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PROVIDER CONTRACT MANAGER Resume Example

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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 Informatics Western Governors' University of Washington Seattle, 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 MANAGER 06/2013 to Current Molina Healthcare of Washington Bothell, 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 Services 10/2002 to 05/2013 Public Health, Seattle & King County Seattle, 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 MANAGER 01/2001 to 08/2002 Maricopa Integrated Health System Phoenix, 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 PROMOTION 05/1997 to 01/2001 Maricopa Integrated Health System Phoenix, 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 SERVICES 01/1988 to 01/1997 Chandler Regional Health System Chandler, 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)
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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

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