• Successfully negotiated Medicare, Medicaid, and MLTC agreements for various ACOs including hospitals, FQHCs radiology centers, laboratories, long term care and skilled nursing facilities, dialysis centers, home infusion providers, durable medical equipment suppliers, orthotics and prosthetics providers, home health agencies (LCHSA, CHHA), and provider organizations.• Demonstrated exceptional oversight and contracting abilities for vendors and IPAs (Independent Provider Associations)• Developed and implemented Quality Programs to address HEDIS quality measures and gaps in care, liaising with Laboratories and DME providers to build a comprehensive data process. • Conducted routine assessments of the ancillary network and state requirements, strategically implementing measures to bridge network gaps• Proven track record in network building for expansion projects.• Provided leadership during times of organizational change or crisis situations.• Delegated work to staff, setting priorities and goals.• Led team meetings and one-on-one coaching sessions to continuously improve performance.• Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.• Created monthly reports for senior management summarizing operational performance metrics.• Recruited and hired qualified candidates to fill open positions.

• Spearheaded the consolidation of MLTC and FIDA networks through the formulation of a robust recruitment strategy• Established and managed contracts for various healthcare entities, including Hospitals, Home Health Agencies, Hospice, and Dialysis centers• Supervised vendor activities, generated utilization reports, and conducted in-depth analysis for performance evaluation

• Developed, executed, and maintained a provider network management strategy developing actions to meet market growth and medical cost targets. • Provided service and education to network physicians. Serviced, contracted, and negotiated with primary care, specialty physicians and ancillary providers for all product lines.• Identified network gaps and completed contracts. Supported regional Network Improvement Plan targets by providing utilization reports and other analytics available to improve and maintain the region. • Strategized for membership growth and retention by securing 22 new marketing sites.

• Account servicing for IPAs and FQHC accounts. • Supported quality department with QARR, HEDIS and risk adjustment programs. • Liaison with the marketing department, identified and secured 10 new marketing sites. • Worked closely with the market director in the renewal of IPA contracts. Improved partnerships within the network by resolving claim and membership problems and by recognizing key contractual issues. • Responsible for the recruitment and credentialing providers identifying network needs.

• Supported provider relations representatives to meet network integrity. • Coordinated the Suffolk County expansion by leading a multi-departmental task force to ensure provider credentialing documents were in order and submitted accordingly. • Created and maintained tracking database for the network expansion projects. Met established customer communications goals, reviewed all provider directory changes, recredentialing/VR reports, member moves as requested. HPN reporting and review.

1/2006 – 5/2008 • Responsible for behavioral health authorizations, reviewing and assigning outpatient treatment forms, maintaining, and analyzing data on the clinical denial reports. • Created a high-risk management database used to report to the Director on the QARR program results.