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Click here or scroll down to respond to this candidateAdnan Zalam(Delivery Service Model)Phone PHONE NUMBER AVAILABLE E. EMAIL AVAILABLE1Success-driven and visionary Operations Executive Leader with over 29 years of extensive leadership experience in driving excellence across customer care, service operations, and workforce management Operations and project leader with over 29 years of experience transforming organizations, processes, and teams across the healthcare and technology industries. Demonstrated success in building client and cross- functional partnerships, driving strategic initiatives, orchestrating workflow improvements, and developing analytics. Passionate about people getting the healthcare they need when they need it. SKILLSContract & Risk Management Develop/Maintain/Manage PMO Complex Contractual Agreements Consulting Services & Large System Delivery Services Data Gathering & Analysis Operational Effectiveness Life Cycle Software Implementation & On-going Support Continuous Process Improvement Influencing & Negotiation Client Services Project & Program Management Team Leadership Across All Projects/Departments Strategic Planning & Priority Setting Planning & Execution Problem Solving IT Coordination Metrics Development Documentation and Reporting Goal Planning & Development Executive Communication Outsourcing & Budget Management Mergers & Acquisitions Legal / HR / Finance Charles Schwab Stakeholders Management Fast-Paced EnvironmentCommunicates in English/Spanish Client-Centric Approach: Strong background in providing exemplary customer service to a diverse client base, covering millions of customers, and managing compliance to quality and service metrics tied to client performance guarantees. Innovation and Change Management: Proven history in steering innovative initiatives, such as call routing platform changes and IVR modernization, Knowledge tools, and CRM implementation highlighting adaptability to evolving technologies. Cross-Functional Collaboration: Demonstrated success in serving as a key liaison to cross-functional departments and supporting business units, ensuring plan compliance, and promoting collaboration. Professional experienceSVP of Program Management & CTO DBMS Health, Inc. 2015 Present Managed all aspects of the information technology department (technical, business, infrastructure, security, training, database, support staff) and I/T budget in/out of the USA. Managed the structuring and restructuring of several I/T organizations (IN, NY, CA, KS). Designed, developed, and implemented several integrated 43 managed care delivery models for BCBS, UHC, Kaiser, TPAs, and hospitals for 23+ years (SQL-Server and Cloud-Base APPs) Reversed-engineered and supported BCBS Claims Processing, Benefits, Benefits Exclusions databases and systems at 32+ BCBS locations (Mergers & Acquisitions in 12 States). Designed a data mining engine and used robust AIs and Hot-Triggers List to proactively manage High-Risk cases. The top 5% of High-Risk patients consume over 75% of the budget. Supported an Integrated Health Management Software, including EMR, UM (Auth), CM, DM, Wellness, Admission, Discharge, reporting, ER, ICU, ICU machines and reporting. Replied to RFPs, negotiator and deal closer with TPAs, Hospitals, Clinics, and carriers. Negotiated M&A and integrated all system as well as removed all redundancies. Adapted to challenging models by automating ACA/ACO and Transition of Care (reduced risk). Marketed teams clinical/medical and technical knowledge to carriers and pharmaceuticals. Lead the Unisys team to design and implement Indianas Child Welfare System (92 counties) Designed/implemented Eli Lillys Oracle Laboratory Info Management System LIMS via E&Y. Adnan Zalam(Delivery Service Model)Phone PHONE NUMBER AVAILABLE E. EMAIL AVAILABLE2Co-founder / CEO (Program Management Director) - DBMS, Inc. 1997 to 2014: Indianapolis, IN Cofounded an entrepreneurial company to develop and deliver an integrated health management software and medical management services to TPAs. The company focused on delivering care management services to self-funded employers, insurance carriers, and hospital networks. The integrated solution includes the UM Authorization, CM, DM, Wellness, Evidence- base customizable assessments, feeding clean authorizations to claims, and customizable care plans within seconds. Designed the Pandemics Global Surveillance Alert System. Created a future roadmap and expanded our healthcare solutions nationally and internationally. The ICMS/SIMS software was first implemented in 2001. Software is available more than 99.98% of the time. It included most of the necessary components managed via an Integrated Health Plan model (such as Kaiser, BCBS, UnitedHealth Care, or other carriers). One of the DBMS Health founders who held several management positions and successfully followed a 5yr entrepreneurial vision for an integrated health delivery model. Designed new products (narrow network); like other competition in the healthcare industry, including the private/Self-Funded industry and utilized the proper life cycle methodology. Lead Market-wide efforts to drive high quality, low-cost operations across all sites. Motivated and crossed trained staff to maintain quality of service throughout corporate mergers process as we achieve goals related to growth. Ensured our in-house products, security and operation adhere to industry standards and maintain proper accreditations and certifications (URAC, ISO, HIPAA, WFME consulting) Visited all clients nationwide resulting in 98% - 100% client retention after mergers and reviewed/approved all related vendor agreements. Held accountable for clinically/medically integrated health delivery systems of care performance scope/targets as well as in-house data mining (A.I. analytics engine that reports errors in advance via consistency reports and proactive identification of high-risk patients) and real-time reporting. Among other technology, I utilized: Front-end: React and the back-end APIs in ASP.NET Core, ASP .Net HTML - CSS - JavaScript Back-end: ASP .Net Core web APIs - Entity Framework - Databases: SQL Server, Oracle & SAP Designed/customized software based on specs, implemented, and trained clients. Created an evidence-base customizable, care plan for a patient with multiple conditions. The software manages 76+ conditions with Gaps in Care. It helped in reducing medical errors. The care plan contains medical problems, goals, and interventions (customizable), where AI alerts the medical director(s) to guide clinical users in following clinical / medical protocols. Acquired and sold health insurance companies and made profit. Created e-commerce solutions for the health insurance, TPA market and worked with a team to create healthcare e-solutions for providers, patients, and payers. Designed a fully integrated hospital management Web/Cloud software solution with Utilization and Case Management part of the all-in-1 integrated health delivery model. Held responsible for P & L and annual budgeting, forecasting and strategic planning. Improved partnerships with clients by providing robust solutions (electronically identify High- Risk Population, accurate eligibility, claims, Labs (Genetic Testing), large claim notifications). Grew the company by 18% - 21% annually between 1997-2014 prior to involving investors and hiring a new CEO.Adnan Zalam(Delivery Service Model)Phone PHONE NUMBER AVAILABLE E. EMAIL AVAILABLE3VP of Technology - Quantum Health Plan (Gentiva) Indianapolis 1993 1996 Reported to the CIO of the California, Indiana, and Kansas operations. Restructured the whole I/T and Business teams between LA and Indianapolis. Held responsible for all I/T Departments (California and Indiana) and merged data centers for 2 managed care organizations.Senior Director Implementation, Anthem BCBS Indianapolis IN 1990 1993 Reported to the VP of Information Technology at Anthem and managed more than 1,700 I/T engineers, database administrators and I/T staff in 12 states. Evaluated, planned, and spearheaded the development of all new BCBS products and services: Managed CASE-2000 Teams activities, databases, and implemented new software. Prepared proposal templates and oversaw proposals for public and private sectors. Consolidated databases and systems as part of the Mergers & Acquisition team Developer & I/T Manager ADP Brokerage on Wall Street NYC 1990 Developed, implemented, and managed ADP payroll software. Held responsible for updating all ADP Brokerage data for Wall Street reporting. EDUCATION:BSU: BS Degree in Computer Science (Minor in Math/Business) - Muncie, IN Graduate Study Exec. Management Programs (Health Benefits) via ADP NY & NJ |
