PROFESSIONAL SUMMARY
Proven Regional Manager with extensive experience in operations, human resources, benefits, supervision, implementing and creating policies and procedures, as well as staffing and organizational development. Experience includes CMO Peachstate Health Plans, HCA Physician Services, Aetna Health Plans and a Federally Qualified Health Center. Create and maintain an atmosphere of warmth, personal interest, and position emphasis, as well as a calm environment throughout the corporation. Dependable, and creative, with excellent interpersonal skills.
PROFESSIONAL EXPERIENCE
(CMO Medicaid) 2011-Present
Regional Contracting ManagerMacon, GA
• Manage Provider Relations for Central and East Regions.
• Oversee expansion project to new region.
• Lead assigned negotiations with the regions hospitals and physicians.
• Review and monitor providers performance standards and financial according to contracts.
• Perform advanced financial analysis to identify medical cost improvement opportunities and develop and execute contracting action plans to achieve results.
• Create actionable financial projections, decision support models, and financial reporting for new and evolving products, programs and initiatives.
• Develop innovative analytics, insights and solutions for medical cost drivers, program valuation studies and network design/provider reimbursement issues.
• Event planning including numerous events: Health fairs, “Teen Pregnancy Prevention Symposium” (providers earned CME’s), “Introduction to Plan” conferences for providers.
First Choice Primary Care Inc.2007-2011
Practice Operations Manager Macon, GA
• Start up of Federally Qualified Health Center. Center including preparing facility for EMR on E-Clinical, ordering all initial start-up aspects of practice.
• Recruitment of physicians, mid-levels, clinical staff, and clerical staff.
• Supervised a clinical and clerical staff as well as Medical Director and Nurse Practitioners..
• Developed guidelines for prioritizing work activities, evaluating effectiveness, and modifying activities as necessary to ensure appropriate staffing levels are maintained.
• Assisted in marketing and promoting , to build revenue within the practic
• Developed and implemented policies and procedures to employees, patient’s family members, and government agencies as needed.
• Partnered with private vendors specializing in advertising and marketing.
• Reviewed service level agreements and assumed responsibility of implementing these procedures.
HCA Physician Services 2001-2007
Practice Regional Manager for Multiple Site Practices 2-Macon, Gray, & Dublin, GA
• Directed planned, started-up and coordinated the operations of multiple practices including multiple specialties. Practices included x-ray facilities which required state policies.
• Executed and trained staff on OSHA, HIPPA and Quality Management procedures for multiple facilities.
• Reviewed and approved financials for practices including annual budgets.
• Handled the recruiting, hiring, and development of all staff including professional, clinical and clerical staff.
• Interpreted the practice’s policies and procedures to employees, patients, family members, government agencies, etc.., as necessary.
• Assured that an adequate number of appropriately trained professionals and personnel are on duty at all times to meet the needs of the patients.
• Adhered to the “Code of Conduct” philosophy and “Mission and Value Statement”.
Aetna U.S. Healthcar...
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