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TKOSolutions

Selected work

Six problems I was in the middle of.

Enterprise healthcare programs where the outcome crossed more teams than any single plan covered—prior authorization, provider eligibility, care management, interoperability—plus a governed decision system I built and run myself.

Start with the operating problem closest to yours.

Each case covers what was happening, why it was hard, what I owned, what I changed, and what it means for a program like yours.

Anonymized enterprise experience/Healthcare payer operations

Making a Prior-Authorization Waiver Work Inside the Claims System

Prior authorization required providers to verify eligibility and benefits, gather documentation, submit a request, and wait for clinical and medical-necessity review before care could proceed. A national health plan committed to removing that review for qualifying providers on specific codes, as part of reducing provider administrative burden.

I ran program management and cross-functional delivery: the recurring governance forums, integrated planning and reporting, testing coordination, dependency and escalation management, and readiness oversight across the teams involved.

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Anonymized enterprise experience/Healthcare payer operations

Connecting Provider Eligibility Modernization Across Programs

Provider eligibility logic, provider experience, claims processing, and adjacent modernization efforts were advancing through separate programs with limited shared dependency visibility.

I connected the programs to each other: surfacing dependencies, aligning release teams, coordinating testing, managing integrated status reporting, and driving the integration discussions that no single program owned.

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Anonymized enterprise experience/Enterprise healthcare transformation

Creating Integrated Governance and Readiness

Status, testing, release, and dependency information was fragmented across teams, tickets, applications, and workstream plans in a complex healthcare transformation.

I led governance, product-level and executive reporting, dependency and release tracking, and escalation structures, and I coordinated system, end-to-end, test-data, and readiness activity across the programs.

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Healthcare product experience/Healthcare technology

Healthcare Interoperability Modernization

Payer-facing CMS Cures Act and FHIR requirements had to become a usable, governed product and operating capability rather than a compliance checkbox.

I owned the product responsibilities that translated payer requirements, regulatory constraints, controls, and technical delivery into an operable platform roadmap.

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Live independent system/Independent product and operations

RachelOS: A Live Governed Decision System

A relationship-driven business needed to turn scattered signals, facts, commitments, and follow-up work into reliable daily action.

I designed, built, and operate RachelOS myself, including the workflow, decision, evidence, approval, and feedback mechanisms shown in the screens below.

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Method-portability evidence/Commercial real estate

CRE Intelligence Model

A commercial-real-estate advisory workflow needed consistent evidence capture, prioritization, and follow-through across market and relationship signals.

I designed the analytical and workflow model as independent work outside healthcare.

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How I describe this work

Enterprise programs carry confidentiality obligations that outlast the engagement. Where a result cannot be published, I describe the mechanism and my own role and leave the number out rather than estimate it. Employment history establishes experience, not employer or client endorsement.

Principal-led healthcare advisory

Bring one operating problem under pressure.

I will help determine what is actually happening, which control or dependency matters, and what leadership should do next.