Veronica Sheffield
Senior Director Clinical Programs @Cohere Health
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WORK HISTORY
Senior Director Clinical Programs @Cohere Health
Own the strategy, goals, and development for clinical programs aimed at managing cost trends and improving health outcomes Collaborate cross-functionally with Medical, Trend Innovation, Clinical Analytics, Product, Operations, and other teams to design and execute clinical programs.Develop and manage relationships with external clients and partners, in collaboration with Business Development and Strategic Accounts teammates.Continuously monitor the performance of programs, partnerships, and integrations to refine and improve clinical and business outcomes of the overall program.Lead Program Managers and other teammates supporting assigned clinical programs.
ABOUT VERONICA SHEFFIELD
I am an experienced RN executive who is passionate about quality health outcomes and the patient experience. I believe that no one should walk their health care journey alone. I thrive when challenged and enjoy utilizing my exceptional communication, problem solving, and analytical skills to identify and deliver solutions to business problems. Proven record as a team leader that collaborates with stakeholders to ensure successful delivery of initiatives on time and within budget. As a leader, I leverage my experience, collaboration, and agility to help navigate and mentor my team to achieve patient-centered, quality goals that have lasting outcomes. I have diverse experience in developing and operationalizing successful population health strategies for both medical and behavioral health.Areas of skill and expertise: § Population Health § Integrated Care Management (Medical/Behavioral Health) § Utilization Management § Post Acute Care (LTAC, SNF, Inpatient Rehab, Home Health) § Transition of Care/ Hospital Discharge Planning § Care Management/Disease Management § Process Improvement § Program & Vendor Management § Leadership/Mentoring § Quality Management § Medicare/Medicaid/Commercial lines of business Accomplishments:§ DME UM program the coordinated UM, pharmacy, medical policy, reimbursement policy, contracting, appeals, and claims edits with greater than 3:1 ROI.§ Post-Acute (SNF, IPR, and LTAC) integrated UM/CM program that reduced PMPM by 30% while increasing member satisfaction surveys to >90% and reduced member appeals to <10%. § Refined AI technology for Medicare readmission program focused on high cost, rising risk members; achieved 4% to 11% reduction in readmission or ED visit when engaged with RN case manager.§ Identified and recouped $1.6M+ in behavioral health claims payout for single line of business; developed process and automation to avoid future errors and expanded to all LOBs.§ Developed programs to be both member-centric and outcome-focused while exceeding contractual, regulatory and Quality Accreditation Standards (NCQA, HEDIS, and STARS).Awards: 2022 Cambia Value Award – Innovation2021 Cambia Excellence in Leadership Award2019 Cambia Excellence in Leadership Award
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