Tedra Taylor

• Lead and develop a team of up to 25 on-site and remote associates within a highly regulated healthcare environment.

• Ensure compliance with federal, state, contractual, and organizational requirements governing utilization management operations.

• Participate in internal and external audit activities, including audit readiness assessments, evidence collection, documentation review, and audit support.

• Support mock audits and contract renewal audits to ensure organizational preparedness and regulatory compliance.

• Monitor quality performance and operational metrics to identify trends, mitigate risks, and implement process improvements.

• Investigate operational issues, identify root causes, document findings, and implement corrective actions to improve compliance and operational effectiveness.

• Partner with compliance, quality, clinical, and operational stakeholders to address regulatory concerns and strengthen internal controls.

• Train and coach associates on regulatory requirements, HIPAA compliance, operational procedures, documentation standards, and quality expectations.

• Communicate policy and procedural updates to ensure consistent implementation across teams.

• Develop and maintain workflow processes that improve efficiency while ensuring compliance with regulatory and contractual requirements.

• Utilize Lean Six Sigma methodologies to improve operational performance, reduce errors, and support continuous improvement initiatives.

• Manage staffing, workload distribution, employee development, and performance management while maintaining compliance and quality standards.

• Led cross-functional teams to enhance operational efficiency and streamline processes.

• Reviewed and processed inpatient, outpatient, prior authorization, and post-service requests in accordance with regulatory requirements and organizational policies.

• Assessed member eligibility, benefits, and authorization requirements to ensure accurate and compliant determinations.

• Collected, reviewed, and documented information from providers to support utilization management decisions and regulatory compliance.

• Maintained accurate documentation and ensured timely processing of authorization requests.

• Collaborated with Medical Management and cross-functional departments to support operational and compliance objectives.

• Maintained compliance with HIPAA, contractual obligations, and healthcare regulatory requirements.