Charlotte, NC     |   (704) 787 – 6617      |     atg18.duke@gmail.com |

Website: www.amandasnowmsn.com

GitHub: amandatsnow (amandatsnow)

 Senior Director Clinical Informatics | Senior Data & Analytics Consultant |  Clinical Operations Manager | Senior Clinical Advisor

Clinical Informaticist with an interdisciplinary skill set bridging clinical nursing expertise with strong analytical and technical skills. Highly experienced health-care leader with strong business acumen within telehealth services, PBM services, pharmaceutical HUB services, and utilization management. Thriving as a cross-functional team member connecting evidenced based clinical practice with technology.

• Client facing clinical operations key contact

• Medical and pharmacy claims data review

• RFP response and defense clinical SME

• Clinical expertise rare disease and oncology

• Telephony call center metric development

• Clinical liaison to technical teams/analyst

Experience

New Century Health | 11/2022 –12/ 2024 | 2 years

Director, Clinical Informatics, Performance Suite

Responsible for end-to-end business, clinical, and technical work processes enabling claims processing and delegated provider reimbursement.

• Responsible for business enablement of coding governance supporting utilization management activities. Created executive level code scope decision-making forums and decisioning content to drive critical financial and clinical prior authorization decisions and to promote stakeholder awareness.

• Responsible for strengthening confidence in system codification. Developed code correction rate KPI, built a scalable and repeatable workflow to ingest all CMS, state fee, and FDA updates. As a result, 26 payers with 53 lines of business deployed, with KPI correction rate <1%.

• Developed a standard suite of reports and dashboards enabling operational activities, utilization management audits, claims processing, financial reconciliations, and billing code maintenance.

• Developed a critical pathway to systematically identify high-cost oncology drugs. Successfully, coordinated with client clinical teams to add over 20 oncology drugs across delegated risk portfolio, which enabled oncology services to reach and support more patients.

• Surveillance of coding publications provided by American Medical Association (AMA), Center of Medicare and Medicaid (CMS), Food and Drug Administration (FDA), and state and local regulatory agencies to ensure regulatory compliance with all claims billing propagation and data stewardship throughout organizational payment systems (CPT, HCPCS, ICD-10, GPI).

Lash Group (Amerisource Bergen) | 8/2017 – 11/2022 | 5 years, 3 months

Senior Data & Analytics Consultant, Data Science & Data and Analytics:

Supporting specialty pharmacy HUB services with nursing service support, data science, analytics, and machine learning initiatives. Data life-cycle management, coding language scripting, and clinical assessment workflow design and implementation onto new and existing clinical CRM platforms.

• Salesforce cloud-based platform implementation and deployment team lead. Responsible for system requirement gathering and translation fr.om clinical partners to technical team. Responsible for functional design of nursing GUI interface, clinical decision support focus areas, and defining user roles.

• Collaboration with clinical operations, strategic account operations, product, technical teams, and regulatory compliance teams to ensure  technical specifications met compliance, contractual, and regulatory standards. Received “Pursuit of Purpose” award this project.

• Developer of client facing interactive Power BI dashboards providing real-time data insights and aggregation of critical HUB service performance metrics. Partner with clients to understand their business and data challenges to provide dashboarding solutions for on-going monitoring and to identify areas that need deeper analytical support.

• Highly skilled with open-source data and clinical research database interrogation, such as PubMed and EBSCO to incorporate latest research findings to real world evidence for insights.

• Collaboratively published patient access case study that instigated program changes boosting fulfillment rates by 11% from 2016 to 2017, and then by an additional 4% from 2017 to 2018.

Accordant Health Services (CVS Health) | June 2006 – August 2017 | 11 years, 2 months

Senior Clinical Advisor, Payer Solutions: 2/2013 – 8/2017 (Promotion)

Promotion from previous role, served as the client facing key clinical contact across payer portfolio consisting of the largest government and commercial health plans in the nation.

• Identified and cultivated patient success measures and anecdotal patient case stories to convey the value of nursing services showcasing nursing expertise and patient outcomes.

• Excellent communication skills and ability to synthesize complex content presenting yearly nursing programs and value outcomes and quarterly clinical performance to health plan executives.

• Responsible for becoming an integrated partner with health plans and understanding their business issues for solutioning. Deployed a data driven strategy to enable direct coordination with health plan’s embedded case management team.

• Served as the project sponsor on numerous strategic patient centered projects. Successfully implemented patient telephony engagement strategies to scale and patient case loads balanced with nursing resources driving upward patient engagement trends influencing health plan’s average 3:1 return on investment.

• Clinical SME supporting RFPs for sales support of new business and business expansions and developing RFP defense strategies for existing business.

Clinical Operations Manager, Payer Solutions: 6/2007-2/2013 (Promotion)

Promotion from previous role, people manager of high performing nursing case management team delivering telehealth services on a population health scale to the largest government payer in the United States, with over 2.2 million covered lives.

• Led clinical team, including direct patient care nurses, assistant managers, and ancillary staff.

• Served on leadership and professional development council, working directly with CMO to drive continuous nursing excellence utilizing evidence-based clinical guidelines.

• Oversight of call center telephony performance, monitoring, and reporting.

• Multidisciplinary approach to identify, mitigate, and strengthen key performance indicators.

• Managed yearly staffing merit and bonus budget based on performance reviews.

• Managed multi-state nursing licensure to ensure nursing practice compliance across all clinical staff.

• Set-up and managed SharePoint sites supporting client specific requirements across the clinical portfolio.

Rare Disease Case Management | Registered Nurse | Certified Case Manager | 6/2006-6/2007

Delivered direct patient care, case management, and care coordination for patients with rare chronic diseases treated with specialty pharmacy medications.

• Managed case load of 150-200 patients quarterly delivering holistic telehealth nursing services to meet the complex needs of patients with rare chronic diseases.

• Care coordination  and complex case management across patient’s care team, including specialists, primary care providers, physical and speech therapy, home health agencies, inpatient hospitals, long-term care facilities, and health plan case managers.

• Performed medication regimen review to identify gaps in care, duplication of therapies, and minimize adverse drug events.