With nearly 30 years of experience as a health plan executive, Diana Criss brings an extensive depth and breadth of managed care expertise to HMA.
Prior to joining HMA, Diana was senior director of operations and clinical management for Consumer Mutual Insurance of Michigan. In this role, she was responsible for development of the Customer Service, Claims, Quality, and Clinical Operations Departments. She led the submission of the Qualified Health Plan process with CMS, including taking the lead with the State of Michigan’s Department of Insurance and Financial Services to secure approval as a Health Insurance Co-Op, the state’s first. Diana guided the organization’s NCQA accreditation and oversaw all processes for claims and customer service as well as the Federal Complaint System (HICS).
Before joining Consumers Mutual, Diana was director of governmental programs with Priority Health. She was responsible for the direction of the Medicaid and MI-Child program including compliance with all state and federal contract requirements, Michigan Department of Community Health re-bid process, compliance audits, and the financial stability of the program. While at Priority Health she also directed the Medicare Advantage process to identify areas for improvement in their position with CMS.
Diana has served in a variety of leadership roles with several health plans, including program director, director of clinical operations, and director of network development, director of operations and regulatory compliance, Medicaid project manager and product manager.
She developed and taught the “Physicians in Medicaid Managed Care” curriculum at Michigan State University and Wayne State University. The curriculum focused on teaching residents how to work within risk models with health plans to deliver high-quality, low-cost health care in the right place at the right time.
Diana received her Associate Degree in Business from Lansing Community College.