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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLE PHONE NUMBER AVAILABLENashville, TN Street Address
LinkedIn ProleDirector of Managed Care/Network Contracting/Provider Engagement Dynamic and organized leader with comprehensive experience enabling organizational success through ecient management of healthcare operations. Strategically focused executive with a progressive and accelerated career trajectory evidenced through increasing levels of operational responsibility. Purposeful development professional: recognized for delivering excellent support to develop, dene, and implement eective plans with a positive outlook on accomplishing long-term goals. Collaborative individual; known for providing expert-level leadership direction to high-performance teams for improving operational eectiveness.Key Skills:- Management - Leadership- Network Contracting and Credentialing - Emotional Awareness- Collaborator - Adaptability- Operations - Sociability- Conict Resolution - Motivator- Attention-To-Detail - Trainer- Documentation & Reporting - Inuencer- Technical Integration - Active ListenerCareer Experience:Farm Bureau Health Plans of TennesseeDirector of Provider Engagement and Provider Relations June 2022 - Present Developed policies, platforms, and key indicators for educating facilities and providers about a new Medicare Advantage plan, ensuring compliance with CMS requirements. Supervised a team responsible for working with facilities, providers, and internal departments. Managed member grievances, provider claims, provider reconsiderations, and built provider goodwill. Reported operational metrics to Senior Management, ensuring transparency and accountability. Ensured HIPAA compliance throughout all operations. Prime Health Services, Inc.Sr. Provider Contracting SpecialistAugust 2021 June 2022 Provided expertise in contracting with Hospitals and Health Systems for a national PPO network specic to various products. Educated and contracted with Health Systems across the country, including major institutions. Developed provider facility network for Workers Compensation network. American Health Plans, Franklin, TNDirector, Managed Care & Network Services2018 June 2021 Spearheaded contracting, credentialing, and network directory publication for Medicare Advantage plans in nine states. Streamlined operations through policy creation, procedural enhancements, and workow optimization. Contracted network partners to meet Medicare adequacy requirements across multiple states. Directed contracting eorts with additional business entities, ensuring compliance and partnership growth with key payors.National Healthcare Corporation, Murfreesboro, TNDirector Value Based Care2015 2018 Led company initiatives related to contracting payers for skilled nursing facilities, achieving favorable outcomes aligned with organizational goals. Supervised a successful Bundled Payment for Care Improvement (BPCI) program, enhancing operational eciency. Directed contracting eorts for Payor contracts across eleven states, fostering strategic partnerships with key national companies.MedSolutions, Inc., Franklin, TNDirector, Network Services, Post-Acute Care & Bundled Payment 2012 2015 Directed contracting eorts for imaging networks and collaborated with hospital partners on a narrow post-acute network for Bundled Payment for Care Improvement (BPCI) programs. Fostered professional relationships with key stakeholders, improving network performance and outcomes.Windsor Health Plans, Brentwood, TNRegional Director of Network Services2006 2012 Employed and governed teams of provider contractors and relations representatives, establishing positive client relationships. Developed and deployed eective strategies for building and managing Medicare HMO networks across multiple states. Utilized team management strategies to attain successful results and meet goals. Additional Experience: Program Administrator, Trinity Hospice of Tennessee, LLC. Consultant, Advantage Information Services, Inc. Executive Director, TBN of TN., Inc. (Medshares Home Health) Executive Director, Almost Family / CareTenders, Inc. Owner and VP Operations, Phoenix Health Systems, Phoenix Medical Adult Day Care Administrator, Columbia/HCA Managing Partner, Stang America On-Air Talent, Radio and TelevisionEducation: Bachelor of Arts in Communications, University of Tennessee Martin, Martin, TN Computer Science & Data Management, Dyersburg State Community College, Dyersburg, TN Technical Prociencies:- Quest Analytics - Salesforce- Microsoft Oce Applications - Intuit Business Software License: Third Class FCC Radiotelephone Operators License Notable Mentions: Manchester Whos Who, Executives and Professionals in Healthcare- HFMA Member - Key People in DME Outstanding Young Men of America - Rotary International |
