Operations

Our consultants build the business processes, tools, reports, and technical requirements to enable effective and sustainable implementation. 

Areas of focus for the operations team include:

  • Documentation of standard operating procedures
  • Development of business processes to operationalize new programs
  • Creation and updates of training materials

Recent projects have included:

  • Standard Operating Procedures: Developed Standard Operating Procedures that clearly define the roles, responsibilities and key functions of the Managed Care Oversight team related to contract management and oversight of vendors in 7 functional areas
  • Business Processes for Dual Eligibles: Led the development of a call center relationship and developed business processes to meet the needs of an initiative to transition dual eligible members to Medicaid Fee for Service for their Medicaid benefits
  • ACA Marketplace Implementation: Collaborated with state agencies and partners to ensure the successful implementation of the enrollment and eligibility functions of Rhode Island’s marketplace for health insurance coverage
  • Marketplace Enrollment Processes: Led the design and implementation of the Tier 2 customer issue resolution team to ensure an effective system was in place to promptly investigate and resolve issues affecting enrollment of consumers in a state-based exchange enrollment system
  • Hospital Care Transitions: Designed, developed and implemented a multipayor Hospital Care Transitions Program, targeting populations at risk for post-acute long term care services, to facilitate transitions to the community and minimize nursing facility length of stay
  • Medicaid LTSS Services: Completed a comprehensive review of an ACO’s services for members who need LTSS, resulting in changes to work flows, creation of training materials for staff to support cultural competency, updates to screening tools, and technical assistance to accurately analyze claims data for LTSS utilization

We are eager to learn more about your operational needs and how we can work together.