Exploring Advanced Utilization Management
Discussing Challenges and Solutions for Advanced UM and Prior Authorization
With increased attention around improved utilization management (UM) and advanced prior authorization following recent CMS rulings and regulation changes, it’s prime time to have a deeper discussion about the advances in UM and the importance of automation and intelligence for both
Join experts from the product and solutions teams at VirtualHealth, Edifecs and Itiliti Health, two leading technology companies within the utilization management and prior authorization space, to explore core utilization management and prior authorization challenges, the importance of optimizing both, and solutions for a modernized UM and prior authorization approach.
Register to access our utilization management webinar with experts from VirtualHealth, Edifecs and Itiliti Health
Speakers
Tyann Alexander
Vice President, HELIOS Solutions Group
As the Vice President, HELIOS Solutions Group, Tyann Alexander brings 28 years of healthcare and over 20 years of utilization management and care management experience. She has worked with and for multiple health insurance providers, MCO/ACOs, and TPAs. Her experience includes Medicare/Medicaid, Medicare Advantage, LTSS/D-SNP/I-SNP, and commercial health plans. Ms. Alexander is a registered nurse and certified case manager with a MBA as well as a BA in healthcare administration. She has experienced the difficulties and challenges at the end user level, from the payer and provider perspective. She has worked with multiple health plans, vendors and other partners to coordinate workflows and systems with the goal of meeting the member/patient needs. Tyann understands the prior authorization process from beginning to end, from intake to notifications, as well as medical claims review, appeals, and grievances. She understands the importance of meeting turnaround times and staying compliant with privacy and regulatory requirements. In her current role, she is focused on how technologies can improve the prior authorization process for all involved.
Marcus Caraballo
Vice President, Product Management
As Vice President of Product Management, Marcus Caraballo leads the vision and direction of VirtualHealth’s product roadmap. He joined VirtualHealth in 2015 as the third employee after receiving his Bachelor’s degree from Columbia University. During his 8 years at VirtualHealth, he has held various product leadership roles, overseeing HELIOS® interoperability initiatives, product partnerships, and enterprise implementations.
Maxim Abramsky
Associate Vice President, Product Management
As an associate vice president of product management and the head of the Prior Authorization Solution at Edifecs, Maxim Abramsky brings over 20 years of healthcare experience to solving many industry problems for Revenue Cycle, Interoperability, Payer-Provider integration, and many more. Mr. Abramsky received his Master’s in Computer Science from National Technical University in Ukraine along with multiple state and national recognition awards. After moving to the U.S., he started his career at Edifecs. Since then, has been part of multiple industry groups including HL7, WEDI, Da Vinci, and several others that are helping shape new standards for industry automation. Recently Maxim Abramsky led the creation of a new interoperability solution helping several dozen health plans achieve compliance with the Centers for Medicaid and Medicare Services (CMS) mandate by their deadline. As part of his duties, Maxim coordinated the business development efforts between multiple industry entities, including electronic health record (EHR) vendors, payers, and providers to achieve true interoperability. In his present role, Maxim is focused on solving the very complex problem of automated real-time prior authorization by employing various technologies and developing new ones related to artificial intelligence, machine learning, natural language processing, and adjacent areas.
Michael Lunzer
Founder & CEO of Itiliti Health
Michael is a thought-leading entrepreneur with a track record of building transformative companies with ROI that leverage technology to optimize sectors plagued with inertia. He co-founded the first-ever technology-based vendor management system for the staffing industry, acquired in 2002 by PeopleClick. Under Michael’s leadership, by 2005 the business processed $2 billion in annual revenue from customers using the VMS platform to manage their staffing needs – tasks previously handled with mere paper and pen. Michael then co-founded Warm Health to replace the cumbersome process of care management communications with plan members with a virtual assistant. Altegra Health (now Change Healthcare) acquired Warm Health in 2012. Michael remained at Change Healthcare serving as business leader of the Smart Connect product until joining Blue Cross and Blue Shield of Minnesota as an Entrepreneur-in-Residence in 2018. While at BCBSMN, Michael observed a vital opportunity to optimize the slow and friction-filled process for applying, authorizing, and improving medical policies. Michael and Kurt incubated Itiliti Health inside BCBS MN.