PROVIDER CONTRACT MANAGER Resume Example Molina Healthcare Of Washington

PROVIDER CONTRACT MANAGER

Professional Summary

Healthcare manager with extensive experience in implementing complex programs, championing quality initiatives and leading performance improvement projects in service delivery, analytics, communications and customer satisfaction. Strong decision maker with a passion for leading teams to successful outcomes and the use of data to deliver desired outcomes.

Education and Training

Bachelor of Science: Health InformaticsWestern Governors' University of WashingtonSeattle, WA

Skill Highlights

Medicaid Health Homes
Project management
Provider credentialing
Managed care contracting

Medicaid & Medicare
Staff training and development
Policy development and implementation

Professional Experience

PROVIDER CONTRACT MANAGER06/2013 to CurrentMolina Healthcare of WashingtonBothell, Washington

Lead statewide contracting efforts for Health Home implementation for Molina Healthcare of Washington's Medicaid Health Home program, resulting in contracts across the state with major care coordination organizations
Conducted gap analysis of community-based service providers to identify network deficiencies and develop Memorandums of Understanding (MOUs) for long term and supportive services to meet the care coordination needs of Medicaid Beneficiaries
Authored provider contracting narrative for Health Plan's response to Washington state's Request for Application for the Medicaid Health Home Program, resulting in Molina's award as Qualified Health Home in Washington
Consulted with Molina Healthcare of Ohio to guide Plan's contracting efforts for the MyCareOhio program for dually-eligible Medicaid/Medicare enrollees.
Advised delegation oversight management on the development of contractual language focusing on the delegation of Medicaid care coordination services
Developed and delivered Medicaid Health Home training module for statewide care coordination organizations

PROJECT PROGRAM MANAGER IV, Community Health Services10/2002 to 05/2013Public Health, Seattle & King CountySeattle, WA

Special Projects Manager leading enterprise project teams in large and small quality improvement projects to address administrative, operational and performance initiatives. Project sites included the Department's Federally Qualified Health Centers across King County
Managed Care Program Manager, responsible for contract negotiation, renewals and contract performance analysis
Core Member, EPIC Practice Management/Electronic Health Record System implementation team responsible for enterprise's Health Information Technology needs assessment, RFP development, vendor selection and pre-implementation planning proces
Provided technical support and oversight for 13 medical application workers and 4 specialty referral coordinators.
Public Health representative and operational consultant for Project Access Northwest, a non-profit organization coordinating specialty care services for uninsured and under-insured adults in King County
Community Health Service Division's Lead on Customer Service Task Force

BENEFICIARY SUPPORT MANAGER01/2001 to 08/2002Maricopa Integrated Health SystemPhoenix, AZ

Performance/compliance audits: billing office, member services, provider services, enrollment
Developed annual benefit design revisions and marketing campaigns for system's Medicaid, Medicare, Long Term Care and Self-Insured health products
Annual contract renewals for over 500 affiliated providers
Pharmacy and Therapeutics Assessment Team member, responsible for making service authorization determinations

MANAGER, MARKETING AND PROMOTION05/1997 to 01/2001Maricopa Integrated Health SystemPhoenix, AZ

Managed five program budgets totaling $11 million annually
Developed informational, educational and marketing materials for enterprise
Organized and produced community-wide health fairs, wellness activities and program promotional activities
Supervised system's graphics and communications functions

DIRECTOR OF PROFESSIONAL SERVICES01/1988 to 01/1997Chandler Regional Health SystemChandler, Arizona

Core team member JCAHO accreditation team
Key author for Malcolm Baldridge Award submissions
Implementer and trainer for Meditech practice management system
Designed physician manpower assessment tool for focused provider recruitment and strategic planning activities

Affiliations

American Health Information Management Association (AHIMA)
National Association of Healthcare Quality (NAHQ)
Project Management Institute (PMI)

Certifications

Registered Health Information Administrator (RHIA, American Health Information Management Association)
Certified Professional Health Information Technology (CPHIT, Health IT Certifications)
Certified Professional Electronic Health Record (CPEHR, Health IT Certifications)
CIW Database Design Specialist (Certification Partners)

Resume Overview

Companies Worked For:

Molina Healthcare of Washington
Public Health, Seattle & King County
Maricopa Integrated Health System
Chandler Regional Health System

School Attended

Western Governors' University of Washington

Job Titles Held:

PROVIDER CONTRACT MANAGER
PROJECT PROGRAM MANAGER IV, Community Health Services
BENEFICIARY SUPPORT MANAGER
MANAGER, MARKETING AND PROMOTION
DIRECTOR OF PROFESSIONAL SERVICES

Degrees

Bachelor of Science : Health Informatics

PROVIDER CONTRACT MANAGER Resume Example

Resume Score: 70%

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