Janice Fagen Email & Phone Number

Denver, Colorado, United States

Texas, United States

Oversaw all matters pertaining to the Medicaid contract with the Texas Health and Human Service Commission (HHSC). Attended HHSC leadership meetings, conference calls and stakeholder meetings. Appointed by the Executive Commissioner of HHSC to serve on the State Managed Care Advisory Committee. Led team that received and responded to inquiries and requests made by HHSC related to the contract in timeframes and formats expected by HHSC. Managed budget and profit and loss for Texas Medicaid line of business. Accountable for all operational aspects of program, including marketing, customer service and engagement programs, fulfillment of ID cards and member materials, creation of member and provider technology applications and provider directories. Oversaw pharmacy benefit management, network adequacy (access and availability), quality assessment and improvement, service and care coordination, complaints and appeals resolution, audit preparedness as well as documented policy and procedures. Led new business proposal development (RFPs and implementations of newly awarded contract). • Expertise in customer service, claims and encounters, provider relations, health care management, provider contracting, quality management, legal, finance, actuary, marketing, IT, program integrity, internal audit and compliance.• Used LEAD (Live the Purpose, Engage, Adapt, and Drive) model and provided opportunities for team building through training. • Drove and executed the financial strategy which resulted in profitability in 2019.• Reduced regulator assigned corrective action plans by 90% in one year.• Presented to State Regulator new medical management system and received approval to implement with no changes required in 2019.• Directed business proposal development team to win increasing lines of Medicaid business three times in eight years.• Built award-winning team recognized by president of division in 2017.

Represented company regarding all matters pertaining to the Medicaid contract. Met with HHSC representatives on periodic basis to review the organization's performance and resolved issues. Led team that receives and responds to inquiries and requests made by HHSC, relating to contract in timeframes and formats acceptable to parties. Attended and participated in regular HHSC and MCO executive director meetings and conference calls, regional advisory committee (RACs) and key stakeholder forums. Resolved issues identified by MCO or HHSC related to contract. Ensured compliance with contract. Oversaw profit and loss of MCO. Managed functional areas, including network development, community outreach, medical management and quality management. Oversaw close out of Unicare Medicaid business. • Created Blue Alliance Agreement combining Anthem Blue Cross and HCSC resources to bid and win Texas Medicaid business.o Selected to lead new company.• Led the dissolution of Unicare.

Tulsa, Oklahoma, United States

Network Development for Gorman Medicare Advantage client

Oversaw sales, marketing, and provider contracting in the Dallas service area. Contracted with physicians, hospitals and ancillary providers. Ensured compliant marketing approach. Exceeded sales targets for annual enrollment period 2008.

Dallas, Texas, United States

Managed PPO network development, provider contracting services and medical management programs for commercial health insurance products.

Developed Dallas Medicaid Network as a consultant.

Houston, Texas, United States

Responsible for building and maintaining a network of providers for individual and group HMO and PPO plans in all 254 counties of Texas.

Ran the business and admissions office, managed care negotiations and several hospital departments for this premiere psychiatric hospital.

Masters, Psychology

California School of Professional Psychology (CSPP) is a division of Alliant University

Ba, Psychology

UCLA