Director Of Medical Services

• Nov 2016 - Present

Oversight of Privileging process of Medical Providers, Maintain Joint Commission Standards as well as Medical Staff Bylaws. Facilitate education and communication between providers and hospital administrative staff. Maintain credentialing database. Assist CMO in addressing various provider issues. Facilitate Medical Staff Meetings and follow up. Enroll rotating medical students and residents in hospital education program.

Director Medical Staff Services

• Nov 2016 - Present

Oversight of Credentialing and Privileging of Physicians and APPs, Provider Communications, Medical Staff Meetings and follow up. Maintain Medical Staff Database. Assist with Education of providers

LPN with CPCS Certification In Mecical Staff Services

• Jan 1986 - Present

I am a business professional with a strong clinical background. I will be utilizing my experience and expertise in the business world obtained through many years in the healthcare arena as a nurse, medical staff services professional and healthcare insurance industry manager. This learning and expanding of knowledge is a value added proposition for all companies that utilize relationship building and critical thinking skills. My career growth process has included the development and… Show more I am a business professional with a strong clinical background. I will be utilizing my experience and expertise in the business world obtained through many years in the healthcare arena as a nurse, medical staff services professional and healthcare insurance industry manager. This learning and expanding of knowledge is a value added proposition for all companies that utilize relationship building and critical thinking skills. My career growth process has included the development and management of relationships providers and those in leadership positions at hospitals, managed care organizations and healthcare plans. I have implemented credentialing processes that have been recognized in the community with error rates lowest in national company. I have experience using tracking information from service funds, cost analysis and other financial information to make decisions on provider contracts and hospital, home health and DME utilization. I analyze data and develop performance improvement programs for care management processes and physician opportunities for performance improvement. My greatest asset to my company is my ability to analyze, adjust and make corrections when needed to issues that may arise in dealing with customers, training and direction of initiatives. Experience has taught me how to build strong relationships with all departments at organizations. I have the ability to work within a team, as point person on a project as well as performing as cross-team member. I have developed strong professional relationships with internal and external partners alike with the personal goal of consistently exceeding expectations. Show less I am a business professional with a strong clinical background. I will be utilizing my experience and expertise in the business world obtained through many years in the healthcare arena as a nurse, medical staff services professional and healthcare insurance industry manager. This learning and expanding of knowledge is a value added proposition for all companies that utilize relationship building and critical thinking skills. My career growth process has included the development and… Show more I am a business professional with a strong clinical background. I will be utilizing my experience and expertise in the business world obtained through many years in the healthcare arena as a nurse, medical staff services professional and healthcare insurance industry manager. This learning and expanding of knowledge is a value added proposition for all companies that utilize relationship building and critical thinking skills. My career growth process has included the development and management of relationships providers and those in leadership positions at hospitals, managed care organizations and healthcare plans. I have implemented credentialing processes that have been recognized in the community with error rates lowest in national company. I have experience using tracking information from service funds, cost analysis and other financial information to make decisions on provider contracts and hospital, home health and DME utilization. I analyze data and develop performance improvement programs for care management processes and physician opportunities for performance improvement. My greatest asset to my company is my ability to analyze, adjust and make corrections when needed to issues that may arise in dealing with customers, training and direction of initiatives. Experience has taught me how to build strong relationships with all departments at organizations. I have the ability to work within a team, as point person on a project as well as performing as cross-team member. I have developed strong professional relationships with internal and external partners alike with the personal goal of consistently exceeding expectations. Show less

Ambassador

• Dec 2019 - Dec 2019

Credentialing Manager

• Sep 2014 - Nov 2016

The Manager of Credentialing is responsible for establishing and maintaining strong and mutually beneficial relationships with all participating health plans, hospitals and nursing facilities. Work in cooperation with various Managers, Directors and VPs to facilitate health plan and hospital credentialing processes and system assignment.

