Senior Director Provider Reimbursements at Magellan Health
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May 2020 - Present
Senior Director Provider Reimbursements
Develop and implement strategies to maximize the probability of success and return on investment for value-based care programs, related alternative payment models, and cost of care savings opportunities for the risk, non-risk, commercial, and public LOB with a strong focus on shifting from a reactive VBC partner to a proactive & innovative one.
2018 - 2020
Executive Director VBC
Executive leader supporting value-based care growth and strategy, services evolution, technologies innovation and at-risk payment development for accountable care services advancing LabCorp into a leading position in value-based care delivery services within large health systems, ACOs, IPAs, MCOs and amongst other strategic partnerships.
2017 - 2018
Vice President of Value-Based Operations
Executive leader providing strategic oversight for a large integrated health system inclusive of 5 hospitals, several ancillary service centers, 2 medical groups and an IPA (> 285K risk-based lives.) Responsible for the design, management, operations and key relationships of all VBAs supporting the integrated health system, ACO partners, IPA partners, an EPO, and a health plan in the greater Sacramento area.
2017 - 2017
Mercy Care Plan / Mercy Maricopa Integrated Care
Vice President, Value-Based Solutions
Executive leader supporting two AHCCCS funded health plans with various lines of business: Acute (Medicaid,) DDD (Division of Developmental Disabilities,) ALTCS (Arizona Long Term Care System,) GMHSA (General Mental Health Substance Abuse,) MCA (Mercy Care Advantage/Medicare,) and SMI (Serious Mental Illness.) Serve as a key participant in executive leadership meetings including two Board of Director meetings and all related committees. Strategic participant in RFP committees and lead the RFP VBS Content Subgroup in preparation for the upcoming integrated RFP for the state. Lead Value-Based Review Committee and Integrated Health Home Subgroups. Created and appointed as Chair of the Data Governance Committee in an effort to minimize data sharing risks associated with all incoming and outgoing data sharing requests. Drive VBS focused interventions supporting Governors’ order to address the opioid epidemic by building strategic external partnerships with key players towards value based solutions. Build innovative, integrated, and strategic APMs that are strategic and independently negotiate upon such driving for win/win solutions. Responsible for building key relationships in the market, attend industry events where leadership presence promotes our mission, and attend conferences that promote our political position. Designed internal processes and created structure that would strategically align all future value-based arrangements to the organization’s primary business objectives through Lean Six Sigma evaluation process. Direct reports include Sr. Director of Informatics, Manager of Medical Economics, and the Manager of VBS Operations.
2015 - 2017
National Director of Medical Economics, Value-Based Collaborative Reimbursement
National finance leader for CCC (Cigna Collaborative Care) programs responsible for building a team to support all collaborative reimbursement programs except CACs bringing them from pilot to implementation stage. Identifying resource and business requirements to support end-to-end contract support needs in collaboration with Matrix Partners. Building financial models for pilots and enhanced phases while overcoming infrastructure readiness barriers. Evaluate performance and client reporting needs, build innovative payment processes to support risk contracts in V2V networks, support customized risk-adjusted cap contracts, and risk-pool incentives across various LOB’s and converging platforms for cap and FFS. Retained my positions with IHA Technical Payment Committee, ASCO’s Payment Reform Workgroup and financial lead on various internal workgroups. Retained my responsibilities overseeing related reserves and budgets, and project lead for third-party vendor gap solution in V2V markets.
2013 - 2015
Financial Analysis Manager CCC/CAC - West Region
Regional finance leader for CCC (Cigna Collaborative Care) and CAC (Collaborative Accountable Care) programs that led a team of senior level economists towards proactive analytics in support of the triple aim. Appointed as Cigna's strategic lead for IHA’s (Integrated Healthcare Association) Value-Based, Pay-for-Performance Program. Represented Cigna's position on IHA’s Technical Payment Committee and ASCO’s (American Society of Clinical Oncology) Payment Reform Workgroup. Appointed, volunteered and led national workgroups that seek to identify P4P pilots in specialty areas such as oncology, OBGYN, and pediatrics. Project lead for building a gap solution with a third-party vendor to deliver performance and client reporting for select networks. Manage CAC reconciliations, SoCal special programs such as non-capitated services budget, leakage and related budgets and reserves. Responsible for delivering tools to our matrix partners that impact performance, quality and total medical cost trends. Changed team’s approach to deliver proactive analytics from a reactive one.
2010 - 2013
Accountable Care Consultant & Analyst
Change Agent consulting the executive leadership of Maricopa and Coconino County’s largest physician practices, FQHC’s, CRS clinics, and hospitals to support the transformation from a reactive model of patient care to a proactive Accountable Care Community in an effort to strategically move towards the triple aim; improve the health of populations, improve patient experiences, and reduce per capita costs of healthcare. Leader in promoting and strengthening partnerships that are strategic to our organization's success. Present to large audiences, executive leadership, and third-party partners with a high level of research, data analytics and best practices presenting a clear message - not just results.
2008 - 2009
21st Century Oncology
Executive regional leader responsible for operational performance for four locations, business growth and development, financials, production, profitability, marketing and advertising, budgeting, staffing, HR, physician/staff/corporate liaison, credentialing, physician recruitment, contract negotiations, and established and enforced TQM and P&P protocol in accordance with regulations.
2000 - 2007
Joint Effort Physical Therapy
Purchased a practice that staffed two employees with no profit margin and quickly grew the practice into $1M LLC within 2 years staffing over 15 employees expanding from one location to two by reorganizing business operations, developing marketing strategies and billing practices. My hands-on knowledge supported the formation of HR policies and procedures where there were none, and my healthcare accounting and finance skills supported the creation and negotiating of business plans for growth with local physicians. I traveled extensively to learn the industry and growth strategies, and coordinated with market referral sources for win/win solutions for patient care.