Experience

Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• COO ABHCA

  • Jun 2020 - Present



Aetna

• Bus. Proj. Senior Program Director, Medicaid East Region

  • Jun 2014 - Jun 2020

  Supports RVP in Medicaid East Region. Supports RVP in Medicaid East Region.



Coventry Health Care - Please refer to Coventry Workers' Comp page

• Director, Corp. Medicaid Operations

  • Feb 2012 - Jun 2014

  Revenue maximization projects encompasssing contract negotiations with vendors and project implementation for new programs. Launch of HRA vendor, eligibilty optimization vendor, RIsk Adjustment software program, and Encounter vendor solutions, Revenue maximization projects encompasssing contract negotiations with vendors and project implementation for new programs. Launch of HRA vendor, eligibilty optimization vendor, RIsk Adjustment software program, and Encounter vendor solutions,



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Sr. Director, Eligibility Optimization

  • Sep 2011 - Feb 2012

  Developed and implemented Disability Advocacy Program that produced increase premium of $3.5M in 18 month period. This new project was a supplmental activity in addtion to managing operations for enrollments, ID cards and responding to RFPs for new markets.

• Vice President Operations, Enrollment

  • Jul 2009 - Sep 2011

  DIrect and indirect oversight of eligiblity and enrollments, ID cards for all Medicaid covered lives (est. 3.4M). Responsible for meeting compliance requirements and creating operational efficiencies to reduce cost.



AmeriChoice

• Executive Director, W Tennessee

  • Aug 2008 - Aug 2009

  Responsible for P&L and market implementation for Tenncare covered lives in W. TN. Grew membership and expanded network while reducing MLR. Responsible for P&L and market implementation for Tenncare covered lives in W. TN. Grew membership and expanded network while reducing MLR.



Unison Health Plan of Tennessee

• Plan President

  • 2007 - 2009

  Responsible for P&L of Medicaid and Medicare membership in W. TN. Maintained 85% MLR for Medicaid plan reduced MLR in Medicare plan in less than 12 months. Grew Medicare membership 400% in 12 month period and expanded network to obtain CMS approval for getting COA to expland into MS and AR in addition to grow across TN. Responsible for P&L of Medicaid and Medicare membership in W. TN. Maintained 85% MLR for Medicaid plan reduced MLR in Medicare plan in less than 12 months. Grew Medicare membership 400% in 12 month period and expanded network to obtain CMS approval for getting COA to expland into MS and AR in addition to grow across TN.



Unison Health Plan

• Director, Corporate and Network Strategies

  • Jul 1999 - Jun 2007

  Responsible for analyzing business growth opportunites, provider rate setting, business improvement initiative (HCIs). Responsible for negotiating all reinsurance contracts and managing claims submissions. Responsible for analyzing business growth opportunites, provider rate setting, business improvement initiative (HCIs). Responsible for negotiating all reinsurance contracts and managing claims submissions.