Managing Partner Resume Example Calibrated Health Solutions

MANAGING PARTNER

Summary

Healthcare executive with consistent track record of effective loss ratio management through process development, refinement and focus on migrating populations to optimal health Served in executive leadership roles for various for-profit, not-for-profit, health plans and medical centers in both the United States and Europe. Uniquely broad industry perspective and expertise in strategic management, operations, product development, insurance risk, business analysis, and health/hospital/managed care systems.

Experience

Managing Partner, 01/2016 to CurrentCalibrated Health Solutions － Lewes, Delaware

Provide operational and financial advisory services to various Care Innovation, Medicare and/or Medicaid projects by applying expertise to drive client results.
Assist clients in assessing business and technical requirements related to implementation of Care Innovation.
Client Initiatives include Accountable Care Organizations, Medicare Shared Savings Programs, Bundled Payment for Care Improvement Initiatives, Comprehensive Joint Replacement programs, Medicare Advantage and or Medicaid managed care, post-acute networks and public health information exchanges.

Director, 01/2014 to 01/2016Delmarva Health Network － Lewes, Delaware

Provide strategic direction, operational oversight and management for the Accountable Care Organization's Medicare Shared Savings Program (MSSP) and Bundled Payment for Care Improvement (BPCI) initiatives.
Evolved a reactive risk management approach focused predominantly on the psycho-social needs of "frequent flyer" patients into a thoroughly defined, multi-layered process and operation to migrate large volumes of at-risk beneficiaries to their optimal level of health.
Procured and deployed comprehensive systems infrastructure to aggregate cross-care setting patient data and enable its injection into the health outcome management process.
Replaced an ineffective non-clinical Care Coordinator staff model with a collaborative, multidisciplinary health outcomes team consisting of Nurse Practitioners, Nurse Health Advocates, Licensed Clinical Social Workers and non-clinical support staff.
Introduced systems, staffing and processes creating new services and revenue streams to both drive down costs and cover operational expenses.
Converted inpatient focused BPCI Governing Council teams of surgeons to cross-care setting clinical process review and improvement forces resulting in $500,000 first quarter gain-share.
Developed and deployed multifaceted HCC score initiative to positively impact CMS benchmarking and maximize MSSP gain-share opportunities.

Head of Acquired Brain Injury Services, 02/2008 to 02/2014QUEST BRAIN INJURY SERVICES － Galway, Ireland

Responsible for practice management, strategic planning, government relations, P&L, client relations, marketing and program development for National Learning Network's government funded acquired brain injury (ABI) services in Ireland.
Oversaw multidisciplinary team including: neuropsychologist, psychologists, counselors, occupational therapists, rehabilitation instructors and administrative staff.
Converted a fledgling, classroom based, training model into a vibrant, outcome driven Community Based ABI Rehabilitation Program.
Achieved 42% service unit cost reduction and 63% increase in service capacity.

In 2009 satisfied minimum service provision of government contract for first time in program's ten year history.
Subsequently service provisions were exceeded by: 2010 - 5%; 2011 - 15%; 2012 - 19%; 2013 - 23%; 2014 - 35%.
Restructured government service agreements to reflect client progression and program outcomes rather than staff activity.
Architect of Outcome Management System (OMS) portal to track client progression and program effectiveness.
OMS received RehabGroup Innovation Award.
Secured grant from Covidien and other funding for development of the brain injury information and training portal - www.acquiredbraininjury.com.
Spearheaded community awareness and fundraising initiatives.

President & CEO, 01/2004 to 01/2008CREENAGHT HEALTH PLANS － Rehoboth Beach, Delaware

Responsible for development and oversight of all operations and strategic planning for this first-to-market "Outcome Driven" community health plan.
Program outperformed projected loss ratios by 10%.
United nine Delaware Chambers of Commerce, 4 local hospitals, the Delaware Medical Society and business leaders to sponsor fully insured small employer health initiative.
Liaised with Delaware Governor & Lieutenant Governor, Delaware State Representatives and Delaware Healthcare Commission to garner support for healthcare initiative and secured access to Delaware State employee health claim information as normative data for rate development.
Formed statewide provider network consisting of over 2,000 physicians and 9 hospitals.
Contracted with A-rated fronting carrier and reinsurer to underwrite fully insured health plan.
Executed strategic relationships with systems, administrative, utilization review, medical/disease management, medical underwriting, health screening and actuarial review business partners.
Negotiated joint venture and expansion of provider network with leading regional PPO.
2004 Chamber of Commerce Leadership Award; 2006 Outstanding Community Service Award.
Program was featured as a "Health Plan Innovator by Munich Re in 2007 International Actuarial Association Conference in Cape Town, South Africa.