Nurse Care Manager

• Sep 2014 - Dec 2015

Care Manager JSA Healthcare Tampa FL 9/14 to current Current Responsibilities Responsible for total coordination and processing of all patient referrals for specialty services. Follows protocols for proper authorization and processing of all referrals. Assists team in educating patient/family, follows JSA standing orders/protocols, assist patients with external resources when needed. Communicates with the patient on a timely basis for all scheduling requirements… Show more Care Manager JSA Healthcare Tampa FL 9/14 to current Current Responsibilities Responsible for total coordination and processing of all patient referrals for specialty services. Follows protocols for proper authorization and processing of all referrals. Assists team in educating patient/family, follows JSA standing orders/protocols, assist patients with external resources when needed. Communicates with the patient on a timely basis for all scheduling requirements. Coordinates pre-admission testing requirements with clinic personnel and patient. Completes all administrative functions associated with referral activities in a timely manner. Enters all referral, hospital, outpatient, DME and other patient specialty health service authorizations into the computer system according to JSA policy and procedure. Receives consultant reports, maintains documentation, and routes to the appropriate physician promptly. Responsible for monitoring all referral reports not received and timely follow-up in accordance with JSA policy and procedure. Other duties as assigned.

Director, OR Services

• Jan 2014 - Jul 2014

Intralign serves as a transitioning partner for hospitals and providers that understand the need to change the delivery model to focus on value delivered as opposed to number of patients served. Intralign is focused on helping hospitals transition in the treatment area most affected by the current healthcare challenges. This position has oversight of credentialing of all first assists and schedulers of cases throughout the United States. Intralign serves as a transitioning partner for hospitals and providers that understand the need to change the delivery model to focus on value delivered as opposed to number of patients served. Intralign is focused on helping hospitals transition in the treatment area most affected by the current healthcare challenges. This position has oversight of credentialing of all first assists and schedulers of cases throughout the United States.

Sr Manager, Provider Networks

• Feb 2013 - Dec 2013

Initiate contract negotiations with providers outlining elements in the downstream agreement with regard to performance expectations such as STAR quality measures, quality bonus incentive, medical loss ratio expectations and correct coding. Provider education on benefits and reimbursement methodology of government sponsored plans. Primary contact for providers serving as a liaison between the provider and the health plan Conduct site visits and educate providers on CMS/State… Show more Initiate contract negotiations with providers outlining elements in the downstream agreement with regard to performance expectations such as STAR quality measures, quality bonus incentive, medical loss ratio expectations and correct coding. Provider education on benefits and reimbursement methodology of government sponsored plans. Primary contact for providers serving as a liaison between the provider and the health plan Conduct site visits and educate providers on CMS/State requirements. Attend face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate area for resolution. Educate providers on issues related to referrals and claims submission; web site education, EDI solicitation and problem solving. Development and implementation of credentialing process Create and implement policies, procedures for interoffice staff. Hire, train and develop talent within the company Show less Initiate contract negotiations with providers outlining elements in the downstream agreement with regard to performance expectations such as STAR quality measures, quality bonus incentive, medical loss ratio expectations and correct coding. Provider education on benefits and reimbursement methodology of government sponsored plans. Primary contact for providers serving as a liaison between the provider and the health plan Conduct site visits and educate providers on CMS/State… Show more Initiate contract negotiations with providers outlining elements in the downstream agreement with regard to performance expectations such as STAR quality measures, quality bonus incentive, medical loss ratio expectations and correct coding. Provider education on benefits and reimbursement methodology of government sponsored plans. Primary contact for providers serving as a liaison between the provider and the health plan Conduct site visits and educate providers on CMS/State requirements. Attend face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate area for resolution. Educate providers on issues related to referrals and claims submission; web site education, EDI solicitation and problem solving. Development and implementation of credentialing process Create and implement policies, procedures for interoffice staff. Hire, train and develop talent within the company Show less

