Dulce T.

Experience

• 

  Aetna, a CVS Health Company

  Dec 2014 - Sept 2018

  Led team of Clinical Care Managers responsible for connecting at risk members to the appropriate providers, resources and psycho education to foster improved member health outcomes proactively, reducing utilization of emergency services, inpatient readmissions and subsequently, reducing cost Supported medical and behavioral health care coordination needs for Medicare, Medicaid and MMP members, conducting health risk assessments followed by development and maintenance of member centered care plans in alignment with individual need, risk and engagement

  • Clinical Care Management Supervisor

    Jun 2016 - Sept 2018

  • Clinical Care Manager

    Dec 2014 - Jun 2016
• 

  WellCare Health Plans

  Sept 2018 - Jun 2020

  Senior Project Manager - Quality Improvement

  Project Manager for Medicare and Medicaid plans with primary focus on improving HEDIS performance. Responsible for identifying providers and measures of highest impact potential and developing recommendations for performance improvement strategy accordingly; oversight of strategy execution in partnership with health plan partners.

• 

  Centene Corporation

  Jun 2020 - May 2022

  Manager of Quality Improvement

  Led project team responsible for optimization of provider Quality performance for both Medicare and Medicaid plans; leveraged KPI data analysis to guide team in strategy development for improved performance in CAHPS, HEDIS and Admin Ops measures, leveraged Lean Six Sigma principles to drive process improvement opportunities both at the health plan and enterprise level

• 

  Oscar Health

  May 2022 - now

  Senior Manager, Process Optimization

  Developed team responsible for process optimization of company workflows related to member grievances and appeals, targeting proactive remediation of member pain points such that overall case volume is reduced, member experience is improved, and department processes are standardized, streamlined and compliant with regulatory requirements