Jay Wade Email & Phone Number

Texas, United States

• Responsible for contracting all Skilled Nursing Facilities with Managed Care Contracting Managers and Federal Government entities in Texas, Louisiana and Mississippi. Includes all contract renegotiations and obtaining.
• Contracts new Skilled Nursing Facilities added due to a Change of Ownership and submits proper documentation to MCOs so that SNFs can be recontracted under new ownership.
• Accountable for contracting government programs to include StarPlus, Medicare, Medicare-Medicaid Plan (MMP), Tricare and Commercial. Including management of 54 SNF’s throughout Texas, Louisiana and Mississippi for all.
• Manage all Credentialing and Re-Credentialing request from Managed Care Organizations to ensure the application and requested supporting documents are completed, executed and returned within the timeframe requested by.
• Maintain compliance to ensure all Licensure and Certificates are current including Medicare Site Surveys.
• Submit demographic information to Managed Care Originations for loading of Non-Par SNFs so that we can verify benefits, submit Prior Authorizations and request Single Case Agreements.

Hartford, Connecticut, US

• Negotiates, executes, and conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts.
• Works with larger and more complex, market/regional national based groups/ systems in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility.
• Contracting in Texas and Oklahoma for multiple specialties including large, medium and small Hospitals and Physician Groups, LTACs, Ambulatory Surgery Centers, Diagnostic Radiology, Hospice, Sleep Centers, MRI Centers.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
• Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and.
• Work with Contract Pricing System to interpret financial analysis, market trends and formulate a contract strategy recommendation for rate proposal to new and existing providers.

Ft. Worth, Texas, US

• Manages all contracting, credentialing and provider relations functions with government, managed care and commercial insurance payors. Functions as the contact between Skilled Nursing Facilities and health plans.
• Responsible for managing contract renewals and obtaining favorable rate increases and contract terms with target health plans.
• Contracts new Skilled Nursing Facilities added due to a Change of Ownership and submits proper documentation to MCOs so that SNFs can be recontracted under new ownership.
• Establishes protocols for credentialing and re-credentialing of Skilled Nursing Facilities with health plans, Managed Medicaid plans, Availity and Aperture.
• Maintain compliance to ensure all Licensure and Certificates are current.
• Submit documentation to MCOs for loading of Non-Par SNFs so that we can verify benefits or submit Prior Authorizations.

• Develops the provider network for Skilled Nursing Facilities in Texas evaluating network adequacy for Commercial and Medicare. Includes building a sub-network of higher level of care providers (Extensive Rehab, Wound.
• Manage and create Skilled Nursing Facility network that meets unit cost targets contracting within budget parameters.
• Responsible for contracting government programs to include StarPlus, Medicare-Medicaid Plan (MMP) and HMO Institutional Special Needs Plan (Nursing Home Plan). Including management of 1,258 SNF’s throughout Texas for.
• Build relationships with key large nursing home chain operators to drive growth and develop strong partnership that supports the Texas market strategies.
• Respond to network contracting request utilizing assessment tools such as CMS Star Ratings, enrollment by county, admit rate and number of facilities within a county, return to admit and Average length of stay.
• Contributes as a key member of the Senior Leadership Team and other committees addressing the strategic goals of the department and organization. Working closely with Medical Director on expansion opportunities.

Indianapolis, Indiana, US

• Accountable for the oversight of the design and development of FFS, Shared Savings and Risk contract arrangements in New Mexico, Texas and Washington for medical groups and hospitals to achieve goals pertaining to.
• Develop collaborative relationships with provider partners to identify opportunities for growing membership, lowering unit cost, creating a value proposition for customers and establishing alternative healthcare.
• Directs new market network development, network expansion, and network acquisition initiatives as well as basic development and execution of provider network development strategies in an entire region.
• Accountable for subordinate(s) development and performance. Providing direction and support to Network Development Managers regarding physician, hospital and ancillary services recruitment, negotiations and contracting.
• Provides interdepartmental leadership to ensure alignment and understanding of network development and implementation processes with key areas such as Health Care Economics, Finance, Legal, Sales, Compliance, Quality.

New York, NY, US

Responsible for identifying and evaluating opportunities, negotiating optimal reimbursement rates, and drafting contracts for an assigned provider network to ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations, policies, practices and procedures.