Experience

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  ManagedCare Payer Consulting

  • Sacramento, California Area

  • Managed Care Project Executive/Principal

    • Dec 2013 - Present
    • Sacramento, California Area

    Provide consulting and project management services including integration of care management, right sizing provider networks, Knox-Keene license applications, regulatory filings and site visit prep, building sales plans and creating operating efficiencies.Well rounded "utility player" that can step in to unsettled situations and capitalize on opportunities to build market share, expand service areas, implement new products and/or resolve regulatory issues.Nearly 4,000 LinkedIn Managed Care Connections and over 600 Industry Executive Endorsements.Past engagement clients include Foundation Health Federal Services/Health Net, SCAN, PacifiCare/United Healthcare, Blue Shield of California and Sutter Health.Recently secured contract with innovative care integration vendor and one of California's largest health plans to build innovative payer-provider relationships.Currently working with large ($ Billion dollar plus revenues) integrated delivery system developing sales plans, revising and negotiating employer group agreements, assisting with regulatory filings and developing operational policies and procedures.

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  Centene Corporation

  • Sacramento, California Area

  • Director Provider Relations w/Expertise in Medi-Cal Start-ups, Managed Care, Network Management

    • Jul 2013 - Nov 2013
    • Sacramento, California Area

    Direct all provider relations and education activities to prepare startup health plan for November 1 effective date serving 100,000 + Medi-Cal beneficiaries in 18 county Rural Expansion of managed care.Work with FQHCs, direct contracted providers and IPAs and Medical Groups to clarify contract provisions and resolve operational issues. Conducted 300+ pre-operational provider education sessions throughout California.

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  OptumInsight/United Health Group

  • Sacramento, California Area

  • Director West Region Payers w/Expertise in Provider Health Plan Startups, Licensing, Expansion

    • Nov 2011 - Apr 2013
    • Sacramento, California Area

    Responsible for business development and revenue targets of $2.5M+. Responsible for Delivery and managing consulting teams on key Optum large scale projects.Key member of business development team that sold $26.5M consulting engagement to large integrated healthcare provider to develop a new startup health plan.Served as executive lead for teams that developed and submitted complete Knox Keene license application for Sutter Health Plan.Served as executive delivery lead over sales, marketing, actuarial, finance and provider network work streams building new health plan. Lead teams and manage client engagement delivery for health plans and other payers in areas of operational efficiency, ACO development, HBE, health reform, cost of care reductions, provider networks and ICD 10 implementation.

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  MedeAnalytics

  • Emeryville, California

  • Client Success Executive w/Expertise in Large Payer Account Growth & Management, Product Development

    • Jan 2011 - Oct 2011
    • Emeryville, California

    Responsible for account management for select large health plan payer clients for privately held healthcare data analytics company.Managed relationships and conducted training for Regional Medical Directors, idenitifed and operationalized enhanced system functionalities, created new utilization reports.

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  Blue Shield of California

  • Sacramento, California Area

  • Director Healthcare Value, CalPERS w/Expertise in Innovation,Cost Reduction, Large Public Employers

    • Sep 2007 - Feb 2010
    • Sacramento, California Area

    Lead process of identifying new initiatives to reduce healthcare costs and annual trends for 400,000+ CalPERS members - identifying expected annual healthcare cost savings of up to $16M.Design and coordinate member wellness programs including onsite clinics, health risk assessments, biometric screenings, triage engines, PHR and disease management programs.Led multidisciplinary project team to develop and implement fourth largest Group Medicare Advantage Prescription Drug program in California.

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  InSight Health Corporation

  • San Francisco Bay Area

  • VP Managed Care Business Development with Expertise in Managed Care Contracting, Revenue Growth

    • Jun 2005 - Sep 2007
    • San Francisco Bay Area

    Identified new non-traditional markets including TPAs, self-insured employers (2,000+ lives) and public sector employer groups - on pace to deliver $2,000,000 in new incremental revenues.Developed innovative pricing mechanisms creating a 15% price advantage in the new markets.Filled pipeline with qualified prospects, delivered sales presentations and closed over $980,000 in new business revenues (first 6 months).Developed contract with State Compensation Fund impacting 50% of all worker's comp business in California.Significantly revised managed care payer contracts to drive new revenues, improve operating efficiencies and obtain regulatory compliance.Developed contract with Aetna Health Plans covering 839,000 California PPO members representing $17,000,000 in annual revenues.

