Program Manager III

• Nov 2020 - Present

Healthcare Advisor

• Oct 2018 - Present

Provider Services Manager

• Jan 2015 - Sep 2019

• Manage Provider Services and Credentialing teams for maintenance and expansion of a quality network. • Analyze provider data to determine recruitment needs for improvement of network adequacy and patient access. • Develop and maintain educational material for providers, including provider newsletters, announcements and notifications. • Maintain policies and respond to compliance reporting needs of federal and state regulatory requirements. • Manage Provider Services and Credentialing teams for maintenance and expansion of a quality network. • Analyze provider data to determine recruitment needs for improvement of network adequacy and patient access. • Develop and maintain educational material for providers, including provider newsletters, announcements and notifications. • Maintain policies and respond to compliance reporting needs of federal and state regulatory requirements.

Credentialing Manager

• Oct 2013 - Oct 2014

• Managed team responsible for the on-boarding and maintenance of network over 2,000 providers. • Responsible for responding to oversight and compliance requirements of contractual arrangements based on NCQA standards, CMS, DMHC and other regulatory requirements. • Managed and conducted monthly Quality Committee meetings, while reporting network changes to providers and internal/external stakeholders. • Collaborated with internal teams on expansion projects to increase membership and develop networks.

Physician Advocate

• Jan 2011 - Sep 2013

• Provided continuous education and training of programs to network providers, medical groups and practice organizations. • Designed and implemented programs that built and maintained relationships with providers and hospitals. • Created recruitment strategies relating to the development and management of provider networks. • Collaborated with contracted hospitals and medical groups, to provide Medicare Risk reports and HEDIS quality initiatives, resulting in a 5-Star rating. • Provided continuous education and training of programs to network providers, medical groups and practice organizations. • Designed and implemented programs that built and maintained relationships with providers and hospitals. • Created recruitment strategies relating to the development and management of provider networks. • Collaborated with contracted hospitals and medical groups, to provide Medicare Risk reports and HEDIS quality initiatives, resulting in a 5-Star rating.

Sr. TriCare Network Manager

• Feb 2008 - Nov 2010

• Negotiated contracts with providers, facilities and ancillary medical groups for a quality and accessible network. • Managed a network of contracted and non-contracted TRICARE providers in 5 Northern California counties. • Conducted provider seminars for education of service member benefits and TRICARE Policies and Procedures. • Identified access issues and developed a corrective action plan to resolve and fulfill network needs. • Negotiated contracts with providers, facilities and ancillary medical groups for a quality and accessible network. • Managed a network of contracted and non-contracted TRICARE providers in 5 Northern California counties. • Conducted provider seminars for education of service member benefits and TRICARE Policies and Procedures. • Identified access issues and developed a corrective action plan to resolve and fulfill network needs.