• Partner with multiple stakeholders and leadership to establish strategic visions, operational objectives and policy and procedures ensuring compliance with State and Federal contracts, related laws, regulations and executive orders. • Monitor and report achievement of committed action plans to senior management. • Direct the development and implementation of operational work processes and systems with direct oversight for multiple departments within the business unit. •… Show more • Partner with multiple stakeholders and leadership to establish strategic visions, operational objectives and policy and procedures ensuring compliance with State and Federal contracts, related laws, regulations and executive orders. • Monitor and report achievement of committed action plans to senior management. • Direct the development and implementation of operational work processes and systems with direct oversight for multiple departments within the business unit. • Accountable for budget, revenue targets and Profit & Loss.• Lead and oversee new business implementation and procurement activities for all products and complex projects. • Evaluate program opportunities and recommendations for effectiveness and ROI. • Perform duties as senior liaison between the business unit, corporate, and external stakeholders. • Oversee preliminary discovery, due diligence for potential liabilities, internal control weaknesses and financial integrity. • Develop new service strategy program across organization with focus on personal accountability, metrics and goals standardization, targeted outreach and approach to key stakeholders. • Build and maintain provider network that promotes high quality/low cost outcomes, through provider assessments and creative contracting. Show less

Seton is one of the largest ministries and thought leaders under the St. Louis based Ascension Health. • Provides leadership to management within areas of responsibility.• Oversees the development and continuous improvement of managed care services, policies, processes, and programs. Prepares and analyzes financial reports, financial analysis and budgetary reports.• Formulates and implements operational strategies and initiatives for Medicaid plan performance by focusing on key… Show more Seton is one of the largest ministries and thought leaders under the St. Louis based Ascension Health. • Provides leadership to management within areas of responsibility.• Oversees the development and continuous improvement of managed care services, policies, processes, and programs. Prepares and analyzes financial reports, financial analysis and budgetary reports.• Formulates and implements operational strategies and initiatives for Medicaid plan performance by focusing on key metrics in operations, medical management, TPA services, re-contracting, quality and reporting which lead to a lower medical loss ratio, higher quality performance and profitability. • Accountable for overseeing reinsurance contracts and recoveries, subrogation recovery, Third Party Administrators, subcontractor and vendor services.• Worked extensively to transition TPA services for Medicaid/CHIP and Employee Plan programs and implementation of additional administrative oversight of medical management, physician contracts, and third-party administration through Central Health and the Community Care Collaborative.• Plans and strategically implements the growth and development of new programs. • Insurance products include: Dell Children's Health Plan- STAR and CHIP, Medical Access Program (MAP)/Charity within the Central Care Collaborative, Seton Employee Benefit Plan. Show less

• Negotiate service contracts, manage consultants, and outsourced vendor functions.• Manage all HHSC contract and reporting deliverables, delegated vendor relationships.• Review regulatory, legal, and legislative issues and requirements.• Conduct ongoing needs assessment to provide continuous quality improvement in all operational areas.• Scale operations to additional product offerings.• Respond to all regulatory inquires, review and monitor all plan document… Show more • Negotiate service contracts, manage consultants, and outsourced vendor functions.• Manage all HHSC contract and reporting deliverables, delegated vendor relationships.• Review regulatory, legal, and legislative issues and requirements.• Conduct ongoing needs assessment to provide continuous quality improvement in all operational areas.• Scale operations to additional product offerings.• Respond to all regulatory inquires, review and monitor all plan document deliverables for HHSC and TDI. • Establish the department’s strategic vision, objectives, and attendant policies and procedures for the organization.• Evaluate and implement improved procedures and practices for accomplishing the organization and department’s objectives and to ensure compliance with all related laws, regulations and executive orders. • Manage budget and forecasting initiatives for department. • Build and maintain provider network that promotes high quality/low cost outcomes, through provider assessments and creative contracting. • Develop and implement activities for the recruitment, contracting and retention of effective providers to promote evidence-based practices. • Meet with contracted providers to develop long-term relationships, resolve operational issues and collaborate regarding effective treatment modalities and outcomes. • Evaluate and negotiate contracts in compliance with company contract templates and reimbursement structure standards. • Analyze provider performance and profiling for interventions data. • Develop market specific provider and member network business plans, strategies, and goals. Show less

• Facilitate operational oversight for multiple departments and identify opportunities for maintaining the most cost efficient operation.• Identification of operational efficiencies; meet regulatory and client expectations and develop a “best practice” approach to all operations.• Meet and exceed requirements including organizational, state, compliance and contractual agreements. • Review and analyze reports, records and directives, and confer with staff to obtain data required for… Show more • Facilitate operational oversight for multiple departments and identify opportunities for maintaining the most cost efficient operation.• Identification of operational efficiencies; meet regulatory and client expectations and develop a “best practice” approach to all operations.• Meet and exceed requirements including organizational, state, compliance and contractual agreements. • Review and analyze reports, records and directives, and confer with staff to obtain data required for planning work function activities.• Establish the department’s strategic vision, objectives, and attendant policies and procedures for the organization.• Evaluate and implement improved procedures and practices for accomplishing the organization and department’s objectives and to ensure compliance with all related laws, regulations and executive orders.• Review and analyze HBR reports, claims data and contract rates to ensure all are on target with initiatives. If not take necessary steps to get on target. • Develop goal metrics for department. • Manage budget and forecasting initiatives for department. • Assist other leaders, health plan SVP, COO, CEO in key strategic initiatives that meet company goals.• Build and maintain provider network that promotes high quality/low cost outcomes, through provider assessments and creative contracting. • Develop and implement activities for the recruitment, contracting and retention of effective providers to promote evidence-based practices. • Meet with contracted providers to develop long-term relationships, resolve operational issues and collaborate regarding effective treatment modalities and outcomes. • Evaluate and negotiate contracts in compliance with company contract templates and reimbursement structure standards. • • Analyze provider performance and profiling for interventions data. • Develop market specific provider network business plans, strategies, and goals. Show less