Summary
Overview
Work History
Education
Skills
Timeline
Generic

Roberta Zumdahl

Scottsdale

Summary

Results-driven leader with strong background in strategic management and organizational growth. Skilled in developing and implementing effective business strategies, optimizing processes, and driving team performance. Known for adaptability, effective collaboration, and delivering measurable outcomes in dynamic environments. Strong communication and problem-solving abilities, coupled with focus on fostering productive and positive team culture.

Overview

42
42
years of professional experience

Work History

Director Health Services

Humana
04.2010 - Current
  • Responsible for overseeing clinical programs, fostering provider relationships, and managing strategic projects.
  • - Continuously assess current clinical needs in the market for the served population and develop and implement clinical programs to address identified gaps.
  • - Provide oversight and management of clinical vendor programs, ensuring timely care, regulatory compliance, and mitigation of care gaps, market abrasion, and delivery of quality, timely care.
  • - Oversee Delegated Independent Practice Associations (IPA) groups to review member clinical management and ensure compliance with delegation requirements, addressing any gaps in both areas.
  • - Assess utilization patterns for vendors and delegates, working collaboratively to manage costs and providing or reducing care or treatment as appropriate.
  • - Oversee and manage the Utilization Management process and day-to-day operations, supervising 8 direct reports and 68 indirect reports.

Director of Network Services

Rehab Choice/ CareLink Options
05.2008 - 05.2009
  • Responsible for the financial aspects of the SNF’st program including Physician & Nurse recruitment and hiring, Strategic projects associated with Skilled Care Networks and development of new and enhanced Post Acute programs.

Director of Clinical Operations

SHPS (Carewise Health)
01.2004 - 01.2008
  • Company Overview: SHPS was one of the leading privately held providers of various healthcare solutions, specializing in condition management, maternity management, and utilization management. with an average annual revenue of $330 million.
  • - Managed a team of 11 managers and indirectly coordinated the work of over 150 nurses and non-clinical staff.
  • - Oversaw day-to-day operations, ensured compliance, upheld quality standards, and drove the development and implementation of enhanced Utilization Management, Disease, and Case Management Programs.
  • - Collaborated with Sales and Marketing teams to represent Clinical Services and promote clinical programs effectively.
  • - Worked directly with several high-profile clients, managing employee bases of over 500+ employees related to acute and post-acute care, discharge planning, and care coordination.

Director Medical Operations

Intracorp
05.2001 - 03.2004
  • Company Overview: A wholly owned subsidiary of Cigna Healthcare

Cigna Health Care
01.1984 - 01.2004
  • Responsible for national Physician and Nurse Prior Authorization program, participated in strategic development of clinical programs, participated in the development of the internal Medical Management System. Managed and directed medical appeals and grievances & Referral department, Primary Care Clinic and Women’s Wellness Center.

Clinical Project Manager Medical /Surgical Specialties

CIGNA Healthcare, Phoenix, AZ
07.1998 - 05.2001

Healthcare Center Manager R.N.

CIGNA Healthcare, Phoenix, AZ
02.1997 - 07.1998

Nursing Supervisor for the Medicare Risk & Medicaid population for Mulit-Specialty Health Care Center R.N.

CIGNA Healthcare, Phoenix, AZ
03.1995 - 02.1997

L.P.N. Team-Lead Surgery Department

CIGNA Healthcare, Phoenix, AZ
01.1991 - 03.1995

Medical Assistant

CIGNA Healthcare, Phoenix, AZ
08.1984 - 12.1991

Education

Associate of Applied Science - Nursing

Maricopa Community Colleges, Gateway Community College
Phoenix, AZ
03-1995

Skills

  • Effective relationship management
  • Organizational strategy development
  • Effective verbal communication
  • Operational efficiency management
  • Project execution
  • Strategic planning
  • Financial budget oversight
  • Organizational change management
  • Strategic program leadership
  • Strategic partnerships
  • Talent sourcing
  • Vendor management expertise
  • Operational efficiency enhancement

Timeline

Director Health Services

Humana
04.2010 - Current

Director of Network Services

Rehab Choice/ CareLink Options
05.2008 - 05.2009

Director of Clinical Operations

SHPS (Carewise Health)
01.2004 - 01.2008

Director Medical Operations

Intracorp
05.2001 - 03.2004

Clinical Project Manager Medical /Surgical Specialties

CIGNA Healthcare, Phoenix, AZ
07.1998 - 05.2001

Healthcare Center Manager R.N.

CIGNA Healthcare, Phoenix, AZ
02.1997 - 07.1998

Nursing Supervisor for the Medicare Risk & Medicaid population for Mulit-Specialty Health Care Center R.N.

CIGNA Healthcare, Phoenix, AZ
03.1995 - 02.1997

L.P.N. Team-Lead Surgery Department

CIGNA Healthcare, Phoenix, AZ
01.1991 - 03.1995

Medical Assistant

CIGNA Healthcare, Phoenix, AZ
08.1984 - 12.1991

Cigna Health Care
01.1984 - 01.2004

Associate of Applied Science - Nursing

Maricopa Community Colleges, Gateway Community College

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Roberta Zumdahl