Experience

Devoted Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Provider Network Director

  • Jul 2020 - Present



Conviva Care Center

• United States
• Hospitals and Health Care
• 500 - 600 Employee

• Area Vice President Market Operations

  • 2018 - 2019

  Selected Achievements: • Oversaw Market profit and loss (P&L) account responsibility for a Medicare Managed Service Organization consisting of 9 staff Primary Care and 34 contracted IPA Primary Care offices with approximately 25,000 members. • Actively participated in leadership meetings and demonstrated awareness of a $16MM market’s operational and strategic priorities, while providing advisement on strategies and processes to enhance systems and key initiatives. • Established… Show more Selected Achievements: • Oversaw Market profit and loss (P&L) account responsibility for a Medicare Managed Service Organization consisting of 9 staff Primary Care and 34 contracted IPA Primary Care offices with approximately 25,000 members. • Actively participated in leadership meetings and demonstrated awareness of a $16MM market’s operational and strategic priorities, while providing advisement on strategies and processes to enhance systems and key initiatives. • Established practices, policies and procedures to ensure alignment to objectives by communicating effectively across all levels of the organization with the appropriate message, the right tone and the appropriate level of impact. • Directed operations teams managing a Medicare Managed Care Market of Primary Care offices focused on Integrated Patient Centered Care with an emphasis on quality and preventive care. Show less Selected Achievements: • Oversaw Market profit and loss (P&L) account responsibility for a Medicare Managed Service Organization consisting of 9 staff Primary Care and 34 contracted IPA Primary Care offices with approximately 25,000 members. • Actively participated in leadership meetings and demonstrated awareness of a $16MM market’s operational and strategic priorities, while providing advisement on strategies and processes to enhance systems and key initiatives. • Established… Show more Selected Achievements: • Oversaw Market profit and loss (P&L) account responsibility for a Medicare Managed Service Organization consisting of 9 staff Primary Care and 34 contracted IPA Primary Care offices with approximately 25,000 members. • Actively participated in leadership meetings and demonstrated awareness of a $16MM market’s operational and strategic priorities, while providing advisement on strategies and processes to enhance systems and key initiatives. • Established practices, policies and procedures to ensure alignment to objectives by communicating effectively across all levels of the organization with the appropriate message, the right tone and the appropriate level of impact. • Directed operations teams managing a Medicare Managed Care Market of Primary Care offices focused on Integrated Patient Centered Care with an emphasis on quality and preventive care. Show less



Humana

• United States
• Insurance
• 700 & Above Employee

• Care Delivery Strategic Consultant, Director Network / MSO Operations, Provider Admin Manager

  • 1996 - 2018

  Selected Achievements: • Increased Net Promoter Score by 5% in Primary Care offices in 6 Medicare Markets, HEDIS / STARs scores in owned offices of 4.5 and a 30 day readmission rate of < 16%. • Collaborated effectively with internal and joint venture partners to make decisions that impact the whole of the organization and make decisions using broad knowledge of the organization’s long- term vision, values, and strategy. • Utilized industry-based knowledge and perspective to… Show more Selected Achievements: • Increased Net Promoter Score by 5% in Primary Care offices in 6 Medicare Markets, HEDIS / STARs scores in owned offices of 4.5 and a 30 day readmission rate of < 16%. • Collaborated effectively with internal and joint venture partners to make decisions that impact the whole of the organization and make decisions using broad knowledge of the organization’s long- term vision, values, and strategy. • Utilized industry-based knowledge and perspective to translate strategies into actions by encouraging internal and joint venture partners to embrace and advance the enterprise strategy in existing and developing markets. • Strategically developed partnerships with associates across the enterprise to align resources, enhance processes and systems that further the organization's strategy and ultimately improved performance and profitability. Director Network and MSO Operations (2008 – 2013) Selected Achievements: • Led operations, creation, and execution of network strategy for North Florida, serving 40K Medicare members, and developed budget for those Markets. • Interfaced and maintained relationships with sales directors in North Florida to determine contracting initiatives while meeting Humana’s business needs. • Exceeded market objectives for Medicare Membership growth, retainable disenrollment, HEDIS / STARs and Medical Expense Ratio Provider Administration Manager (2007 – 2008) Selected Achievements: • Developed and managed Medicare Advantage HMO networks in various Florida counties, that included contracting, auditing and maintaining contracts and relationships. • Initiated, established, and expanded a provider network and completed Centers for Medicare and Medicaid Services (CMS) filing for Medicare Advantage HMO in five Florida counties for the Jacksonville Market. • Managed and contributed to financial viability of 4 large Managed Service Organizations of approximately 35,000 members Level 3 Contractor (2003 – 2007) Show less Selected Achievements: • Increased Net Promoter Score by 5% in Primary Care offices in 6 Medicare Markets, HEDIS / STARs scores in owned offices of 4.5 and a 30 day readmission rate of < 16%. • Collaborated effectively with internal and joint venture partners to make decisions that impact the whole of the organization and make decisions using broad knowledge of the organization’s long- term vision, values, and strategy. • Utilized industry-based knowledge and perspective to… Show more Selected Achievements: • Increased Net Promoter Score by 5% in Primary Care offices in 6 Medicare Markets, HEDIS / STARs scores in owned offices of 4.5 and a 30 day readmission rate of < 16%. • Collaborated effectively with internal and joint venture partners to make decisions that impact the whole of the organization and make decisions using broad knowledge of the organization’s long- term vision, values, and strategy. • Utilized industry-based knowledge and perspective to translate strategies into actions by encouraging internal and joint venture partners to embrace and advance the enterprise strategy in existing and developing markets. • Strategically developed partnerships with associates across the enterprise to align resources, enhance processes and systems that further the organization's strategy and ultimately improved performance and profitability. Director Network and MSO Operations (2008 – 2013) Selected Achievements: • Led operations, creation, and execution of network strategy for North Florida, serving 40K Medicare members, and developed budget for those Markets. • Interfaced and maintained relationships with sales directors in North Florida to determine contracting initiatives while meeting Humana’s business needs. • Exceeded market objectives for Medicare Membership growth, retainable disenrollment, HEDIS / STARs and Medical Expense Ratio Provider Administration Manager (2007 – 2008) Selected Achievements: • Developed and managed Medicare Advantage HMO networks in various Florida counties, that included contracting, auditing and maintaining contracts and relationships. • Initiated, established, and expanded a provider network and completed Centers for Medicare and Medicaid Services (CMS) filing for Medicare Advantage HMO in five Florida counties for the Jacksonville Market. • Managed and contributed to financial viability of 4 large Managed Service Organizations of approximately 35,000 members Level 3 Contractor (2003 – 2007) Show less