Executive Vice President, 02/2002 to 02/2008ALTERNATIVE HEALTH SOLUTIONS － Doylestown, Pennsylvania

Provided employee benefit consulting, underwriting, plan design, wellness and medical/disease management supports for the development and deployment of outcome driven health solutions.
Services delivered to employer groups, unions, state agencies, chambers of commerce, third party administrators, hospitals, physician organizations and brokerage firms.

Vice President, 01/2001 to 01/2002THE LOOMIS COMPANY － Wyomissing, Pennsylvania

Consolidated, implemented and managed over 10,000 medical member lives through the Pennsylvania Public School Health Care Trust in conjunction with a grant from the Heinz Foundation.
Developed and marketed Outcome Driven products for self-insured markets.

Vice President, 01/1999 to 01/2001AMERICA'S CHOICE HEALTH PLANS － King of Prussia Summit, Pennsylvania New Jersey

Recruited, deployed and managed sales and service force for first-to-market, on-line benefits administration.
Achieved 18-month business growth of over 15,000 health members.

Regional Sales Manager, 02/1998 to 02/1999PRIVATE HEATLH CARE SYSTEMS － Waltham Saddle Brook, Massachusetts New Jersey

Responsible for marketing network and medical management products to large employer groups, third party administrators and health plans throughout New Jersey, Pennsylvania, Ohio, Kentucky, Delaware and Maryland.
Coordinated with provider contracting team to identify and fill network service gaps.

Senior Account Executive, 02/1996 to 02/1998New York Life Insurance Company － Portland, Maine

Responsible for sales/marketing, service management and P&L of a block of employer sponsored Life, AD&D, Dental, Short/Long-Term Disability and Health benefits consisting of over 25,000 member lives.
Oversaw dedicated service team of over 60 staff members covering claims, member services, utilization review/case management, underwriting and administrative roles.
Managed ongoing plan design reviews and cost containment initiatives.
Negotiated provider contracts and spearheaded network development in Northern Maine.
1998 national and regional sales leader awards; 1996 regional sales leader award.

Account Executive, 01/1993 to 01/1996Lexington, Massachusetts

Marketed employee benefits programs through national consulting firms throughout New England.
Generated over 15,000 new business member lives - resulting in HMO expansion into Maine.
Spearheaded fee arrangement with Maine physicians on behalf of the University of Maine System.
Developed database to track P&L of the New England region.
1994 Presidents Trophy recipient for national sales leader & set company record for new business sales.
1995 regional sales leader award.

01/1992 to 01/1998NEW YORK LIFE INSURANCE COMPANY

Underwriting Consultant, 02/1992 to 02/1993New York, New York

Underwriting project lead for integration of New York Life employee benefits divisions and subsidiaries into NYLCare Health Plans Inc.

Underwriter/Manager, 01/1987 to 01/1992THE PRUDENTIAL INSURANCE COMPANY － Parsippany, New Jersey

Managed 50,000 member lives consisting of employer accounts under Fully Insured, Administrative Services Only and Minimum Premium programs.
Achieved profitable loss ratios for block of business from 1988-1992 through innovative process integrating progressive underwriting methodology, ongoing health risk review and strategic medical management deployment.

Education and Training

Bachelor of Arts:Political Science & HistoryKean University － New Jersey

Army National Guard -1986-1994

Skills

Administrative, AD, approach, Architect, Army, benchmarking, benefits, benefits administration, case management, CMS, com, community health, consulting, contracts, cost reduction, Council, Client, clients, client relations, database, direction, disease management, financial, fundraising, government, Healthcare Commission, Innovation, Leadership, marketing, market, clinical support, medical management, access, Network, networks, clinical Care, processes, marketing and product, program development, public health, Rehabilitation, risk management, sales, staffing, strategic, strategic planning, underwriting

Resume Overview

Companies Worked For:

Calibrated Health Solutions
Delmarva Health Network
QUEST BRAIN INJURY SERVICES
CREENAGHT HEALTH PLANS
ALTERNATIVE HEALTH SOLUTIONS
THE LOOMIS COMPANY
AMERICA'S CHOICE HEALTH PLANS
PRIVATE HEATLH CARE SYSTEMS
New York Life Insurance Company
NEW YORK LIFE INSURANCE COMPANY
THE PRUDENTIAL INSURANCE COMPANY

School Attended

Kean University

Job Titles Held:

Managing Partner
Director
Head of Acquired Brain Injury Services
President & CEO
Executive Vice President
Vice President
Regional Sales Manager
Senior Account Executive
Account Executive
Underwriting Consultant
Underwriter/Manager

Degrees

Bachelor of Arts : Political Science & History
Army National Guard -1986-1994

Managing Partner Resume Example

Resume Score: 80%

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