Experience

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  The AmeriHealth Mercy Family of Companies

  • Vice President, Special Needs Plans

    • 2012 - Present

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  Universal American

  • United States
  • Insurance
  • 700 & Above Employee

  • Vice President, Corporate Development

    • 2008 - 2012

    A family of healthcare companies dedicated to providing quality managed care products by working collaboratively with providers to improve its member's health.Served as leader for emerging business group, cultivating product ideas from across the enterprise and identifying new business opportunities resulting from national health care reform. • Served as team leader on multi-state Medicaid managed care proposals including economic feasibility, state contract analysis, proposal preparation, and interface with state government leadership and key advocacy groups.• Collaborated on Medicaid infrastructure development to support capitated initiatives for the dual population, including internal readiness assessment, care management redesign, quality improvement program development, training and education requirements, and state and local community partnership building approach.• Developed national blueprint to evolve safety net providers into high-performing patient centered medical homes, and achieve benchmark levels of quality, efficiency and patient experience.• Designed national rural health care strategy, including initiative to create rural accountable care organizations, rewarding better health outcomes at lower costs.Served as the executive business owner responsible for developing and operationalizing managed long term care innovations in targeted markets.• Devised the companywide strategic direction of integrated acute and long term care solutions for the dual eligible population, including policy analysis, care delivery model design, organizational fit and operational execution.• Owned the development and operations of Medicaid Special Needs Plan’s (Institutional and /or Dual Eligible) in core markets, including establishing state relationships to accelerate new market opportunities.• Spearheaded project team to enter the nursing home diversion business, including feasibility analysis, care delivery model development and program operations.

  • Vice President, Network Development

    • 2006 - 2008

    Provided strategic and operational leadership to network management teams to support Medicare Advantage business growth objectives in national and east coast markets.• Managed a $4 million budget and over 50 multi-state, field–based provider relations managers and representatives.• Developed comprehensive provider networks (primary care, specialty care, ancillary, acute and long term care) meeting Medicare access and adequacy requirements to support growth strategy in HMO and PPO product lines.• Deployed technological tools and processes to support effective and efficient provider network administration• Executed provider incentive programs through community partnerships with key provider groups under the UAM Healthy Collaborations shared savings model, aligning financial incentives with improved care and costs.

  • Vice President, Health Plan Operations

    • 2003 - 2006

    Accountable executive for the development, implementation, and management of UAM’s first product launch into the Medicare Advantage market.• Profit and Loss responsibility for Private Fee for Service (PFFS) line of business spanning 15 states, 20,000 members and over $50 million in revenues.• Led the successful expansion effort into 20 additional states, leading to largest enrollment growth in company history, and positioning PFFS plan as fifth largest in nation at over 200,000 members.• Provided analytic, management and operations support for UAM entrance into Medicare Part D Prescription Drug business through nationwide venture with CVS.

  • Vice President, Business Development

    • 2002 - 2003

    Business and product development executive for CHCS Services, a wholly owned subsidiary of Universal American Corp. providing elder care management and third party administration services for senior market insurance products.

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  Living Strategies, Inc

  • Bala Cynwyd, PA

  • Vice President, Business Development

    • 2000 - 2001
    • Bala Cynwyd, PA

    A renowned national elder care management organization that was acquired by UAM in 2001.Served as the chief business and product development officer for the nation’s premier elder care management organization, providing support to employee caregivers through a national network of geriatric care managers linked by a state of the art web based technology platform.• Cultivated partnerships with large and mid-sized employer groups in the pharmaceutical, healthcare, automotive, financial services and public sectors that want to improve employee productivity impacted by elder caregiving issues.• Oversaw operational infrastructure including network recruitment and development strategy, service delivery processes and procedures, quality assurance program design and geriatric care manager training program. • Created proprietary system specifications for three key applications that compose the technology interface: “desk top” care management application; client tracking and management system; and family caregiver support application.

