Rise

Pre-Conference Workshop Part 1: Enhancing Member Experience and Risk Management with AI in Healthcare

• Understand the role of machine learning in analyzing member feedback and health data to uncover trends and insights 
• Discuss why healthcare’s unique complexities require AI models that enhance current practices 
• Learn about AI-driven predictive analytic models that identify at-risk members early 

Diana Kelley, AI Expert, Advisor, Board Member and Instructor
Former Cybersecurity Field CTO, Microsoft
Former Global Executive Security Advisor, IBM Security  

Mark Dwinnells, Sr. Director, Medicaid Compliance Officer
Commonwealth Care Alliance

Pre-Conference Workshop Part 2: Leveraging Data Analytics for Proactive Grievance Management

• Discuss how data analytics can be used to predict potential grievances before being escalated 
• Outline how to effectively integrate real-time analytics into daily operations 
• Highlight the value of integrating data across departments to gain a holistic view of potential grievance triggers 

Michelle O’Neill, Chief Compliance Officer
Summit Health

Day 1 Opening Remarks

Mark Dwinnells, Sr. Director, Medicaid Compliance Officer
Commonwealth Care Alliance

Cultivating a Member-Centric Approach in Clinical Services and Operations

• Explore how to align clinical services and operations with member needs in the appeals process 
• Discuss the value of integrating patient advocacy into clinical decision-making for appeals and grievances 
• Learn how to leverage clinical insights to improve the overall member experience 

Deborah Curry, Director of Risk Adjustment and Recoveries
Promedica

Daron Webb, Quality Assurance Manager, Appeals and Grievances
CareOregon

Effective Management of High-Volume Appeals

• Review strategies for streamlining operations to handle appeals more efficiently 
• Discuss best practices on prioritizing cases to ensure timely resolutions 
• Outline the role of cross-functional teams in managing workload and reducing backlog 

Andrew Meggison, Director of Regulatory Affairs
Health Plans Inc.

Ian Wayton, Account Executive
I3 Verticals

Audit Excellence in Appeals and Grievances: A Proactive Approach

• Highlight best practices for preparing for internal and external audits 
• Review how to continuously improve your processes to keep up with regulatory changes 
• Hear about successful examples of effective audit strategies 

Tracy Jones, Senior Compliance Coordinator
Summacare

Johnathan Randle, Director of Compliance Operations
HAP

Julie Balistreri, Senior Medicare Compliance Program Manager
Mass General Brigham Health Plan

Achieving Quality Improvement through Appeals and Grievances Management

• Explore how effective management of appeals and grievances can positively impact quality measures 
• Discuss strategies for analyzing appeals and grievances data to drive positive results 
• Learn about aligning appeals and grievances processes with broader quality improvement goals 

Deborah Curry, Director of Risk Adjustment and Recoveries
Promedica

Laurie Delgado, Vice President of Appeals and Grievances
Beacon HS

Day 1 Closing Remarks

Mark Dwinnells, Sr. Director, Medicaid Compliance Officer
Commonwealth Care Alliance