Kajsa Craven

Experience

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  Compassionate Hospice Care and Palliative Care

  Jan 2012 - Jan 2013

  COMPASSIONATE HOSPICE AND PALLIATIVE CARE, DIRECTOR OF CLINICAL SERVICES (2012 – 2013)

  Recruited, hired, and trained 25 personnel, championing training and professional development to align operations with standards and market trends while ensuring regulatory compliance.► Grew patient population by 50% by developing relationships within SNFs and hospitals, taking on complex members, admitting members after hours, and showing up / being accountable to build trust.► Boosted communication efficiency by devising template for nurses to report in weekly physician rounds.► Balanced priorities across people leadership, budget administration support, recordkeeping and reporting, and all aspects of patient services. Show less

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  Centura Health

  Jan 2013 - Jan 2018

  CENTURA HEALTH, CO HEALTH NEIGHBORHOODS, MANAGER OF AMBULATORY CARE (2013 – 2018)

  Motivated and guided team of 8 Registered Nurses (RN) and Social Workers, leveraging combined business and clinical nursing acumen, applied case management expertise, and analytical thinking to solve problems.► Helped implement and become NCQA credentialed for case management and aligned operations with NCQA standards through staff education.► Generated highly individualized care coordination plans by bridging communication with patient teams and mitigated issues through ongoing patient assessments / observation to maximize wellness and safety.► Educated physician groups about ambulatory care services and local resources. Show less

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  Bright Health

  Sept 2018 - Feb 2023

  Devise creative strategies for medical cost management (MCM) and P&L growth, review trends, predict barriers to market success, and accelerate action planning addressing future and current states. Enhance executive relationships with care partners in 13 states/markets nationwide, navigating difficult business decisions like closing commercial and Medicare plans. Launch market-targeted programs for risk adjustment, HEDIS, and provider engagement.► Head market-specific risk adjustment projects valued at ~$2M+ ROI and support national risk adjustment initiatives.► Closed risk and HEDIS gaps, aligned unattributed members with PCPs, and confronted social determinants of health (SDOH) issues by partnering with in-home physician group for proactive member engagement and in-home visits.► Identified large, poorly performing care partner in risk adjustment and collaborated with their executives to create embedded coder position for pre-visit planning / post-visit review to improve accuracy and increase ROI.► Managed unresolved high-cost claims by prioritizing and escalating to appropriate leadership and making recommendations for settlements or other payment strategies using non-conventional solutions. Show less Led team of geographically-distributed clinicians, championing accountability to value-based care (VBC) contract conditions through diligent oversight and thoughtful recommendations. Strategized clinical policy decisions within organization as SME for market-level / state nuances. Solved clinical problems and improved processes as escalation point for complex issues.► Drove STARs/quality improvements throughout region by coordinating with cross-functional teams to create and enhance workflows and accelerating performance of RNs with market oversight responsibilities.► Lead clinical implementation of Medicare and commercial plans, including risk adjustment, case management, utilization management, HEDIS, and HIE, to onboard large care partners such as Centura Health (CO) and Nebraska Medicine (NE).► Maintained network keepage, member satisfaction, and health insurance standards in coordination with interdisciplinary teams and care partners.► Reported quarterly market performance to executives as leader of Joint Operating and Joint Clinical committees. Show less Designed and applied collective intervention set, monitored and reported performance, and enhanced programs to advance clinical performance operations. Achieved goals by engaging with care partners and promoting continuous innovation.► Oversaw clinical program governance and owned working relationships with senior leaders to improve utilization, keepage, quality/HEDIS, and risk adjustment.► Reduced member and provider abrasion while helping optimize MCM by supporting Market Lead RNs, Case Management, Care Navigation, and Utilization Management teams throughout West Region. Show less Surveilled high-risk members, monitoring care management/complex care management (CM/CCM) activity outcomes. Worked with internal teams and care partners to request, review, and abstract medical records for HEDIS, quality of care concerns, quality improvement programs, and care coordination. Streamlined processes across multidisciplinary teams.► Created tracking report, reporting structure, and plan to manage high-cost members for reinsurance company.► Streamlined performance and assisted clinicians working at top of license by creating daily market report for CMO.► Supported cross-functional teams by creating early warning system to keep a pulse on market activities, such as emergency department (ED) and inpatient (IP) use, network keepage, and early identification of high-cost members.► Facilitated member adoption of population health management tools, like case and chronic care management, providing collaborative support to Market team/care partner on strategies to improve these processes.► Developed referral process workflow and reporting structure between care partner and health insurance company. Show less

  • MANAGER – MARKET SUCCESS, WEST & CENTRAL REGIONS (2022 – 2023)

    Feb 2022 - Feb 2023

  • MANAGER – CLINICAL MARKET PERFORMANCE, WESTERN REGION (2021 – 2022)

    Jan 2021 - Feb 2022

  • REGIONAL LEAD – CLINICAL MARKET PERFORMANCE, WESTERN REGION (2019 – 2021)

    Jan 2019 - Jan 2021

  • MARKET LEAD – CLINICAL MARKET PERFORMANCE, COLORADO (2018 – 2019)

    Sept 2018 - Jan 2019
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  MedArrive

  Feb 2023 - Jun 2023

  Regional Clinical Director

  Implement and execute Enhanced Care Management Programs for California Medicaid population. Responsible for coaching towards and attaining clinical and operational performance goals, supporting ongoing clinical education needs, clinical strategy discussions and supporting external care partners.• Facilitate successful launch of state based Medicaid program• Hire and provide direct oversight and ongoing support to clinical team• Ensure success of clinical and operational metrics and KPI’s• Support clinical program design and refinement opportunities Show less

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  Abby Care

  Dec 2023 - Apr 2024

  Director of Nursing
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  AdhereHealth, LLC

  Apr 2024 - now

  Client Success Manager