Jennifer Nightingale Email and Phone Number
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Health Care Administration and Author*AuthorPublished Debut Novel - Alberta & the SparkContributes to E/O Media - Coast WeekendPublished in The Rain MagazineNon-Fiction, Prose & PoetryRead original work at Ric's Open Mic. Bridge & Tunnel and multiple author events throughout the Pacific Northwest and at Wrecsam Library in North Wales.*Healthcare *Over 20 years’ experience in the healthcare industry in Sales, Provider Networks and Compliance with a focus on government programs (Medicare, Medicaid and TRICARE and Veterans Affairs) as well as commercial healthcare provider networks. *Experience building custom provider networks for Administrative Services Only (ASO) self-insured employer groups.*Deep knowledge of healthcare reimbursement methodologies, provider networks and interdependencies across multiple business functions.• Highly adaptable to the ever changing landscape of healthcare. • Strong focus on opportunities and challenges to the industry from the Accountable Care Act.• Deep interest in population health management and innovations to move from fee for service to payment methods that are aggregated and prospective; including companion incentives, such as pay for performance and treatment protocols to assure that quality is improved• Experienced in the broad spectrum of healthcare administration business functions including but not limited to: Provider Healthcare network contracting and management, compliance for Federal and State programs, Sales.
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Freelance WriterOregon Coast WeekendAstoria, Or, Us
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Behavioral Health Network ContractorUnited Behavioral Health/Optum Mar 2023 - PresentAstoria, Oregon, United States
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News Reporter - Part TimeDaily Astorian Apr 2019 - PresentAstoria, Oregon, United StatesE/O Media's newspapers and magazines provide accurate, fair and timely reporting about the people and issues impacting the communities we serve in the Pacific Northwest, reflecting the responsibility and spirit of a free press -
Independent Writing And Editing ProfessionalLeague Of Intertidal Writers May 2017 - PresentAstoria, OregonDirector of League of Intertidal WritersManages communication and publicityDistributes publicationsOrganizes fundraisers, workshops and other eventsPublished novel, Alberta & the Spark, April 2019, Nestuccaspitpress.comPublished poetry collection, Between the River and the Sea, 2018E Book available through Amazon - May 2019 https://www.amazon.com/Jennifer-Nightingale/e/B07RT1BRZV?ref=dbs_p_ebk_r00_abau_000000
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Senior ConsultantSalem Health Feb 2020 - Oct 2023Salem, Oregon, United StatesResponding to the impact of Covid-19 on contracts and payment policiesSupporting Salem Health Medical Group with Deep Dives into Value Based OpportunitiesExploring embedded telehealth within the integrated delivery system -
Provider Contract ManagerKaiser Permanente Jun 2019 - Jan 2020Portland, Oregon AreaManage network expansion and special projects in Oregon and SW Washington State.Negotiates with external providers/vendors for development and implementation of contracts. Interacts with internal departments pursuant to contract development/implementation. Supported special contracting needs for Gender Pathways and expansion of behavioral health network and other projects as assigned, -
Senior Network ManagerAetna Jun 2016 - Apr 2017Portland, Oregon AreaDevelopment of strategies, contracts and rates to improve member access to quality, sustainable provider networks in the Pacific Northwest Market. Partner with strategic healthcare delivery systems in Alaska, Washington and Oregon to build strong relationships and support continuous quality improvement. -
Director Contracting Administration, Tricare ProgramAnthem, Inc. May 2012 - Feb 2016Government Business DivisionServe as subject Matter Expert for TRICARE for market leadership. Create internal educational collateral for each East region respective state in the 32 state plus DC region in the TRICARE Managed Care Support T2017 bid. Participation in Pre-Build Network Preparation Activities for TRICARE Managed Care Support T2017 Request for Proposal, Provide research of relevant policies and context for Network Development team. Work directly with assigned states for recruitment and related activities for provider network build. -
Director, Contracting & Provider ServicesAmerigroup Washington, Inc. Government Business Division Of Anthem, Inc. May 2012 - May 2014Seattle, WaProvide oversight and direction to a team of contractors and provider relations representatives to build and maintain a quality network of hospitals, physician and ancillary providers to meet the access and care needs of the enrollees of government programs served by Amerigroup Washington.Evaluate and assist in the negotiation of contracts in compliance with contract templates, reimbursement structure standards, and other key process controls. Establish and Maintain strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties. Develop, translate and execute strategies or functional/operational objectives to support changes and opportunities as a result of the Patient Protection and Affordable Care Act/Direct others to resolve highly complex or unusual business problems that affect major functions or disciplines.- Provide leadership, training and mentorshipAmerigroup has two goals. We help some of the most financially vulnerable members in the health care system – including low-income mothers and children, seniors and people with disabilities – to lead better, healthier and more independent lives. Through preventive health care programs, we help members avoid unnecessary sicknesses. For those members with chronic diseases, we help coordinate their care, making sure they get the right care at the right time. By providing access to high-quality, cost-effective care, we help the state and federal governments that pay for Medicaid and Medicare save money. We provide health care coverage to members eligible for programs such as Temporary Assistance for Needy Families for mothers and children, the Children’s Health Insurance Program, Supplemental Security Income, Medicare Advantage and Special Needs Plans.
