Case study
Care navigation that cut avoidable escalations
Led product work across value-based specialty-care and care-navigation programs (Surgery, Urgent Care, Behavioral Health, Oncology Care).
Timeframe
2021–2022
Focus
Redacted, de-identified outcomes
Summary
Led product work across value-based specialty-care and care-navigation programs (Surgery, Urgent Care, Behavioral Health, Oncology Care).
Summary
Led product work across value-based specialty-care and care-navigation programs (Surgery, Urgent Care, Behavioral Health, Oncology Care).
Intervention
Unified member record for clinicians and care guides.
Outcome
Routing and escalation rules cut the exception queue by making ownership visible.
End-to-end flow
Detail
Constraints
- Clinical governance and benefit partner rules.
- Variable patient acuity and time-sensitive routing.
- Nurses and care guides needed shared facts for coordination.
Interventions
- Unified member record for clinicians and care guides.
- Routing rules tied to clinician roles.
- Completion dashboards and coordination rituals.
Outcomes
- Routing and escalation rules cut the exception queue by making ownership visible.
- Care plan completion rates converged — the gap between highest and lowest programs shrank.
- Frontline teams stopped flagging routing as a top reason for delayed resolutions.
Artifacts
- Routing rule map documenting which roles owned which decisions at each step.
- Care plan completion dashboard summarizing program-level completion trends.
- Coordination checklist aligning nurses, care guides, and benefit partners.
Details are anonymized because of healthcare, client, and commercial confidentiality. Where exact figures cannot be shared, I describe the operating problem, intervention, observed directional change, and what I directly owned.