Darla has more than 23 years of experience in healthcare operations, IT, and nursing. She is focused on all aspects of health plan operations, with expertise in care management and utilization management. Darla provides expert analysis covering operations and program development in the areas of UM/medical management, appeals, benefits, claims, customer service, membership, project management, product documentation, training, and case management. Recent experience includes leading core and care management systems. She is an experienced subject matter advisor for system implementations for all lines of business, including Medicaid and Medicare.
- As a Medicare manager of utilization management, established policies and procedures and developed and managed the organization to ensure regulatory compliance
- Provided clinical guidance and requirements definition support for a health plan’s clinical management and core system procurement initiative
- Led configuration teams and worked with technical teams on reporting as the QNXT subject matter advisor in UM, Pharmacy MTMP, CM, DM, customer service, and member/provider appeals
- 23+ years of healthcare experience
- Bachelor of Science, Nursing, University of Wisconsin