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VP Policy Research Compliance in Denver CO Resume Dorien Rawlinson

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VP Policy Research Compliance in Denver CO Resume Dorien Rawlinson Powered By Docstoc
					                                Dorien M. Rawlinson
                                     rawlinsonmdgn@msn.com

                                                                                  Cell: (303) 981-4032
Larkspur, Colorado 80118                                                         Home: (303) 681-3560
                                 SUMMARY OF QUALIFICATIONS

Independent, results-oriented healthcare executive with more than 20 years experience in various areas
of research, insurance, health administration and public health policy. Skills and expertise include:
       Public Health Policy                               Product Development, Project Management
       Healthcare Operations Management                   Grantsmanship, Academic Medicine
       Strategic Planning and Implementation              Human Capital Acquisition, Personnel
                                                            Management
       Healthcare Compliance and Regulation               Training, Peer mentoring
       Contract Negotiation and Administration            Clinical Research Trial Administration

                                   BUSINESS EXPERIENCE
2008 - 2012     University of Colorado Denver, School of Medicine
                Research, Grants and Finance Manager, Department of Orthopaedics
                Responsible for Grant applications, contracts, award management, Clinical Trial
                administration, industry and sponsor relationships, financial management, procurement,
                HR and payroll in an Academic setting.
        Submitted over 60 grant applications totaling 12 million dollars in requested funding during the
        2011 fiscal year.
        Award management of 7 clinical trials, 4 research awards and 13 resident and fellowship
        educations awards, total grant award income for current fiscal year of approximately $2.4 million.
        Develop and manage relationships with industry sponsors and peer organizations and charitable
        organizations.
        Oversee clinical trial standard operating procedures, IRB management and internal audits
        Serve as purchasing, procurement, travel system liaison and authorizing official.
        Departmental account reconciliation and close out of grants, AEF funds, and donations.
        Project Management and fiscal guidance for annual Golf Tournament and CME programs.

2003 - 2008     Rocky Mountain Health Management Corp. dba Rocky Mountain Health
                Plans
                  Director, Front Range Provider Administration
                  Responsible for Managed Care, Medicare, and Self-Funded provider networks and
                  professional relations on the Colorado Front Range. Including contract negotiation and
                  service for over 2000 physician, IPA, ancillary and hospital provider agreements for the
                  eastern half of the state, as well as all ancillary contracts for the entire state.
        Completed strategic network negotiations, allowing the opening of Colorado service areas in both
        Metropolitan and rural areas.
        Negotiated complex hospital network negotiations that resulted in an 8-10% hospital cost savings
        for my area of responsibility.
        Implemented a robust self-funded network provider along with specialized marketing tools to
        provide group-specific network and cost analysis.
        Established service metrics and personal accountability models for the Department
         Identified and implemented operational changes including reimbursement methodology changes
        Served as Business champion for E-Health Initiative in 2006.
        Lead product development efforts including introduction of partially self-funded products,
        dependent coverage plans, and revised dual option pricing.
        Member of Corporate Steering, Legislative Advisory, Fraud and Abuse Committees.
                                                                                    Rawlinson, Dorien M.



2001 - 2003    State of Colorado, Department of Regulatory Agencies
                 Health Policy and Research Analyst, Division of Insurance
                 Responsible for Health Policy and research activities as a part of the Commissioner’s
                 Office. Responsibilities included facilitation of health policy decisions, recommending
                 actions to improve the access and affordability of health care, active participation in the
                 legislative process, development of rules, bulletins and position documents representing
                 the Commissioner.
       Managed regulatory policy and procedures for Division including oversight of the Health Policy
       Advisory Committee and cooperative work with the Attorney General’s office.
       Chaired committees overseeing small group laws, basic health benefits plan, and network
       adequacy regulations
       Implemented privacy standards as a result of Gramm-Leech-Bliley Act, HIPAA.
       Investigation of unauthorized entities, illegal insurance activities and review of market conduct
       examination protocols and reports
       Involvement in national health policy development through NAIC, interface with local CMS
       officials, CHP+ Evaluation Working Group, and the Health Academy.
       Served as key representative in outreach programs including speaking engagements, media
       responses, and writing articles for state publications.
       Appointed to Total Compensation Advisory Committee – State of Colorado Employee Benefits

1999 - 2001    UnitedHealth Group, UnitedHealthcare of Colorado
               Compliance Manager
               Responsible for oversight of Integrity and Compliance Program for the health plan,
               including preparation, management and corrective actions for market conduct
               examinations, ongoing monitoring and auditing, drafting filing and implementing new
               policy forms, regulatory reporting, analysis and risk management.
       Managed regulatory examinations including market conduct, financial, quality examinations
       Oversaw Business Contingency Plan, Safety Committee and Disaster Recovery Plan
       Contract and Policy form development, filing, implementation and related audit activities
       Statutory and Regulatory interpretation and analysis
       Risk Management including assessment, monitoring and auditing. Findings reported through
       corporate legal department

1993 - 1999    Rocky Mountain Administrative Services Company (RMASC)
               Blue Cross Blue Shield of Colorado, Nevada, and New Mexico ( now Anthem BCBS)

1997- 1999       Compliance Director – BlueCross BlueShield of Colorado and HMO Colorado, Inc
                 Responsible for development and design of an integrated compliance program for the
                 Colorado Market Business Segment. Evaluated prior compliance process to determine
                 strengths and weaknesses in order to develop a new program approach that integrated
                 business operations with the legal counsel and product development.
       Established standards, templates, and training programs for company compliance
       Audited critical compliance-related business risks, managed state market conduct examination
       activities
       Worked with industry and regulatory groups to negotiate new legislation/regulation

1995 - 1997    Project Manager, Product Development – Strategic Services Division
               Responsible for development and implementation of products and strategic initiatives for
               Colorado, New Mexico, and Nevada, as well as RMASC subsidiaries

       Managed the development and implementation of the BlueAdvantage product line which helped
       increase the company’s enrollment to the highest ever reported
       Managed the physical consolidation of business operations for the Colorado and Nevada plans


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                                                                                    Rawlinson, Dorien M.



1993 - 1995    Manager, Customer Service – Health Management Services
               Managed customer service and special projects for a national dental administrator.

       Trained and supervised customer service representatives in two locations to ensure excellent
       service to customers in nine states. Project manager or participant in various strategic initiatives
       and new business implementations
       Improved customer service outcomes to meet all service metrics and decreased call volume
       through improved first call techniques
       Project manager for new client implementation for plans in Virginia and Washington

                                             ACADEMICS

University of Colorado Denver – Denver, Colorado
Business School
Graduate Coursework

Colorado School of Public Health – Aurora, Coloroad
Health Services and Management Program
Certificate of Public Health Sciences Candidate, MPH candidate

Northern Arizona University – Flagstaff, Arizona
School of Health Professions
Bachelor of Science, Health Services Administration and Business Management


                                                 OTHER

Founder, Leadership in Healthcare Policy, Research and                     2012 - Present
Compliance in the Greater Denver Area

Colorado Women’s Forum in Health Care                                      2009 - Present
Vice President, 2011
Acting President, 2012

University of Colorado Denver                                              2010 – Present
MBA- Health Administration
Volunteer Mentor




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DOCUMENT INFO
Description: Dorien Rawlinson is an independent, results-oriented healthcare executive with more than 20 years experience in various areas of research, insurance, health administration and public health policy.