Tom Minard

About Tom Minard

Licensed RN. Experienced in Commercial and DC Medicaid Health Insurance plans and Managed Care Utilization Review. Collaborated with a team of people who applied clinical acumen and business operational skills to address the ever changing problems confronting healthcare delivery. Helped fix the broken healthcare system to make it work better for my customers. Used Six Sigma and project management skills to develop and implement strategies that remedy the malfunctions of healthcare delivery such as the 30-day readmission crisis that plagues Americas seniors. Program managed enterprise efforts to decrease Emergency Room utilization and unit costs, resulting in conservative estimates of $137 M dollars. Led standardization and process improvement projects to achieve the “Triple Aim”: Improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and Reducing the per capita cost of health care. Skills:~Project Management leadership ~Utilization Review ~Emergency Department alternatives ~Leadership of clinical and non-clinical utilization review team operations ~Leadership of clinical teams through annual OSR audits and NCQA health plan accreditation ~Member benefits and Certificate of Coverage review ~Medical, High Risk, Disease and Care Management Programs ~Commercial and Administrative Services Only (ASO) insurance products ~Medicare and Medicaid (CMS) Coverage Guidelines ~District of Columbia (DC) Medicaid regulations ~Quality and Compliance clinical collaboration and integration ~Out-of-Country ambulance egregious billing process ~Durable Medical Equipment provider contracting and operations ~Certified Six Sigma Greenbelt My work experience includes a District of Columbia (DC) Medicaid Health Plan, UnitedHealthcare, Mid Atlantic Medical Services Inc.(merged with UHC in 2003), Criticare Systems Inc and various community hospitals in the Metro Washington DC/Maryland area.

Experience

1. Clinical Nurse Consultant

   Incenta Llc - Health Technology Firm

   Jan 2023 — Present · Washington, DC, US

   Part-time Advocate for members and Health Care Provider resolution expert for Self-funded employer groups. Consulting with Human Resources leadership, business vendors and insurance brokers. Billing SME.

Education

• Villanova University

  Biology/Biological Sciences, General

• Villanova University

  BSN

• Villanova University

  Religion/Religious Studies - Minor