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  Genesis HealthCare

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

  • Senior Corporate Director, Full Life Services, Community Services Division

    • 1997 - 2000

    One of the nation’s largest specialized healthcare providers dedicated to the delivery of high quality, personalized long term care.Managed the development, operations and marketing of Full Life Services, an elder care management product, designed to help family caregivers develop broad based solutions to elders’ complex problems.• Responsible for an operating budget of over $2 million and professional staff of 12 members.• Facilitated the design of NetLinkTM, the clinical information system providing automated support to the assessment, problem management, report production, and resource database features of Full Lifesm Services• Developed and executed a nationwide sales plan targeting Full Lifesm Services in assisted living communities, as a population management tool, generating revenues of $2.5 million.

  • Director, Strategic Business Development, Managed Care Division

    • 1995 - 1997

    Responsible for directing the development of network alternatives and integrating mechanisms to position the nation’s third largest, $2 billion eldercare provider for managed long-term care.• Implemented the company’s first risk sharing arrangement with United Healthcare’s EverCare Program, designed to reduce preventable hospitalizations among nursing facility residents through enhanced primary and preventative care.• Led the evaluation of the national PACE model replication, integrating Medicare/Medicaid financing and service delivery for frail elders living in their homes. • Directed diversification of company’s operating portfolio by developing a network of home and community based services including home care, home management/support, adult day health care and other supportive services. • Authored winning proposal securing $28 million in revenues in company’s first national Veterans Administration contract award.

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  Pennsylvania Department of Aging

  • Secretary of Aging

    • 1994 - 1995

    The Commonwealth’s department focused on enhancing the quality of life for all older Pennsylvanians by empowering the family, the individual and diverse communities,Appointed by the Governor and unanimously confirmed by the Pennsylvania Senate to become the State’s chief advocate for health, economic and social needs of 2.5 million older people and their families.• Managed the daily operations of the $450 million cabinet level agency including ten executive management team members and over 125 employees.• Directed the PACE Program, a $230 million outpatient pharmacy benefit program for over 350,000 older beneficiaries, one of the nation’s largest prescription drug benefit programs for low income older adults. • Procured statewide expansion of home and community based services through a $30 million Medicaid Waiver program, enabling over 6,000 at risk older people to remain in their homes rather than in nursing homes.

  • Deputy Secretary for Development and Operations

    • 1992 - 1994

    Served as Chief Operating Officer of the Department managing the statewide system of home and community based long-term care services through oversight of field operations for 52 Area Agencies on Aging. • Implemented the nationally recognized Family Caregiver Support Program providing services and financial support for family caregivers supporting older people in their homes, a $22 million initiative that became the model for The National Caregiver Support Program enacted by Congress in 2000. • Advanced statewide development of long-term care services by evaluating quality improvement practices and their application in the home and community setting• Established the annual direction for over $1 million in aging research, training and service demonstration initiatives

  • Executive Assistant to the Secretary of Aging

    • 1989 - 1992

    Served as the key advisor to cabinet level Secretary on statewide long-term care public policy initiatives and appointed as the Executive Director of the Governor’s Policy Council on Long-Term Care.• Architect of Pennsylvania’s State Plan on Aging, establishing a three year aging agenda including a blueprint for state long-term care reform.• Advanced the Department’s legislative agenda through policy development, analysis and negotiation with the legislature, and health and aging advocacy groups.

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  Meritcare, Inc.

  • Greater Pittsburgh Area

  • Assistant Vice President, Corporate Development Services

    • 1988 - 1989
    • Greater Pittsburgh Area

    A prominent healthcare organization that owned and operated skilled nursing and long-term care facilities.• Spearheaded corporate joint venture and acquisition efforts for the 58 facility nationwide long-term care company.• Managed facility based strategic development and diversification initiatives.

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  Forbes Health System

  • Greater Pittsburgh Area

  • Director of Market Planning

    • 1985 - 1988
    • Greater Pittsburgh Area

    A regional healthcare system dedicated to providing quality, patient-driven care in southwestern Pennsylvania.Championed strategic planning and marketing efforts for the 700 bed, vertically integrated health care delivery system.

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  Allegheny Valley Hospital

  • Assistant Administrator

    • 1984 - 1985

    A 325 bed hospital recognized as a leader for providing superior medical care in a community based setting. Assumed direct line management responsibility for clinical and support services departments.

  • Assistant Director of Planning and Marketing Services

    • 1981 - 1984

    Supported facility capital and program planning efforts for a $50 million hospital campus expansion and renovation project.