Shally Sinha

Experience

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  Sutter Health - Palo Alto Medical Foundation

  Jan 2005 - Jan 2014

  -Served as PCP to a large patient panel from a diverse ethnic and socioeconomic background, providing comprehensive pediatric care to from infancy through adolescence, including acute and chronic diseasemanagement-Special interest in counseling families on lifestyle approaches to address obesity and related disorders-On-call responsibilities for newborn nursery and inpatient admissions at a local hospital, providing high-quality patient care under stressful conditions-Demonstrated expertise in coordinating care with specialists for complex patient cases, ensuring seamless care delivery Show less

  • Primary Care Pediatrician

    Jan 2006 - Jan 2014

  • Urgent Care Pediatrician

    Jan 2005 - Jan 2006
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  Sutter Health - Palo Alto Medical Foundation

  Jan 2015 - Jan 2021

  Medical Director, Utilization Management

  -Delivered leadership and support to ensure compliance with regulations and improve patient outcomes, collaborating with prestigious institutions and utilizing evidence-based resources-Implemented patient-friendly workflows and conducted regular presentations on clinical topics to increase engagement among staff-Collaborated with claim staff to review medical claims and improve accuracy and timeliness of reimbursement for services provided

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  Optum

  Jan 2021 - Jan 2022

  Medical Director Population Health and Utilization Management

  -Optum lead client-facing physician for John Muir Health (UCSF-affiliated integrated hospital-based healthcare system)-Participated actively in VBC huddles to review and triage complex inpatient and SNF cases and identifying barriers to discharge-External-facing role with health plans for complex case management, repatriation of members at out-of-network hospitals, and member utilization of inpatient services-Data analysis of significant utilization trends and impact to cost and quality of care-Physician case reviewer using evidence-based resources like CMS, Interqual, NCCN and Commercial health plan medical policies-Provided extensive training to UM RNs and MDs on prospective, concurrent and retrospective reviews Show less

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  Accenture

  Jan 2022 - Jan 2024

  Chief Medical Director, Radiant Services, Accenture

  -Provided oversight and strategic direction for BPO services in health management, utilization management and care management services, overseeing 500+ offshore RNs-Helped address post-pandemic U.S. healthcare RN staffing shortages with care innovative methods, increasing client cost savings -Chaired Radiant Quality Committee overseeing quality improvement projects and ensuring adherence to URAC and NCQA standards

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  Collective Health

  Jan 2024 - Jan 2024

  Senior Medical Director, Clinical Operations

  -SME for the development of CH’s new Utilization Management (UM) product, collaborating with operational and technology leadership, to implement best practices and ensure quality-Partnered with Legal and Compliance team to ensure UM product adherence to regulatory requirements and minimize organizational risk-Spearheaded an intervention-based savings metrics dashboard in collaboration with data science and data engineer teams to identify medical cost savings from care navigation -Collaborated with customer success teams to understand and support client clinical needs Show less

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  Blue Shield of California

  Mar 2025 - now

  Chief Medical Director, CalPERS Account