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  CHC Managed Healthcare Consulting

  • Sacramento, California Area

  • Founding Principal with Expertise in BD, PMO, Health Plan Operations and Compliance

    • Jan 1999 - Jan 2004
    • Sacramento, California Area

    Led startup of independent consulting firm providing comprehensive healthcare contract services to managed-care payers and providersDeveloped partnerships with health plan CEOs and COOs to produce new businessDeveloped sales proposals, SOWs, priced engagements, negotiated contracts, built project plans, deliverables and performance metricsPerformed operational assessments, systems reengineering, provider network development, provided interim management and project management servicesMajor health plan clients included PacifiCare, Health Net, Blue Shield of California, Foundation Health and United HealthcareKey member of RFP response team for TRICARE Region 11 and Region 2/5 procurements each worth $500 million Selected as a member of Society of Industry Leaders for prominent NYC Venture Capital Fund Managers including Gerson-Lehrman and Vista Investments

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  Health Net

  • Sacramento, California Area

  • VP General Manager California Medi-Cal Programs with Expertise in P&L Management, Medicaid Program

    • Jan 1998 - Jan 1999
    • Sacramento, California Area

    P&L responsibility for $500,000,000 Medi-Cal programs throughout California with 130 employees/ $6 million budgetDirected sales, marketing, enrollment, member services, health education, regulatory compliance, claims, finance, provider relations, eligibility and capitation management and administrative operationsIncreased revenues by $42,000,000, added 44,000 new members in one yearManaged relationships with both the HCFA and California DHS, maintained regulatory compliance with all state/federal lawsSuccessfully administered complex publicly funded program within highly matrixed health plan environment

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  Foundation Health Corporation

  • Sacramento, California Area

  • VP Provider Compliance with Expertise in Risk Contracts, Regulatory Compliance

    • Jan 1995 - Jan 1997
    • Sacramento, California Area

    Responsibility for all functions within provider oversight/compliance/education for 120 capitated/delegated Independent Practice Associations and medical groups located throughout CaliforniaAppointed by CEO to lead team that transitioned 100,000 Foundation Health Medical Group members to FPA MSO.Directed provider education functions supporting national TRICARE and California Medi-Cal operations impacting 3 million membersKey member of corporate task force that secured initial NCQA accreditation.

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  Foundation Health

  • Director Provider Network Services with Expertise in Call Centers, Provider Relations

    • Jan 1992 - Jan 1995

    Directed all provider services functions including four regional provider relations offices, provider inquiry call center and provider education programs with 6 managers, 84 staff and $4 million budget oversight.Managed high-volume call center (500,000 calls/year) reducing wait times and abandoned rates by 66%.Developed regional and national provider education programs to support commercial and DoD TRICARE programsParticipated in creation of Foundation Health IPA, contracting with 400 physicians and retaining 30,000 new members, preserving $36 million annual revenue stream.

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  Blue Cross & Blue Shield of Ohio

  • Professional Relations Representative, Provider Relations Manager, Director Provider Relations

    • Jan 1979 - Jan 1992

    Represented BCBSO to 400 institutional and 23,000 professional providers throughout state of Ohio.Managed five regional offices in Toledo, Cleveland, Cincinnati, Dayton and Columbus.Selected by CEO to lead company reorganization of provider reimbursements ("Blueprint"); developed new products, risk sharing prospective reimbursement, utilzation management protocols, reorganized operations and renegotiated provider contracts resulting in $12,700,000 reduction in annual health care costs.Served on account management teams and developed statewide PPO product for 90,000 State of Ohio employeesLiaison to UAW/Auto accounts including Ford, GM and Chryler, designed UM protocols

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  Aetna Life & Casualty

  • Toledo, Ohio Area

  • Sales Representative with Expertise in Prospecting, Small Group and Individual Sales Presentations

    • Jan 1976 - Feb 1979
    • Toledo, Ohio Area

    Sell Aetna Life and Health products to individuals, small businesses and mutliple employer trusts throughout Northern Ohio.