Experience

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  Priority health

  May 2000 - Jan 2010

  Primary responsibilities include the general oversight of key systems and processes in support of the Medicare product lines. Oversight responsibilities include but are not limited to: • Compliance and implementation of federal regulations & Centers for Medicaid and Medicare Services (CMS) policy and guidance • Systems/software development & implementation • Medicare Web Presence• Systems Availability & Production Support• Key Vendor Relationships• Inbound and outbound file transfer processesOther responsibilities include:• Interpretation and impact analysis of CMS guidelines & policy and Federal regulations• Planning and development for current and future Medicare product lines• Project Management• Product Analytics• Process Improvement Show less

  • Technical Administrator Medicare Product Lines

    Jun 2006 - Jan 2010

  • Project Manager

    Dec 2002 - May 2006

  • Senior Support Technician

    May 2000 - Dec 2002
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  Kocsis consulting group

  Jan 2011 - Dec 2011

  Principal consultant
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  Trizetto healthcare products

  Jan 2012 - Feb 2019

  Darrell McCaul was an Advisory Consultant for the TriZetto Corporation. TriZetto offers a broad portfolio of healthcare IT products and services that can be delivered individually or combined to create a comprehensive solution. Focused exclusively on healthcare, TriZetto serves more than 500 payers, providers and benefits administrators. Its payer customers serve more than 100 million health plan members, or approximately 40 percent of the insured population of the United States.Darrell has 18+ years of health care experience, including 5 years in Medicare Advantage, and has been a certified Project Management Professional (PMP) since 2005. He has been involved in the Medicare Advantage and Part D products since their inception and in the launch of six Medicare products. These experiences have provided Darrell with vast perspective on Medicare products and CMS as a whole. Darrell has served as both a project manager and an administrative leader with oversight of functional areas such as Enrollment, Marketing, Sales, Premium Reconciliation, Customer Services, IT, Medical Management, Provider Network, Claims and Finance to ensure compliance. He has a strong understanding of federal regulations including CMS guidance for Medicare Advantage plans. He is a versatile project manager with expertise in business process development and process improvement, business and IT project management, business and systems analytics, requirements development and management processes as well as customer service. He is also capable of successfully managing multiple projects ranging in complexity and duration simultaneously. Show less

  • Sr Project Manager

    Aug 2014 - Feb 2019

  • Advisory Consultant

    Oct 2013 - Jul 2014

  • Senior Consultant II

    Jan 2012 - Oct 2013
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  Catalyst solutions - a heathcare consulting company

  Feb 2019 - Sept 2019

  Director, client engagement

  Role Summary: Acted as a trusted advisor to Catalyst clients, leveraging my industry knowledge to uncover challenges at clients/prospects and provide solutions that led to consulting engagements that help clients achieve business strategies, operational effectiveness and best practices. Responsible for project oversight/governance, collaboration of Catalyst Practice Leads, Advisory Consultants, and other functions within Catalyst and growth of current/former client relationships to cultivate new business. I was expected to be a successful relationship builder, credible adviser, team leader, and creative problem solver.Duties and Responsibilities - Manage the relationship with the client throughout the project duration and acting as the main point of contact between Catalyst and the client at the project or program level for overall client relationship.- Ensuring the services delivered by Catalyst conform to what has been contractually agreed to between Catalyst and client monitoring the delivery of said services against agreed schedule, quality, scope and budget.- Manage Catalyst project or program resource planning and addressing resources performance issues.- Manage the financial aspects of the contract in concert with Catalyst business operations personnel- Act as the escalation point when issues arise with Client’s resources / services and managing any dispute or conflict for engaged projects/programs.- Reporting internally within client organization and Catalyst on project performance (services delivery, progress, project metrics, etc.).- Participated in the sales stage of the project to provide input on solutions development and deliverables. Show less

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  Catalyst solutions - a healthcare consulting company

  Jun 2019 - Nov 2019

  Principal (interim)

  Role Summary: Acted as a trusted adviser to Catalyst clients, leveraging personal industry knowledge to uncover challenges at clients/prospects and provide solutions that could lead to consulting engagements that help clients achieve business strategies, operational effectiveness and best practices. Responsible for project oversight/governance, collaboration of Catalyst Practice Leads, Advisory Consultants, and other functions within Catalyst and growth of current/former client relationships to cultivate new business. Also, as a principal, I was expected to be a successful relationship builder, credible adviser, team leader, and creative problem solver.Duties and Responsibilities - Develop trusted relationships with health plan executives to diagnose health plan challenges and develop solutions.- Drive multi-million-dollar sales goals by overseeing the establishment and development of relationships with prospects.- Envision/deliver solutions related to: Health Plan Operations, Health Plan Technical Consulting, Information Management, Compliance and Regulatory, Quality Assurance/Testing. This includes but is not limited to, sales proposals and power point presentations to clients.- Provide oversight on engagements to ensure client satisfaction and additional opportunities are identified for follow on work. Drive quality service by establishing and enforcing organizational standards and core values.- Provide thought leadership to clients directly and participate in the development of white papers, blogs and webinars to establish Catalyst as an industry thought leader.- Enhance team competence by assisting with planning the delivery of solutions, answering technical and procedural questions for less experienced team members, teaching improved processes, and leading/mentoring team members.- Ensures and maintains up to date account activity in Salesforce and fully use its functionality to manage account portfolios. Show less

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  Projé

  Jan 2020 - Aug 2021

  Senior project manager
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  Blue cross and blue shield of louisiana

  Aug 2021 - now

  • Lead Program Manager

    Jul 2023 - now

  • Senior Program Manager

    Aug 2021 - now