Shaniqua Ford
35728 Champagne Way
Winchester, CA 92596-
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Shaniqua Ford--35728
Champagne Way, Winchester, CA
92596
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Professional Summary
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Dynamic and accomplished Healthcare
Consulting Executive with over 25 years of
experience in provider and payer
operations, health plan strategy, and
enterprise transformation. Proven ability to
lead complex, multi-million-dollar
consulting engagements across clinical,
operational, and technical domains.
Expertise in strategic planning, staff
development, and thought leadership with
a track record of building high-performing
teams, delivering enterprise AI-enabled
solutions, and driving long-term client
success. Trusted advisor to C-level
executives with a focus on innovation,
compliance, and scalable growth in the
healthcare sector.
Selected Accomplishments
• Led a portfolio of high-impact
consulting engagements with
consistent delivery of contractual
targets, client satisfaction, and
revenue growth exceeding $1.5M
annually per client.
S. Ford
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Actively collaborated with clients to
identify complex operational issues
and implemented scalable,
technology-enabled solutions
aligned with long-term success.
Oversaw the design, development,
and deployment of clinical care
management platforms, leveraging
Agile, AI-driven tools, and crossfunctional leadership across onshore
and offshore teams.
Built and mentored diverse
consulting teams, elevating staff
capabilities through structured
development plans, feedback loops,
and strategic coaching initiatives.
Recognized thought leader
contributing white papers, leading
executive-level workshops, and
representing firms at national
healthcare innovation forums.
Established and maintained deep,
trust-based relationships with
clients and stakeholders, leading to
long-term partnerships and
expanded scopes of work.
Consulting Leadership Highlights
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Client Portfolio Management:
Directed multiple, simultaneous
consulting projects with full
accountability for deliverables,
staffing, timelines, and quality
assurance.
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Strategic Advisory & Solution
Delivery: Partnered with provider
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Shaniqua Ford
35728 Champagne Way
Winchester, CA 92596-
and health plan executives to craft
data-informed strategies, address
systemic gaps, and lead solution
implementation.
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Staff Development & Retention:
Recruited, trained, and retained
high-performing consultants while
fostering an environment of
professional growth, collaboration,
and excellence.
Growth & Revenue Generation:
Contributed to firm growth by
securing new engagements,
expanding services with existing
clients, and leading go-to-market
initiatives.
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Thought Leadership & Industry
Presence: Presented healthcare
innovation content nationally,
authored thought leadership
publications, and facilitated
knowledge-sharing across teams.
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Cultural Contributor: Actively
shaped firm culture by modeling
excellence, integrity, and a
commitment to impactful healthcare
transformation.
PROFESSIONAL EXPERIENCE
Citius Healthcare Consulting, Malvern, PA
2016-May 2025
Practice Lead: Clinical Services; Executive Consultant; Medical Management Transformation
Commonwealth Care Alliance (CCA): Provided strategic guidance to the CMO and crossfunctional teams to deliver comprehensive assessments encompassing business, clinical,
and technical aspects of a care management platform. Actively engaged in strategic
planning sessions, focused on the expansion of organizational capabilities and
stabilization of current operations. Conducted detailed cost-benefit analyses and
informed decisions on future outsourcing opportunities and optimized staffing ratios,
ensuring the alignment of resources with organizational goals. Facilitated the
identification of key areas for improvement, driving efficiency and promoting
sustainable growth for the organization. Collaboration with senior leadership to develop
and implement actionable strategies that enhance overall performance and positioning
for long-term success and growth.
Executive Consultant; Medical Management Transformation and Education
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Shaniqua Ford
35728 Champagne Way
Winchester, CA 92596-
Arkansas Blue Cross Blue Shield: Led the coordination of clinical and business teams to
develop comprehensive utilization management training content focused on
orientation modules on regulatory compliance, basic principles, prior authorization,
concurrent and retrospective reviews. Facilitated on-site training for staff and
collaborated with leadership to align training programs with organizational strategy.
Ensured training materials were modular and adaptable for integration into an existing
or future learning management system.
Executive Consultant; PMO- Business Analyst
Alameda Alliance: Provided Executive Consulting for the implementation of several
Medi-Cal CalAIM initiatives, ensuring alignment of business and technical claims
processes according to state regulations. Coordinated cross-functional teams to ensure
timely and successful execution of project deliverables. Conducted comprehensive
analyses to ensure compliance with applicable state regulations and optimized claims
processing efficiency. Developed and implemented strategies to streamline workflows,
resulting in improved accuracy and reduced processing times. Provided expert guidance
and support to stakeholders, ensuring clear communication, and understanding of
project goals and regulatory requirements.
Program Manager; Business, Technical and Report Analyst Support
Progeny Health: Responsible for oversight of business, reporting and technical teams
ensuring proper requirements documentation and implementation for creation of a
new Care Management application for a Population Health Program. Managed external
vendor relationships revolving around data integration and reporting. Supported the
executive team in identifying risks, ensuring the project remained on course, budget and
on time. Successfully implemented product exceeding client expectations.
