Healthcare professional/Network Management/Provider Client Relations/
Experienced executive leader and manager with more than twenty years in the healthcare industry. Demonstrated leadership skills in strategic alignment, project planning and development, solution focused outcomes, and quality improvement initiatives. Areas of expertise are office management and supervision, network management, account management and clinical care, in fast-paced work environments. Independent, driven, self-starter with proven problem solving skills who happens to be an adaptive and effective team leader and manager.
SUMMARY OF QUALIFICATIONS
- Supported Texas team in obtaining 40 Million dollar account supporting foster care redesign in Texas in Regions 2 & 9;
- Developed Child Placing Agency-CPA (Providence Kids) over the course of a year and half to facilitate the award of the foster care redesign contract;
- Proven track record of successfully developing services and managing people, teams in a behavioral health care delivery systems;
- Developed full service behavioral and medical networks including hospital, outpatient, physician, and ancillary services across the country and specifically for medical networks the following states: GA, CT, NJ and TN;
- Implemented and managed new products and services which lead an increase of 7% in the Employer Accounts division, but no change for Commercial and Public Sector;
- Improved provider and client satisfaction that lead to a 10% increased business from two significant clients that have maintained a contract with us for several years (CPS & JPD).
Providence Service Corporation
Texas State Director July 2011 – May 2013 Austin, Texas
- Develops and monitors statewide budget for 3 offices in Austin, Dallas and San Antonio;
- Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
- Ensures compliance with all local, state, and federal laws and standards including Providence Service Corporation of Texas’ policies and procedures
- Directs and leads State Management Team overseeing state operations including maintaining compliance and regulatory standards, assuring financial success, compliance with contract outcomes and assuring compliance with accreditation standards
- Maintains contact with key officials, lead contacts in order to establish good relationships and learn of developments that impact operations
- Develops strategic planning initiatives, goals and in an effort to improve census development for each unit in the state.
- Identifies and develops potential area for expansion, and other sources of potential revenue.
- Creates strategic alliances with competitors or other entities to strengthen programs and assure continued growth and viability.
- Monitors expense and revenue trends, reduce costs if necessary and eliminates problem financial areas.
- Identifies programs that need assistance and implements plan to improve operations.
Senior Network Recruiter January 2011 – July 2011 Austin, Texas Area
HEOPS, Inc. located in Nashville, TN. They provide strategic support to healthcare providers, managed care; network development and healthcare back office support services.
- Developed physician network for Amerigroup in GA for application of additional business statewide;
- Extensive experience in the development of both physical and behavioral medicine networks;
- Strong planning, and direct response techniques help HEOPS create a unique approach to network development that yields outstanding results.
ValueOptions, Inc. (FHC Health Systems) located in Norfolk, VA.
Account Executive September 2009 – November 2010
- Identify new business opportunities; direct and/or contribute to new proposal submissions.
- Monitor status of client accounts; assess client needs, identify and resolve problems, and respond to client inquiries concerning account services.
- Monitor and gather information, analyze and report on account status and program effectiveness including claims, eligibility, utilization, performance standards and revenue targets.
- Monitor and assess quality of service and program design.
- Provide continuous education to clients for appropriate use of services; provide resources to clients regarding health policies, health legislation, and trends in managed care industry.
Independent Consultant: 03/07 to 07/08
HEOPS, Inc. located in Nashville, TN. HEOPS’s provides departmental outsourcing/insourcing solutions and strategic support to healthcare providers, managed care, network development and healthcare back office support services.
- Business development activities such as responding to RFP’s resulting in 5-7 million dollars in contract award.
- Strategic business planning providing direct response techniques to help HEOPS create a unique approach to network development yielding outstanding results.
- Development of both physical and behavioral medicine networks.
ADAPT of AMERICA located in Dallas, TX. Adapts recovery-oriented services are designed to unlock the potential within all of us to live successful lives in the community. Adapt now assists over 5,000 persons with severe and persistent mental illness create lives in the community.
- Responsibility for overall productivity of 100 staff members in GA and TX and for P&L for 9 million dollar budget.
- Supervision of Adapt Community Solutions (ACS), 1.5 million dollar crisis and mobile crisis unit that serves NorthStar Texas and other commercial populations.
- Accountable for clinical and financial performances as well as contractual compliance.
Cenpatico Behavioral Health (CBH) – (Centene Corporation)
Vice President, Network Management & Contracting, 10/25/04 to 03/07
- Responsible for managing a department of 36 staff who handle all aspects of provider recruitment and retention, contracting, provider relations, and credentialing in GA, WI, OH, IN, TX, MO and KS.
- Development of two new departments within the network management which facilitated network operations within our operation in the company.
- Supervise hospital, large group (PHO) and physician contracting for all states.
- Monitor provider performance data, including satisfaction survey data, complaints data, and access and availability data.
- Monitor and assess quality of service. Develop and implement solution focused resolutions for any area of concern.
- Coordinates and approves all communications to network providers, including mass communications (e.g., provider manual, website, provider newsletter) and focused provider activities.
- Trained, and supervised activities of contracting and provider relations staff. Implements policies and procedures to promote workflow efficient for business needs across all states.
ValueOptions, Inc. (FHC Health Systems)
Vice President, Provider Relations, Western Region, 4/22/02 to 10/22/04
- Primary oversight of employer solutions division (ESD) service center’s accounts for provider relations and contracting activities. Major national accounts in the ESD include union and non-union memberships; employer group and health plan programs; MHSA, EAP and Disability networks.
- Development of MH/SA and EAP networks for ESD clients.
- Acting account management liaison. Participation in client meetings with ESD clients and Union leaders for key books of business. Support national health plan and employer business development and strategic alignment needs.
- Maintained relationships with ESD clients in support of business need, including problem resolution and program development.
- Acts as a resource in the development of responses to RFP’s, and participated in sales presentations.
- Managed 30 Provider Relations and Contracting staff in three primary Service Centers (CA, TX, & MI). Territory covered 38 states.
- Successful management of 4 million dollar annual operating budget for the Western region.
- Supervised and contributed to provider newsletters, the provider handbook, provider mailings, training, and other provider network management issues.
Magellan Behavioral Health (MBH)
Area Contract Manager (FL, PR & VI), 8/98 to 4/02
- Acted as client liaison (Aetna) to address specific market concerns.
- Recruitment of all provider types that require face to face and/or special negotiations including facilities, CMHC’s, Agencies, Large Groups, and providers requiring special fee arrangements.
- Negotiated all contract language and fee arrangements for facilities, programs, organizational providers, key and large groups in defined geographic territory for all lines of business.
- Analyzed current and projected market trends to recommend cost effective fee/pricing proposals.
- Recommended new approaches for effective cost sharing arrangements.
- Coordinated with sales/marketing on product pricing proposals that include provider rate structures in defined geographic territories.
Magellan Behavioral Health/Human Affairs International (HAI),
Clinical Advisor, 2/98 to 8/98 - Promoted to Area Contract Manager
MHNet, located in Austin, TX. Director of Network Development, 08/96 to 02/98
Licensed Professional Counselor (LPC) – State Of Texas – Expires August 31, 2013
Licensed Mental Health Counselor (LMHC) – State of Florida – March 31, 2013 – Inactive
Master of Business Administration (MBA), University of Phoenix, 2002 (On-campus program)
Master’s Degree in Counseling & Human Services, Florida State University, 1989
Bachelor’s Degree in Psychology, University of Central Florida, 1987