Joe Mcgrath Email and Phone Number
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Transformational Healthcare Leader | Consultant | Value-Based Care AdvocateI am a hardworking, roll-up-your-sleeves, results-driven executive leader with extensive hands-on experience in health plan and provider operations. Having directly managed or overseen every aspect of these processes, I bring a comprehensive understanding of the challenges and opportunities within the healthcare landscape.My expertise lies in transforming health plan departments to enhance their competitive edge at county, state, and national levels. I collaborate with health plans and providers to refine contract negotiation strategies, managing complex contracts from start to finish. Leveraging innovative marketing approaches, I proactively enhance provider relations by identifying and addressing their unique needs, building sustainable partnerships.A key focus of my work is implementing value-based care continuums that unify contracting, provider relations, and quality teams into cohesive, goal-oriented units. By elevating reporting systems to deliver actionable insights into trends and key milestones, I drive more effective Joint Operating Committees (JOCs), empowering providers to unlock the full value of their data.As a hands-on leader and trusted advisor, I consistently deliver measurable improvements in quality, risk management, and patient experience through comprehensive training and development initiatives. My collaborative approach ensures alignment across all organizational levels, from frontline teams to the C-Suite, resulting in sustainable, impactful transformations.If you’re seeking an innovative leader or consultant to improve operations, strengthen partnerships, and achieve strategic objectives, let’s connect. I bring a proven track record of success and a passion for driving meaningful change in healthcare.
Sellers Dorsey
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- sellersdorsey.com
- Employees:
- 254
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Senior Director ConsultingSellers DorseyNew Braunfels, Tx, Us
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PresidentFjm Consulting Llc Mar 2024 - PresentIn my current role, I am transforming health plan departments to enhance their competitive edge at the county, state, and national levels. I collaborate with health plans and providers to improve their contract negotiation skills by managing complex contracts throughout both the front and back ends of the process. Additionally, I am leveraging innovative marketing strategies to proactively enhance provider relations by identifying their needs.I am also implementing a value-based care continuum that facilitates collaboration between contracting, provider relations, and quality teams, thereby unifying diverse departments into cohesive, goal-oriented teams. My focus includes elevating reporting to provide insights into trends and key points in time, which in turn drives more effective Joint Operating Committees (JOCs) aimed at helping providers understand the value of the data at their disposal.Furthermore, I consistently drive enhancements in quality, risk management, and patient experience through comprehensive training and development initiatives. My ability to engage across all organizational levels has enabled me to implement foundational improvements while keeping management, including C-Suite executives, actively involved at every stage of development.
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Regional Vice President Value Based Contracting/EngagementHumana Jan 2020 - Jan 2024Louisville, Kentucky, UsAs the Regional Vice President of Contracting and Provider Engagement, I was tasked with managing team of contract negotiators and provider relations specialists in cultivating and maintaining relationships with key providers and stakeholders, which included hospitals, physicians, and ancillary providers. Essentially, I was also tasked with building a cohesive team culture that emphasizes cooperation and accountability. By fostering this collaborative mentality, we were able to successfully secure contracts with multiple large health systems, which proved valuable in exceeding AEP growth for three consecutive years. During this period, I honed my skills in building teams, engaging effectively with both the C-Suite and department heads, and driving strategic initiatives in accordance with organizational goals.Notable accomplishments included:• Reduced provider departures and cut contract unit costs.• Played a pivotal role in slashing MLR by redesigning the Humana JOC presentation format into a more engaging analytical format, which greatly improved communication with both C-Suite and department heads.• Generated annual savings by renegotiating one of Humana’s oldest and largest VBA contract.• Established complex value-based networks for as many as 500K+ lives spanning nine states.• Introduced analytical tools that enabled proactive engagement with providers at the C-Suite level as part of the transition from point-in-time reporting to trend analysis. -
