• Negotiate complex contracts with Physician Networks, behavioral health providers, and health Systems, focusing on unit cost competitiveness and affordability to support total cost of care and line of business objectives.• Perform complex financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives. • Oversee contracting and network development staff and external consultants in developing provider networks for new and expansion markets.• Responsible for developing and implementing business strategies for all provider businesses in Massachusetts and Rhode Island, including professional, specialty, and large, fully integrated hospital care systems within the geographic area. • Oversee and engage in managed care provider contracting activities to ensure efficiency and maintain compliance with the business unit’s policies and standards, government laws, and regulations. This included leading the design of network configuration strategies to improve quality and efficiency.• Manage unit cost budgets, target setting, and performance.• Support new business launches via recruitment initiatives in diverse markets while considering individual market circumstances, provider community, budgeting constraints, and available resources.• Monitor adequacy targets and performance and develop and implement business solutions to address process and quality. • Direct cross-functional and industry-wide teams with segment-wide and enterprise-wide impact.

• Review and analyze provider contract proposals. Negotiate contract language and financial components of provider agreements.• Manage the ongoing renegotiation of provider contracts to maintain competitive rate increases and amend contract terms to conform to Optum Standards and CDO’s business strategy, legal and regulatory requirements, and business development needs.• Serve as the strategic owner for designated payer accounts and payer relations, fostering and sustaining strong relationships and serving as a reliable partner.• Acted as the company spokesperson for Joint Operating Committee meetings with external stakeholders for clients, where I presented current initiatives to c-suite executives. • Presented data analytics of all Provider Network-related issues: appeals, retention, negotiations, and cost-saving measures. • Led and managed large-scale initiatives and cross-organizational projects effectively.• Research and negotiate with internal/external partners/customers to resolve highly complex, escalated and time-sensitive issues. • Collaborated with contracting and network development leadership to develop strategies for reducing costs, standardizing reimbursement methods, and maintaining competitive provider networks.• Act as liaison between the Provider Contracting department and other internal departments to resolve issues and answer questions related to provider contracts• Work cross-functionally with various teams to identify strategic partnership and expansion opportunities within existing payer relationships, contributing to company growth.• Worked closely with legal and regulatory teams to ensure compliance with network adequacy requirements and deliver strategic recommendations.• Ensure implementation of training and education programs for external providers. Identify network composition and service gaps to assist network contracting and development teams.

• Dual role, leading the northeast region's Provider Relations and Network Contracting. • Developed and conducted full-scale training for Provider Relations and Provider Contracting team members. • Dual role, leading the northeast region's Provider Relations and Network Contracting. • Developed and conducted full-scale training for Provider Relations and Provider Contracting team members. • Responsible for regional and network development and management of behavioral health plans, including lead vendor management. • Own and drive strategic and operational priorities for network providers, leading and bringing in support from internal corporate departments as necessary.• Lead implementation of new accounts/partnerships by identifying provider account management needs, and meeting network provider needs.• Conduct internal and external Stakeholder meetings.• Vendor management representing the organization to Optum clients. • Research problems and negotiate with internal/external partners/customers to resolve highly complex, escalated, and sensitive issues. • Lead cross-functional meetings as required and ad hoc groups to address contracting issues, communicate the status of negotiations, and document critical financial and legal terms. • Conduct weekly meetings directly with health plan stakeholders regarding all network-related issues (e.g., expansion goals, quality, credentialing, claims issues, etc.).

Responsible for building and maintaining Provider networks that promote quality customer outcomes. Develop and implement activities for the recruitment, contracting and retention of effective providers to promote evidence-based practices—partner with providers to track the outcomes of treatment for members.• Meet with contracted providers to establish long-term relationships, resolve operational issues, and collaborate regarding effective treatment modalities and outcomes.• Developed market-specific provider network business plans, strategies, and goals, retaining existing provider base.• Evaluate and negotiate contracts in compliance with company contract templates and reimbursement structure standards.• Analyze Provider performance and profiling for intervention data.• Analyzed provider appeals and Grievance data and presented it to senior leadership committees. • Actively represented the Provider Partnerships organization in various department and enterprise governance forums.• Worked closely with legal and regulatory teams to ensure compliance with network adequacy requirements and deliver strategic recommendations.• Developed and delivered provider orientation, training, and education materials.• Interpersonal collaboration with all levels of the organization, maintaining provider data accuracy.• Collaborate to evaluate trends, identify preferred practice patterns, and educate providers on clinical initiatives and expectations.

• Negotiated savings of $2MM+ over three consecutive years. • Implemented strategic contracting initiatives for large hospital systems• Implemented National agreements with telehealth Providers. • Partner with Physician and Provider Relations to identify, form relationships, and implement telehealth programs at outreach sites• Participate in monthly and quarterly operating reports with Division and corporate leaders.• Work with provider groups and vendor partners to report quality metrics and data consistently and accurately.• Establish and maintain effective and consistent communications with Division and Facility stakeholders.• Identify, develop, and oversee analyses, models, and tools for informed performance views.• Collaborated with contracting and network development leadership to develop strategies for reducing costs, standardizing reimbursement methods, and maintaining competitive provider networks.• Vendor management with Joint Operating Committee meetings with external stakeholders for clients, where I presented current initiatives to c-suite executives. • Single-handedly negotiated numerous high-value hospital system agreements under budget. • Responsible for regional and national Network Development for new Health plans.• Lead full contract process of negotiations and conduct red-line agreements for all contract types and lines of business (e.g., large Hospital systems, large physician groups, ancillaries, etc). • Research problems and negotiate with internal/external partners/customers to resolve highly complex and escalated and sensitive issues. • Lead cross-functional meetings as required and ad hoc groups to address contracting issues, communicate the status of negotiations, and document key financial and legal terms. • Conduct weekly meetings with health plan stakeholders regarding all network-related issues (e.g., expansion goals, quality, credentialing, claims issues, etc.).

• Conduct full process cycle of negotiations and draft individual and group contracts. • Research problems and negotiate with internal/external partners/customers to resolve highly complex and escalated and sensitive issues. • Identify, develop, and oversee analyses, models, and tools for informed performance views.• Collaborated with contracting and network development leadership to develop strategies for reducing costs, standardizing reimbursement methods, and maintaining competitive provider networks.• Responds to provider inquiries, concerns, complaints, appeals, and grievances.• Initiates and maintains effective channels of communication with providers and related office staff.