Humana

• Manages client denials and concerns through analytic review of clinical documentation.
• Delivers final determination based on skillsets and partnerships with Humana parties.
• Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.

Healthcare operations leader with deep expertise in quality improvement across diverse provider networks. Responsible for overseeing the performance and reliability of the organization's network infrastructure. Leads cross-functional efforts that improve provider engagement, optimize workflows, and elevate overall network performance.