Summary

Overview

Work History

Education

Skills

Timeline

AHMED ELAGAB

Nashville,TN

Summary

Diligent Healthcare Executive with robust background in executive board leadership. Successfully driven strategic initiatives and governance improvements while fostering organizational growth. Demonstrated expertise in high-level decision-making and collaborative team leadership.

Overview

years of professional experience

Work History

Executive Board Member – Clinical Case Management & Revenue Expansion

Tellegacy LLC

02.2025 - Current

Appointed to Tellegacy’s governing board to architect a nationwide clinical case-management program aimed at reducing loneliness, closing care gaps, and expanding intergenerational engagement.
Chair the Clinical Programs Committee; authored the operating blueprint that fuses virtual care, social-determinants data, and outcome tracking, positioning the organization for value-based contracts.
Collaborate with finance and fundraising teams to diversify revenue streams—negotiated inaugural health-plan pilot and championed grant proposals supporting first-year growth targets.
Provide fiduciary and strategic oversight during quarterly board meetings and ad-hoc workshops, translating complex clinical metrics into actionable KPIs for executive leadership.
Serve as ambassador for Tellegacy, cultivating partnerships with payers, health systems, and community organizations to amplify the mission’s reach.

Director of Clinical Quality & Compliance

Leidos QTC Health Services

08.2021 - 08.2024

Directed national quality-assurance function overseeing 200+ medical providers; reduced audit cycle-time 22% and lifted documentation accuracy from 88% to 97%.
Led cross-functional task forces to rewrite 40+ clinical SOPs, aligning with updated VA and DoD disability-exam standards.
Produced executive dashboards spotlighting compliance gaps, driving a 15-point rise in provider performance scores year-over-year.
Mentored a 12-person team of QA analysts and clinical educators; instituted peer-review rounds that halved onboarding time for new hires.
Acted as principal SME for policy change management and provider credentialing during M&A integration.

Director of Clinical Operations & Health Strategy

Medova Healthcare Financial Group LLC

05.2013 - 08.2019

Built the care-management department from the ground up, scaling to 45 FTEs while maintaining 100% compliance with state and federal regulations.
Chaired high-dollar claim review committee, recovering $11 M in medical spend through negotiation, coding accuracy, and fraud-abuse detection.
Launched telemedicine service line and secured multi-state licensure for physicians, adding a new revenue stream that reached break-even in six months.
Created analytics suite tracking readmission risk and chronic-disease spend; insights drove a 9% year-over-year cost reduction.
Provided expert testimony in fraud and malpractice cases, collaborating closely with legal teams to safeguard corporate interests.

Senior Medical Officer, Emergency & Acute Care

Federal Ministry of Health

01.2011 - 12.2012

Led mixed-discipline teams in urban emergency departments, managing up to 250 high-acuity cases weekly across four hospitals.
Streamlined triage workflow, cutting average door-to-provider time from 18 to 10 minutes.
Supervised and mentored 20+ interns; introduced case-based teaching rounds still used as departmental standard.
Coordinated cross-agency disaster response drills and served as on-call hospitalist for critical-care escalations.
Maintained rigorous EMR documentation and partnered with legal teams on mortality reviews and medico-legal queries.

Medical Authorization & Utilization Review Officer

DAMAN National Insurance – Munich Re Group

01.2010 - 01.2011

Directed utilization-management unit reviewing 1,200+ prior-auth requests monthly; achieved 98% turnaround within SLA.
Developed electronic review templates that improved reviewer consistency and cut appeal overturn rate by 30%.
Collaborated with actuarial teams to project cost-savings of revised benefit designs that informed payer policy updates.
Led fraud-investigation task force, coordinating with regulators and law enforcement on cases totaling $3.4 M.
Delivered provider-education workshops on coding and documentation, reducing repeat denials by 12%.

Medical Review Officer – Quality & Integrity

NextCare Health – Allianz Group

01.2009 - 01.2010

Designed and launched the organization’s first comprehensive medical-review program covering pre-authorization, concurrent review, and retrospective audit.
Reduced inappropriate utilization by 17% within the first year through evidence-based protocols and clinician coaching.
Oversaw transition to ICD-10 coding standards, training 50+ staff ahead of regulatory deadline.
Investigated and adjudicated fraud cases, contributing to $2 M in recoveries and policy refinements.
Established KPIs and quality dashboards adopted by corporate headquarters for regional benchmarking.