 Led restructure of clinically integrated network contracting for value based payor programs covering 40,000 commercial lives, 5,000 Medicare Advantage and DSNP members, 14,200 managed Medicaid members and three employer direct contracts with a network across two local health systems and over 700 physicians. This included reworking network governance and taking leadership over both local chapter board of managers and quality committees, developing contemporary policy and operating agreement documents. Engaged provider leadership, facilitating multiple chapter boards and quality committees including setting network and local chapter strategies, financial goals and clinical benchmarking. Managed all payer contracting and relationship aspects for all value based contracts including financial and clinical JOCs.  Reformulated network strategy creating a fully self-funded operation since 2017, with all operations paid via shared savings and no direct hospital or physician contributions in five years. Drove network shared savings and quality bonuses of $18M over 2017-2023 performance years while generating $8M in care management fees during the same period. Transitioned nearly 20,000 patients from traditional FFS to value based contracts specific to Medicare Advantage and managed Medicaid products. Crafted Medicare Risk Adjustment/HCC recapture programs increasing RAF resulting in premium improvement of $223 PMPY in the initial performance period with our largest MA payer. Aligned clinical and administrative teams in STARS improvement program that picked up 1.3 STARS in only 24 months. Crafted health system level value based strategy, supporting hospital and physician contracting efforts including contract structures and financial modeling while leading value based negotiations with payers.

 Led ground up technology strategy for provider network aligning multiple data sources across inpatient and ambulatory EMRs, multiple paid claim and eligibility data sources. Included establishing business use cases, while driving system evaluation and selection. Key stakeholder in implementation of data analytic platform Optum Performance Analytics and Optum Care Coordination Platform serving as both executive sponsor and project manager now serving as system subject matter expert. Led network development including hospital and physician contracting, formulating financial and quality benchmarks and leading formation of local boards and quality committees. Transitioned organization from purchased services arrangement with founding hospital to stand-alone operation including HR, financial services and technology in a budget-neutral manner.

 Regional executive with P&L for MSO operation which included delegated claim processing, reinsurance management, two call centers across member services and pre authorization, Utilization Management, Case Management, Quality Improvement, provider relations and all financial management. Reestablished all market client relationships, converting expired management service agreements to five-year terms in the first six months with a 100% client retention rate during my tenure. Clients were both hospital/health systems and IPAs. Provided strategic leadership as contracted executive for IPA/PHO clients with 1,200 physicians and 40,000 capitated/risk enrollees across commercial, Medicare Advantage and Medicaid payers. Included leading all board, finance and UM committees engaging hospital executive teams and key network physicians. Led all payer contracting for capitated contracts for all payer types. Drove 32% increase in existing client revenue while boosting EBITDA 12%. Executive over both in house and client licensed utilization review organizations (URO) in Illinois.

 Established TPA Link, LLC, a back-office/BPO TPA implementing five client claim system implementations (Plexis Claim Manager) with 32,000 members within the first 24 months.  Led network contracting for start-up Providers First PPO product aligned with a provider-based association and regional brokerage.

 Constructed a complete operations center for a startup TPA/MSO client with over 500 providers and 50,000 self-insured lives in carve out benefit program.  Managed provider contracting and network administration for several single specialty provider networks including diagnostic imaging, ambulatory surgery centers, podiatry, chiropractic and physical therapy.

 Contracted provider network, transitioning from leased to direct contracted, developing network of 120 hospitals and 11,000 physicians across three states in only 9 months.

 Led network development into four additional states with over 250 hospitals and 37,000 physicians contracted.  Direct oversight of provider relations, network development and credentialing units managing a multistate provider network covering 11 states serving one million members.