Executive Project Manager; Data and Business Analyst
AmeriHealth Caritas: Led key stakeholders in reviewing and managing the end-to-end
workflow process for appeals and grievances, ensuring efficiency and compliance.
Defined, documented, and implemented future state processes to enhance the
management of appeals and grievances. Provided strategic oversight and support for
data analytics, enabling the development of comprehensive inventory and dashboard
reports for the executive team. Directed an application assessment in preparation for an
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Shaniqua Ford
35728 Champagne Way
Winchester, CA 92596-
upgrade ensuring alignment with organizational goals. Coordinated timely document
gathering for multiple Department of Health audits, enduring compliance, and accuracy.
Engaged technical writers in the creation of desktop-level procedures and system usage
documentation. Collaborated with the executive team to project COVID-19 impact on
staffing and develop risk mitigation strategies.
Program Manager/Data Analyst/Technical Resource
Dominion National: Spearheaded the organizations’ requirements analysis,
development, migration, and testing initiatives for dynamic content conversion,
transitioning from Drupal to ASP.NET and MSSQL Server. Directed the creation of new
API’s using C# to enhance provider search capabilities. Led both offshore and internal
teams through comprehensive analysis and redevelopment of the member enrollment
portal, integration of a single-group-e-commerce solution. Augmented the in-house
development team to drive the successful revamp of the organization’s website.
Ensured seamless transitions, robust technological solutions, and improved user
experience.
Executive Consultant/Care Management Assessment Program Owner
Denver Health Medical Plan: Tasked with leading teams reviewing and identifying
requirements within the Medical Management Operations and IS departments.
Responsible for reviewing the technology infrastructure capabilities and technical
requirements for inclusion in an RFP. Reviewed potential Medical Management Systems
and provided background on each vendor based on previous engagements. Coordinated
the development of the Request for Proposal (RFP) for the new Medical Management
platform including soliciting vendors to submit RFP responses and facilitating and
coordinating answers to vendor questions related to the RFP. Developed selection
criteria, established weighted scoring system for evaluation, coordinated the
development of CM and UM case scenarios, coordinated the on-site visits, created a
formal Medical Management Platform recommendation, attended, and supported
executives on selection process and assisted with vendor contract negotiations.
Executive Consultant/Program Manager/Technical Resource
Trustmark, Inc.: Led teams through the optimization and workflow process
improvements within the Healthcare Management Department (UM, CM, Physician
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Shaniqua Ford
35728 Champagne Way
Winchester, CA 92596-
Review, Quality, Intake, Claims Medical Management) and upgrade of current
application. This included analysis of current state and creation of current and future
state workflows, Standard Operating Procedures and Guidelines ensuring URAC
Accreditation was not affected. Provided consultative services on how to collect data
required to extract for Client and Internal Metric Reporting and Real-Time Dashboard
creation. Assisted team in optimizing use of their Healthcare Management Application
by programming business rules established by the clinical business users. Acting Trainthe-Trainer when needed for the technical team. Reporting educator assists clients in
understanding reporting capabilities which allows them to obtain an increased insight
into the division functions and processes. Successfully helped clients gain many
efficiencies by increasing application use and elimination of manually performed tasks.
Senior Business Analyst/Product/Program Owner Consultant
Progeny Health, LLC: Led the strategic development and enhancement of an in-house
care management application. Conducted staff interviews to gather comprehensive
business requirements and designed templates for the upgraded application.
Coordinated and facilitated agile sprint sessions, fostering collaboration between
business and IT teams. Through meticulous analysis, identified and addressed gaps in
the current application, aligning the upgraded and new application development with
business needs. Ensured the delivery of a robust user-centric care management
solution.
Senior Business Analyst Consultant
Community Health Group (CHG): Led the initiative to identify business requirements
for a new tool designed to schedule appointments with the member population,
through comprehensive interviews with the HEDIS unit. Captured and documented
business requirements and design elements based on on-site meetings and an in-depth
review of current workflows. Collaborated with the IT security team and identified
processes and limitations, proposed improvements for members, providers, helpdesk,
and system administrators. Evaluated related processes, including Master Data
Management (MDM), data governance and telecom, to ensure holistic and efficient tool
development.
Data Analytics Specialist-Implementation Services Consultant
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Shaniqua Ford
35728 Champagne Way
Winchester, CA 92596-
Zyter LLC: Responsible for leading a project geared towards analyzing reports for
optimization and revamping the out of the box reporting package for provision to client
customers. Designed, defined, and created report specification documents focused on
Operational Efficiencies, Utilization, Case and Disease Management. Completed analysis
of report requirements identifying gaps in data fields based on industry trends. Led
Business Analyst team and DBAs to create test plans, create and load test data and
work with both on and offshore DBAs to ensure the package was completed on time
and as expected. Communicated with Cognizant Developers process of reporting
packages to enhance performance of domains. Consulted with client customers to
gauge the appropriateness of the data being provided to ensure that it aligned with
industry standards for reporting including but not limited to CMS regulations. Engaged
and tracked process of reporting life cycle from being in Spec, Development, Quality
Assurance and User Acceptance Testing. Created documentation for the Product Team
for presenting to current and future clients.