Manager, Health Services

• Aug 2010 - Feb 2013

Select Accomplishments •Develop and maintain relationships with hospital and skilled nursing case managers as well as health plans case management departments to assure that patients receive appropriate level of care including working with home health for discharge planning. •Tracking information from service funds, cost analysis and other financial information to make decisions on provider contracts and hospital, home health and DME utilization. •Oversight and analysis of data and… Show more Select Accomplishments •Develop and maintain relationships with hospital and skilled nursing case managers as well as health plans case management departments to assure that patients receive appropriate level of care including working with home health for discharge planning. •Tracking information from service funds, cost analysis and other financial information to make decisions on provider contracts and hospital, home health and DME utilization. •Oversight and analysis of data and development of performance improvement programs for case management processes and the consumer assessment of healthcare providers and systems (CAHPS, HEDIS and STARS). My current position has assumed the responsibility of credentialing as well as contracting to acquire new primary care providers to the company. •Point person for the Special Needs Population with the health plans working with external and internal partners to assure compliance and success for plans as well as the company. Show less Select Accomplishments •Develop and maintain relationships with hospital and skilled nursing case managers as well as health plans case management departments to assure that patients receive appropriate level of care including working with home health for discharge planning. •Tracking information from service funds, cost analysis and other financial information to make decisions on provider contracts and hospital, home health and DME utilization. •Oversight and analysis of data and… Show more Select Accomplishments •Develop and maintain relationships with hospital and skilled nursing case managers as well as health plans case management departments to assure that patients receive appropriate level of care including working with home health for discharge planning. •Tracking information from service funds, cost analysis and other financial information to make decisions on provider contracts and hospital, home health and DME utilization. •Oversight and analysis of data and development of performance improvement programs for case management processes and the consumer assessment of healthcare providers and systems (CAHPS, HEDIS and STARS). My current position has assumed the responsibility of credentialing as well as contracting to acquire new primary care providers to the company. •Point person for the Special Needs Population with the health plans working with external and internal partners to assure compliance and success for plans as well as the company. Show less

Manager, Provider Relations

• May 2007 - Dec 2009

Select Accomplishments •Managed a 13-member team of provider relations representatives and operations coordinators for the West Florida region of a national managed care company, directing provider contracting, negotiations, and service. •Analyzed PMPM data by specialty to develop action plans that decreased medical cost and financial risk. •Strategized membership growth and retention, improving provider count and assuring satisfaction of internal and external partners by taking… Show more Select Accomplishments •Managed a 13-member team of provider relations representatives and operations coordinators for the West Florida region of a national managed care company, directing provider contracting, negotiations, and service. •Analyzed PMPM data by specialty to develop action plans that decreased medical cost and financial risk. •Strategized membership growth and retention, improving provider count and assuring satisfaction of internal and external partners by taking responsibility for resolving issues and problem solving. •Trained and monitored team in quality assurance and data systems, consistently exceeding goals. •Maintained the lowest contract credentialing rate in the company. •High levels of associate satisfaction by focusing on growing not only the company but individuals. Show less Select Accomplishments •Managed a 13-member team of provider relations representatives and operations coordinators for the West Florida region of a national managed care company, directing provider contracting, negotiations, and service. •Analyzed PMPM data by specialty to develop action plans that decreased medical cost and financial risk. •Strategized membership growth and retention, improving provider count and assuring satisfaction of internal and external partners by taking… Show more Select Accomplishments •Managed a 13-member team of provider relations representatives and operations coordinators for the West Florida region of a national managed care company, directing provider contracting, negotiations, and service. •Analyzed PMPM data by specialty to develop action plans that decreased medical cost and financial risk. •Strategized membership growth and retention, improving provider count and assuring satisfaction of internal and external partners by taking responsibility for resolving issues and problem solving. •Trained and monitored team in quality assurance and data systems, consistently exceeding goals. •Maintained the lowest contract credentialing rate in the company. •High levels of associate satisfaction by focusing on growing not only the company but individuals. Show less

Director, Medical Staff Services

• Jan 2001 - May 2007

Directed a medical staff of over 1,000 providers, reviewing credentials files and working closely with leadership on peer review, utilization management, quality, malpractice insurance, bylaws, and regulations Assured steady communication between leadership, 12 internal divisions, staff, administration, and board Teamed with patients, staff, and physicians to address quality issues and resolve grievances, developing and revising privilege criteria to guarantee care standards and… Show more Directed a medical staff of over 1,000 providers, reviewing credentials files and working closely with leadership on peer review, utilization management, quality, malpractice insurance, bylaws, and regulations Assured steady communication between leadership, 12 internal divisions, staff, administration, and board Teamed with patients, staff, and physicians to address quality issues and resolve grievances, developing and revising privilege criteria to guarantee care standards and using HEDIS and other measures to evaluate providers Managed and implemented orientation and education for over 700 physicians and allied health

Medical Staff Coordinator

• Jan 2000 - Jan 2001

Administered initial credentialing of physicians and allied health professionals for a multi-site hospital Presented complete files to the credentials committee, transmitted recommendations to the Medical Executive Committee, and facilitate correspondence between applicants and division chairs Maintained customer satisfaction through follow-up, availability, and diligent research

Management Training

• Jan 1991 - Dec 1996