John Phomm
Director, Government Programs Operations & Products @Sentara Health
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WORK HISTORY
Director, Government Programs Operations & Products @Sentara Health
Tampa, FL, US
Provide enterprise leadership for Medicare operations and product execution within a multi-state health plan, overseeing benefit configuration, system implementation, regulatory readiness, and operational delivery across business, IT, compliance, finance, clinical, and network operations.Serve as initiative owner for CMS-0057F Interoperability and Prior Authorization mandate, leading enterprise strategy, vendor evaluation, governance, and implementation planning to support CMS regulatory requirements across the organization.Work closely with senior leadership, PMO governance, and capital committees to support enterprise regulatory and operational initiatives.Key areas of responsibility:• CMS Interoperability / FHIR APIs / Prior Authorization APIs• Medicare benefit configuration and AEP readiness• QNXT core administrative platform• Product and operational implementation• Program governance and executive reporting• Vendor selection and funding approvals• Cross-functional leadership across business and IT• Health plan system migration and transformation initiatives
EDUCATION
Value-Train School for Six Sigma
Certification, Green Belt Six Sigma
Keller Graduate School of Management of DeVry University
Master of Business Administration (M.B.A.), Master of Project Management (M.P.M)
Clayton State University
Bachelor's Degree, Business Management
SKILLS
ABOUT JOHN PHOMM
Healthcare leader with 20+ years of experience delivering enterprise strategy, operations, and regulatory initiatives across Medicare Advantage, Medicaid, and Marketplace programs within large health plan organizations.Currently serving in a Director role supporting Government Programs operations and product execution, with responsibility for enterprise initiatives including CMS-0057F Interoperability, Medicare benefit configuration, system implementation, and regulatory readiness across business, IT, compliance, finance, and operations.Experience includes leadership across national and regional health plans supporting Medicare, Medicaid, Star Ratings, Risk Adjustment, interoperability, and core administrative platforms including QNXT.Known for leading complex, high-visibility programs in matrix environments while partnering with senior leadership, PMO governance, and cross-functional teams to support regulatory compliance, operational readiness, and enterprise transformation.Areas of focus:• Medicare Advantage & Government Programs • CMS Interoperability / FHIR / Prior Authorization APIs • Product & Benefit Configuration • QNXT / Core Administrative Systems • AEP / Bid / Implementation • Star Ratings / Risk Adjustment / Quality • Program Governance & PMO Leadership • Vendor Selection & Implementation • Multi-state Health Plan Operations • Regulatory Programs
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