Senior Business Analyst Consultant
San Francisco Health Plan (SFHP): Led the identification of multiple constituent contact
points and the assessment of available and required data across various organizational
departments. Mapped major inter-departmental processes, capturing activities and
data requirements throughout entire workflows. Measured performance metrics from
initiation to satisfaction of specific requests, developing high-level process flows to
visualize current processes. Provided strategic recommendations for process
improvements, driving positive impact on operational efficiency. Conducted cost-savings
analysis and developed preliminary ROI assessments, enabling client to make informed
decisions on issuing RFPs for CRM and BPM solutions.
Senior Business Analyst Consultant
Johns Hopkins HealthCare, LLC (JHHC): Oversaw the comprehensive assessment of the
current member portal and user experience, evaluation existing versus future data with
a strategic analytical perspective. Identified mobile app options and developed a phase
one member engagement plan aligned with client goals, incorporating functionalities
such as health record access and maintenance, proactive preventive care alerts,
caregiver support coordination, health information research, healthy living rewards and
incentives ancillary product services campaigning, electronic billing and payment, health
metrics, and current and future technology applications. Delivered actionable analytics
through journey analytics to enhance member satisfaction and enable rapid
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Shaniqua Ford
35728 Champagne Way
Winchester, CA 92596-
improvements to the member experience. Assessed the business intelligence and
analytics talent pool, identified skill gaps, and formulated talent acquisition,
development, and deployment plans to enhance the generation of insights and support
business users through targeted training and development.
Senior Business Analyst Consultant
Cigna HealthSpring: Analyzed client-specific requirements within utilization, case, and
disease management and leveraged extensive experience with care management
software application to identify and document new requirements for a request for
proposal. Conducted fit-gap analysis identified and finalized functional requirements.
Developed detailed use cases and scenarios, prioritized, and scored requirements and
gaps and evaluated results against the assessed software application. Successfully
completed the project assessment phases on time and in alignment with client
expectations.
Systems Administrator
Trustmark, Lancaster, PA
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Responsible for activating and deactivating users to maintain security and new user PC setup.
(Active Directory and LDAP). Perform maintenance functions including tables, letter templates,
ad hoc and monthly internal and external reporting (SQL). Maintain assessment database.
Implement guideline changes. Maintain knowledge of Healthcare Management Policies and
Procedures, Guidelines, URAC standards, Department of Labor, and HIPAA regulations. Assist in
training users. Function as a liaison with other CoreSource offices to help with interfaces. Work
with other CoreSource Information Technology areas as needed. Manage fallout/error reports.
Coordinate implementation of care management systems and testing of new releases.
Coordinate activities and provide vendor relationship management with the Information
Technology vendor. Provide help desk support for Healthcare Management users.
Configuration of ISA and GS Control segments for x12 278 data files. Perform as an Authorized
Project Manager for Trustmark Companies to lead compliance audits. Maintain system
efficiency. Troubleshoot problem reported by users. Analyze and isolate issues.
Trustmark, Lancaster, PA
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Business Analyst- Technical Services
Work with Operations and IT staff to design enhancements and processes as a Subject Matter
Expert and/or Tester. Gather, maintain, and document Business Requirements for Projects,
Programming Requests and Help Desk Tickets. Create traceable test plan and document
testing results. System testing and troubleshooting of all programs. Support and maintain all
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Shaniqua Ford
35728 Champagne Way
Winchester, CA 92596-
programs. Submit IT Helpdesk Tickets, Programming Requests and CBAs. Implement new
system programs and enhancements, including creation of technical and user documentation.
Effectively communicate and interact with unit members, IT staff, Project team members and
other personnel. Backup Workflow Support Operator and Computer Operator.
Trustmark, Lancaster, PA
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Senior Eligibility Specialist, 2007
Support the Eligibility Supervisors by assisting with administrative duties, including but not
limited to daily operational reporting, call monitoring and QA functions for the Eligibility
Customer Service Representative (CSR) and Eligibility Coordinator roles, problem-solving and
call backs of a complex or sensitive nature. Developed, maintained, and distributed user and
training documentation programs for the Eligibility Customer Service Representative (CSR),
Fulfillment Specialist, Eligibility Coordinator, and supervisor positions. Documentation
encompassed standardized desktop reference materials, and user training manuals. Training
covered department and position policies and procedures, software/systems, other tools, etc.
These programs encompassed the needs of new and promoted employees, as well as the
ongoing needs of incumbents. The programs specifically include customer service excellence
techniques and skills development. Training delivery entailed formal classroom presentation
and formal small group or individualized sessions, mentoring, on-the-job training/intervention,
computer-based training, etc. Managed and completed internal projects related to all functions
of the department. Project roles included project manager, analyst, and tester as well as
documentation and training resource and complying with legal audits and data requests.
Education and Certifications
Elizabethtown College 1994
Elizabethtown, PA
Employee Health Benefits Associate (EHBA)
America’s Health Insurance Plans (AHIP)
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