Experience

CareNu

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Senior Provider Network Contract Specialist

  • Oct 2023 - Present

  Tampa, Florida, United States



Humana

• United States
• Insurance
• 700 & Above Employee

• Senior Stars Improvement Professional

  • 2017 - 2023

  Tampa, Florida, United States Developed, led, and managed long-term relationships with physicians, groups, and healthcare systems to support and improve quality performance. Key providers included Advent Health, Lakeland Regional Health Systems, Tampa General Medical Group, University of South Florida Health, Watson Clinic, and large ACO, IDS, IPA and MSO entities. • Directed providers and recommended improvements to include clinical and quality management, population health, incentive programs and operations. •… Show more Developed, led, and managed long-term relationships with physicians, groups, and healthcare systems to support and improve quality performance. Key providers included Advent Health, Lakeland Regional Health Systems, Tampa General Medical Group, University of South Florida Health, Watson Clinic, and large ACO, IDS, IPA and MSO entities. • Directed providers and recommended improvements to include clinical and quality management, population health, incentive programs and operations. • Managed Tampa market PCP claims analysis process to correct attribution errors and improve provider engagement. • Member of Caregivers and ACCESS, and Disability Network Resource Groups. • Recipient of Shining Star Award for outstanding contributions to Humana's success related to collaborative efforts to improve provider engagement.

• Large Practice and Ancillary Contracting Executive

  • 2014 - 2017

  Tampa, Florida Led, negotiated, and executed physician, specialist, and ancillary provider contracts for Commercial, Medicaid, and Medicare lines of business. Concentrated contracting efforts to ensure Medicaid network adequacy in AHCA regions 1, 2, 3, 5 and 6. • Managed the statewide Medicaid Chiropractic and SNF networks. • Reestablished the statewide Medicaid DME and Home Health networks within 60 days following a third-party vendor’s unexpected closure. • Established the Medicaid DME network… Show more Led, negotiated, and executed physician, specialist, and ancillary provider contracts for Commercial, Medicaid, and Medicare lines of business. Concentrated contracting efforts to ensure Medicaid network adequacy in AHCA regions 1, 2, 3, 5 and 6. • Managed the statewide Medicaid Chiropractic and SNF networks. • Reestablished the statewide Medicaid DME and Home Health networks within 60 days following a third-party vendor’s unexpected closure. • Established the Medicaid DME network rate at 80% of Medicaid Allowable for AWP which enabled renegotiation of the national DME contracts at the same rate. • Negotiated and executed statewide Medicaid SLAs and drove opportunities to enhance cost savings. • Tampa Market Medicaid SME. • Recipient of North Star Award for outstanding contributions to Humana's success related to Medicaid DME and Home Health network improvements.



American Eldercare, Inc.

• Provider Relations Specialist

  • 2009 - 2014

  Tampa, Florida, United States Led and managed Medicaid network and expansion efforts in AHCA regions 5, 6 and 7. Contracted 200+ ADC, AFCH, ALF, DME, SNF, Home Health, Dental, and Vision providers to ensure network adequacy in AHCA regions 1, 2, 3, 5, 6 and 7. • Lobbied State of Florida House and Senate Representatives to support implementation of the LTC Diversion program. • Negotiated and executed SLAs for all provider types, most of which were high priority due to pending Acute Care discharge. • Provided… Show more Led and managed Medicaid network and expansion efforts in AHCA regions 5, 6 and 7. Contracted 200+ ADC, AFCH, ALF, DME, SNF, Home Health, Dental, and Vision providers to ensure network adequacy in AHCA regions 1, 2, 3, 5, 6 and 7. • Lobbied State of Florida House and Senate Representatives to support implementation of the LTC Diversion program. • Negotiated and executed SLAs for all provider types, most of which were high priority due to pending Acute Care discharge. • Provided training regarding contracts, billing practices, and general information. • Marketed at conferences, business networking meetings, and community events.

• Medicaid Pending Specialist / Care Manager

  • 2006 - 2009

  Tampa, Florida, United States Interviewed 60+ applicants monthly to assess eligibility for the LTC Diversion program enrollment pending Medicaid approval in AHCA regions 5 and 6. • Collaborated with the Department of Elder Affairs and the Department of Children and Families offices to track Medicaid applications. • Documented communications with members, their family, financial advisors, and attorneys to obtain necessary verifications required to process program enrollment. • Maintained a caseload of 15+… Show more Interviewed 60+ applicants monthly to assess eligibility for the LTC Diversion program enrollment pending Medicaid approval in AHCA regions 5 and 6. • Collaborated with the Department of Elder Affairs and the Department of Children and Families offices to track Medicaid applications. • Documented communications with members, their family, financial advisors, and attorneys to obtain necessary verifications required to process program enrollment. • Maintained a caseload of 15+ members, documented monthly visits and assessments of needs to develop care plans and coordinate service provision. • Monitored members’ acute care episodes, documented weekly visits and contacts with clinical staff to update care plans, coordinate discharge planning and service provision.



Hillsborough County Head Start

• United States
• 1 - 100 Employee

• Senior Social Worker

  • 1999 - 2005

  Tampa, Florida, United States Interviewed clients to determine eligibility for Head Start programs. Maintained a caseload of 80+ clients and documented recommended services and courses of action suggested to satisfy client needs and support self-sufficiency. • Developed, marketed and facilitated nationally recognized male involvement programs to promote and advance responsible fatherhood. Coordinated surveys and program analysis to determine program priorities relative to fund utilization. • Collaborated with the… Show more Interviewed clients to determine eligibility for Head Start programs. Maintained a caseload of 80+ clients and documented recommended services and courses of action suggested to satisfy client needs and support self-sufficiency. • Developed, marketed and facilitated nationally recognized male involvement programs to promote and advance responsible fatherhood. Coordinated surveys and program analysis to determine program priorities relative to fund utilization. • Collaborated with the Florida Commission on Responsible Fatherhood, Child Abuse Council and Hillsborough County Health and Social Services to direct the process and planning for the First Annual 2002 Tampa Bay Fatherhood Festival. • Coordinated and facilitated monthly training for clients, staff and community agencies at federal, state and local conferences. Show less



National Head Start Association

• United States
• Civic and Social Organizations
• 300 - 400 Employee

• Consultant

  • 2003 - 2003

  United States Traveled to rural Head Start programs throughout the U.S. and U.S. Territories to provide insight and expertise to increase male involvement. • Interviewed parents, staff, and managers to discuss expectations regarding program development, implementation, and improvement. • Recommended new and innovative strategies to the National Head Start Association for the development of a national model for Head Start male involvement programs.



State of Florida Department of Children and Families

• Public Assistance Specialist

  • 1997 - 1999

  Tampa, Florida, United States Interviewed applicants to determine eligibility for TANF programs. Maintained a caseload of 180+ clients and documented the provision of benefits. • Utilized various databases to investigate incomplete and/or contradictory information provided by clients. • Served on the Quality Assurance Committee and developed strategies to improve efficiency that enabled the agency to provide quality services.