Largest single health insurer in the United States serving 85 million members.I manage healthcare delivery system relationships; and negotiate contract terms and reimbursement methodologies/rates with hospital, physician group, and ancillary provider entities to achieve performance objectives and competitive provider networks for the commercial, Medicare Advantage, managed Medicaid and TRICARE health plans and products offered by UnitedHealthcare.In this role, I negotiate and implement value-based, outcomes-focused and accountable care reimbursement methodologies designed for hospitals, primary care services, and integrated delivery systems, and include telehealth, bundled care, quality incentives, shared savings, and CMS risk adjustment and STARS (HEDIS) rating performance.

Actuarial and consulting company serving a full spectrum of business, government, education and nonprofit organizations.Management consultant in the healthcare technology and operations practice area.I provided project management and analysis for multiple client engagements, which included: Accountable Care Organization strategy and development, NCQA accreditation, HEDIS/CAHPS performance, ICD-10 implementation, ASO market analysis, health and dental plan acquisition review, health plan operational capabilities and gaps assessment, clinical cost and utilization benchmarking, integrative care management analysis and strategy, administrative cost benchmarking, delegate and vendor management strategy, disease and case management program development, Medicare Part C and D regulatory compliance and data validation audit, Medicare Advantage and managed Medicaid delivery system performance evaluation, and analysis activities related to health care reform including Health Insurance Benefit Exchanges and the Patient Protection and Affordable Care Act.

BlueCross BlueShield Association health plan company serving nearly 3 million members in Washington, Oregon, Utah & Idaho.In this role, I oversaw strategic program development, operations and management of the behavioral health and dental services department for commercial and government health plans, including TRICARE, Medicare Advantage, and the Federal Employee. Responsible for 45 FTEs and 3.6 million dollar annual budget. My responsibilities included leadership and management of business processes for multiple functional areas:Clinical Services: utilization management, case & disease management, integrative care & medical home management, appeals, quality assurance and medical policies and procedures;Provider Network Services: network management & development, contract negotiations, reimbursement strategy and provider relations; andOperations and Customer Service: provider and member call center, benefit & reimbursement policy, claim systems configurations (legacy and FACETS), claims pricing and adjudication and payment integrity.I wrote responses and participated in the purchaser request for proposal (RFP) processes; and presented program value offerings to key accounts and community collaborative organizations.I developed and implemented a comprehensive strategy to federal mental health parity, including utilization and care management, provider and member communications, benefit and system configuration, and consultation with sales and marketing, actuarial, legal/regulatory, and key accounts.