with clinical and operational teams (Claims, Billing, IT), and managed key reportsNoteworthy Professional Achievements:o Progressed through roles from RN Manager to Clinical Director within Anthem (now Elevance Health)o Achieved an 86th percentile performance in internal audits for care manager visits, 98% compliance in DMAS NJ Choice submissions, 85% in timely visit completion, and 84% in PCA tool completiono Completed McKinsey Academy’s Business Strategy and Management Accelerator Program, She Suite-Velvet Suite’s leadership training, and Elevance Diversity Talent Cohort for high-potential talent developmento Co-led the APEX African American Exchange group

Experience

1. Clinical Director

   Elevance Health

   Nov 2017 — Present

   Summary: Manage a team of clinicians specializing in Skilled Nursing Facility (SNF) and Private Duty Nursing (PDN), including overseeing care delivery, ensuring quality member outcomes, optimizing member benefits, promoting the efficient use of resources, addressing complex clinical needs and managing long-term care for members with chronic conditions•Facilitate alignment with the State of NJ and coordinate with Directors across multiple clinical practice areas to address member issues on authorizations and treatment eligibility•Recovered a $50 million organizational deficit by addressing coding issues and analyzing trends in care transitions•Proactively design programming and initiatives to address social determinates of health, including implementing nutrition and housing initiatives; collaborate with major healthcare plans like AETNA, United Healthcare, and Blue Cross Blue Shield•Drive the waiver initiative, building workstreams to support the expansion of Medicaid eligibility•Spearhead initiatives around value-based contracting and reimbursement systems•Create and implement desktop processes for the Care Management (CM) team•Parse operational metrics and developed presentations for the NJ State Plans•Forecast and address reductions in force to maintain a high quality and high morale workforce; implement team motivation strategies during hiring freezes•Lead recruitment and retention efforts, including virtual job fairs, salary adjustments, and restructuring training programs, resulting in successful onboarding and retention of clinical staff•Enhance clinical staff\'s competencies and knowledge in key areas such as PCA tools and conversion conversations•Regularly review and update compliance protocols to reflect changes in laws and regulations•Ensure management is trained in protocols, implement the Community Services Survey for MLTSS eligibility, and oversee interim care plans to assess member needs

Education

• Western Governors University

  BSN Nurse Leadership, Registered Nursing/Registered Nurse

• Rutgers University–New Brunswick

  Bachelor of Science - BS, Public Health

• Western Governors University

  MSN Nurse Leadership, Nursing Administration

  2026