| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Street Address Lochwood LaneWest Chester, PA Street Address
EMAIL AVAILABLEcell: PHONE NUMBER AVAILABLEOBJECTIVE Looking to bring value, dedication, and energetic leadership skills to a company in need of someone with excellent communication and effective decision-making skills. I offer proven and measurable successes in strategic thinking, leading, and influencing change in the healthcare industry.PROFESSIONAL EXPERIENCECLINICAL INTELLI-PRINT, LLC, Oaks, PA 2024- PresentPresidentResponsible for the overall management and oversight of an automated publishing and printing solutions company for the clinical research industry.Manage a team of project coordinators/graphic designers and sales staff responsible for the day to- day management, growth strategy and market expansion of our printing servicesEVOLENT HEALTH, Arlington, VA 2008-Janury 2024(Prior to being acquired by Evolent Health in 2023, worked for National Imaging Associates, Inc. (NIA), a subsidiary of Magellan Healthcare)Vice President, Provider Relations/Network DevelopmentManage the provider education and communication programs for Magellans specialty medical services for the clients provider networks using a multi-media approach.Serve as a key client management contact and support for all provider relations activities by participating in Joint Operation Committee (JOC) meetings with clients regularly.Contributed to the increase in the overall provider experience satisfaction rate by 5% in three years.Meet with key stakeholders regularly to determine provider/network needs.Direct, monitor, trend, routine, and long-standing provider complaints, claims, contracting, credentialing, and other network provider performance issues requiring educational and interventional initiatives.Oversee contracting, recruitment, and rate negotiation efforts for the ancillary network.Oversee the assessment of network needs to meet network adequacy and ensure quality networks.Support new business development through contributions to the RFP process.Assist with the design and institution of new programs to add value to the current Magellan product design.Responsible for the overall provider communication and provider relations/education strategy on a national level.Direct oversight of the workflow and provider education of the provider analytics program for the physical medicine and musculoskeletal programs.AETNA, Wilmington, DE 2003 - 2008(Formerly Coventry Health Care, Inc.)Director, Provider RelationsOversaw the ongoing education, servicing, recruitment, and provider negotiations for over 25,000 providers in Delaware, New Jersey, and Maryland.Responsible for the oversight of provider contracting, credentialing, servicing, and other delegated functions for high-tech imaging services, dental and behavioral health services provided by third-party vendors.Managed, coordinated, and facilitated processes and procedures to ease administration for physicians and their staff.Responsible for ensuring that Provider Relations goals were consistent with the Health Plans Cost Containment Initiatives.Manager, Medicaid Program Operations 2000 - 2003Responsible for the day-to-day activities of the Health Plans Medicaid Product.Developed and monitored the budget for the Medicaid Product.Developed and managed the implementation of policies and programs as they related to state and federal mandates.Responsible for the implementation and the strategic plan for growth for both Delaware and Maryland Medicaid.Supervisor, Provider Relations 1996 - 2000Managed Provider Relations field representatives responsible for the ongoing recruitment, servicing, and problem resolution for providers and staff.Negotiated and implemented Medicaid provider agreements/contracts with ancillary and professional providers.Oversaw the production and maintenance of the provider directories, bi-monthly newsletters, education materials, and satisfaction surveys.KEYSTONE HEALTH PLAN EAST, Philadelphia, PA 1993 - 1996Manager, Professional ServicesResponsible for overseeing the ongoing education, servicing responsibilities, and problem resolution for over 5,000 Medicaid providers.Established servicing requirements and procedures resulting in 85% increase in provider visits in one year.Responsible for promoting positive working relationships with providers and hospitals by orienting staff, communicating policy changes, and gathering and presenting statistical and financial data for provider performance.Contributed to the recruitment and servicing of 2,000 providers for PPO.EDUCATIONMasters of Science in Health Care AdministrationSt. Josephs University, Philadelphia, PABachelors of Science in Health and Human DevelopmentPennsylvania State University, State College, PAPROFESSIONAL ASSOCIATIONS/ORGANIZATIONSPennsylvania State University and St. Josephs University Alumni Mentorship Program |
