ProgenyHealth, LLC

Medical Director

• Leads the ProgenyHealth Medical Management program, with accountability for the performance and outcomes of the Clinical Operations Department.
• Maintains and oversees the NICU Utilization Management (UM), NICU & Maternity Case Management (CM) and Quality Management (QM) Programs and monitors adherence and compliance by reviewing and analyzing company data and dashboards to measure effectiveness.
• Builds customer loyalty through data-driven insights and compelling demonstration of program value.
• Supports the preparation, evaluation, and presentations of client program results at periodic client meetings.
• Engages and builds relationships with payer medical directors as well as hospital NICU teams, outpatient obstetric clinicians, and community partners as needed.
• Provides oversight of external publications that highlight ProgenyHealth’s medical management results.
• Works in close partnership with the SVP of Clinical Operations to ensure best-in-class training programs for all clinical staff.
• Will assist with the implementation and successful launch of new clients, new product lines, and/or technologies, as needed.
• Responsible for our continued successful accreditation by URAC and NCQA, as well as oversight of all State, Federal and Client standards/regulations necessary for ProgenyHealth to provide our services to our customers.
• Leads the Medical Advisory Board and Quality Improvement Committee and manages relationships with members that include practicing physicians across the US.

Chief Medical Officer – CMO

Manager

• Focus on empowering the caregiver and family to support optimal wellness while advocating for the necessary services and community resources across the health care continuum.
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Build and maintain relationships with caregivers and healthcare providers to develop an individualized plan of care that is member focused and addresses physical and psycho-social barriers to optimal outcomes
• Identify any impediments to member progress and advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team

NICU Case Manager, LCSW

• Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program.
• Completes needs assessments for all members in CM and develops care plans individualized to the needs of each member as per ProgenyHealth policies and procedures.
• Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess plan of care.
• Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits.
• Interfaces with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc.
• Provides education to members regarding condition, treatment plan, benefits, services, and how to access needed care.
• Monitors ongoing progress towards goal achievement and reassess changes in health status throughout continuum of care.
• Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure that services are actually being delivered and meeting the needs of the member.
• Participates in interdisciplinary and client rounds with pertinent health care team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.

ProgenyHealth, LLC

Chief Medical Officer – CMO

NICU Case Manager, LCSW

Nurse Case Manager – NICU

Nurse Case Manager – Maternity