Medicare Advantage Provider Network Lead
Current• Serve on the Medicare Senior Leadership Team and lead the development of the national MA network strategy.Primary focus areas:• Advanced the national network team to centralize and own network oversight, provider contracting operations, and value-based and fee-for-service provider contracting for all markets.• Led team to increase participation of membership aligned to a provider in a value-based agreement (VBA) to 65% overall for an increase of 5% nationally.• Created dedicated governance team to enhance audit readiness, reduce non-standard contract terms, and streamline governance review of contracts and automated data sharing with providers. • Responsible for the design and delivery of national provider incentive programs that aim to improve quality outcomes for over 300,000 customers by motivating providers to engage in driving quality prior to taking risk. • Oversee the relationship management, contracting strategy and execution, operations, and outcomes of national MA risk partners. • Set up comprehensive reporting nationwide to oversee VBAs to sustain superior Star ratings, underwriting margin, and customer retention duration.• Effectively align negotiation outcomes within desired unit cost targets set annually.• Directed provider network activities for over 40,000 provider contracts to ensure the successful completion of the Novation of contracts for eight legal entities, and the expected change of control with the acquisition of Cigna's Medicare Advantage business in 2025.• Represented the network workstream for MA during diligence and integration efforts during the pending sale of Cigna’s Medicare businesses.