Regional Medicare PresidentWellcare Health Plans Feb 2017 - Jun 2019Tampa, Florida, UsAs Medicare Regional President, I was faced with the challenge of a persistent 2.5-star rating in terms of customer experience feedback. The task of implementing new programs and overhauling existing ones required high level of adaptability and in-depth understanding of member needs. This was made possible through the development and rollout of strategic initiatives for enhancing the quality and accessibility of Medicare services in the region. In addition, I also conducted intensive market research and competitive analysis, which allowed us to identify market trends, customer preferences, and emerging opportunities for product development and service enhancements. Overall, this experience strengthened my financial acumen and strategic planning competencies.Notable accomplishments included:• Introduced a new member appreciation program, which led to an unprecedented 3-star rating in 2017, followed by a 3.5-star rating in 2018, and a remarkable 4-star rating by 2019.• Instrumental in achieving the company's top net income margin by focusing on revenue growth from improved star ratings, risk adjustment, and quality-focused benefit design, effectively slashing MLR by 2% and boosting revenue by 8.4%.• Minimized member turnover rates from 18% to 10.2% year over year.• Improved medical loss ratio by 2% through strategic contract renegotiation and implementation of Value-Based Agreements (VBAs), which greatly reduced contract unit costs and optimized overall expenditures.• Transformed the region from the lowest-performing Medicare Plan to the highest in terms of YOY membership growth and net margin. It also became the second highest plan in Star Ratings, with a 3% improvement in Medicare rate and a 6.8% enhancement in Risk Score. -
Vp, Complex Care Products Operations (Mmp, D-Snps & Star+Plus)Centene Corporation Aug 2013 - Jan 2017Saint Louis, Mo, UsAs the company’s Vice President of Complex Care Operations, I was tasked with facilitating the turnaround of a D-SNP Plan facing closure due to poor star scores. Managing the organization through a turnaround situation taught me the importance of resilience in inspiring change within highly challenging environments. In addition, I was also able to improve my operations management skills, along with my ability to leverage data for organizational success.Notable accomplishments included:• Restructured the program into a highly successful Star Quality Program, which led to the achievement of the Plan's inaugural 3-star rating and recognition as the nation's first Dual ONLY 4-Star Plan.• Improved engagement with providers: Collaborated and coached our Contracting and Provider Engagement Teams to significantly increase provider understanding and participation in stars, risk scores, and cost control initiatives. • Enhanced Awareness: We worked towards establishing greater awareness of our key systems and provider groups across Texas, which led to improved engagement and collaboration.• Revamped Analytics: We implemented new analytics trends that upgraded the efficiency and accuracy of Medicare data reporting, helping streamline the company's DSNP Membership. -
Vp, Gm Medicare, Marketplace & CommercialAetna, A Cvs Health Company Sep 2011 - Aug 2013Hartford, Connecticut, UsAs Vice President and General Manager, I was in charge of negotiating and executing contracts with crucial healthcare provider partners to drive revenue growth and expand our market footprint. Striking a balance between financial objectives and member needs enabled me to gain a holistic understanding of the healthcare landscape and master the ability to drive results through cross-functional collaboration.Notable accomplishments included:• Enhanced network access for over 20K members, while generating a 15% reduction in out-of-network claims.• Increased first-year budgeted net income by 3% as a result of rigorous effort in outperforming sales targets, minimizing disenrollment rates, improving risk scores, and implementing MLR reductions through contract renegotiations.
Joe Mcgrath Education Details
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Our Lady Of The Lake UniversityBusiness Administration And Management -
Texas State UniversityHealthcare Administration
Frequently Asked Questions about Joe Mcgrath
What company does Joe Mcgrath work for?
Joe Mcgrath works for Sellers Dorsey
What is Joe Mcgrath's role at the current company?
Joe Mcgrath's current role is Senior Director Consulting.
What is Joe Mcgrath's email address?
Joe Mcgrath's email address is jm****@****usa.edu
What schools did Joe Mcgrath attend?
Joe Mcgrath attended Our Lady Of The Lake University, Texas State University.
Who are Joe Mcgrath's colleagues?
Joe Mcgrath's colleagues are Holly B., Rachel Marsh, Jd, Msw, Megan Mueller, Julie Cannariato, Marcos R., Amanda Elhart, Leah Hartlander.
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