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Director, Provider Contracting For Washington And AlaskaCigna Healthcare Apr 2010 - May 2012SeattleManaged contracting relationships and renewals with hospitals, physician, and ancillary providers doe Strategic Providers in Washington and all Providers in Alaska.-Identified opportunities, and develop / execute contracting strategy within assigned territory. -Prepared, analyzed, reviewed, and projected financial impact of provider contracts and alternate contract terms. -Negotiate contracts, and effectively manage the negotiation process. -Track financial performance of contracts and ensure compliance with contracting guidelines. -Ensured compliance with the company's contracting policies / procedures, and the smooth operation / administration of provider agreements.Provided guidance or expertise to less experience specialists.Worked closely with Sales and Marketing to meet the needs of Alaska based employer groups and problem solved access and other issues.-Responded to provider inquiries / concerns / complaints, and assist in resolving elevated and complex provider service issue. -Managed other projects and duties as assigned. -Built and maintained strong relationships with the provider community and matrix partners. -
Provider Network Executive IiPremera Blue Cross 2006 - Apr 2010•Negotiate and re-negotiate high-volume, key and strategic, acute care hospitals and physician group contracts.•Function as the single point-of-contact for all on-going contractual and service issues as needed by providers.•Set targets and priorities in order to meet market-specific network needs.•Partner with Health Care Economics to understand trends and financial impact of contracting strategies.•Represent Health Care Delivery Systems on Cross Functional Advanced Imaging Management Project Team•Present at Provider Education Workshops•Foster relationships with key decision makers for strategic health care delivery systems -
Contract Administrator, TricareRegence Blue Shield Dec 2002 - Feb 2006Manage provider network for the Uniformed Services which are designed to support and complement services available at Washington’s 5 Military Hospitals. - Negotiate contracts and support contractors in their efforts to close Agreements for Hospitals and Physician Groups for the TRICARE network - Serve on the Puget Sound Multi-Service Market Office (MSMO) Behavioral Health Cross Functional Executive Team to address access concerns. - Visit Military Treatment Facilities in Washington state to: - Present Network updates, field concerns at Prime Service Area Executive Council Meetings - Participate in Military Treatment Facility Briefings and Ad Hoc Contingency Exercises -
Network ConsultantAetna Health Plans Sep 1999 - Dec 2002Designed, developed, contracted, maintained and enhanced relationships with hospitals, ancillary providers, and physicians that serve as contracted networks Negotiated complex, competitive contract relationships with providers according to guidelines and standards. Managed projects, customer expectations and business priorities to achieve business objectives.
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Cost Containment Manager/French Travel Assistance/Health Insurance ProgramsSos International Oct 1997 - Jun 1999Managed an international program that administered health insurance and emergency medical assistance services for clients residing outside their home country: including budget management and staff supervision. Trained Alarmed Center Staff to understand fundamentals of American healthcare delivery and reimbursement Negotiated Contracts with PPO networks to provide cost containment to European Brokers Served as liaison for Paris based clients with beneficiaries in North America Managed relationship with US based PPO vendor Coordinated cost estimate and payment guarantees to clients in Latin America and The Caribbean. -
Compliance Specialist, Nw Region:Qualmed Washington Health Plan - Bellevue Wa Feb 1994 - Feb 1997QualMed Washington Health Plan - Bellevue WA (1996-1997)Compliance Specialist, NW Region: Served as a liaison, educator and resource for internal and external managed care staff to inform them of regulatory changes in government programs Managed audits with Center for Medicare & Medicaid Services (CMS) then (HCFA)Sales Representative - Senior Programs: (1994-1996) Consistently performed over quota. Completed requests for proposals Conducted informational presentations
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Medicare Member ServicesProvidence Health Plans In Washington 1990 - 1993
Jennifer Nightingale Skills
Jennifer Nightingale Education Details
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Bachelor Of Science (Bsc)
Frequently Asked Questions about Jennifer Nightingale
What company does Jennifer Nightingale work for?
Jennifer Nightingale works for Oregon Coast Weekend
What is Jennifer Nightingale's role at the current company?
Jennifer Nightingale's current role is Freelance Writer.
What is Jennifer Nightingale's email address?
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What is Jennifer Nightingale's direct phone number?
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What schools did Jennifer Nightingale attend?
Jennifer Nightingale attended Seattle University, Seattle University.
What are some of Jennifer Nightingale's interests?
Jennifer Nightingale has interest in Social Services, Uso Volunteer (Seattle Tacoma Airport), Environment, Poverty Alleviation, Disaster And Humanitarian Relief, Human Rights, Animal Welfare, Health.
What skills is Jennifer Nightingale known for?
Jennifer Nightingale has skills like Managed Care, Provider Relations, Medicare, Medicaid, Healthcare, Health Insurance, Utilization Management, Ppo, Health Policy, Healthcare Industry, Network Development, Physicians.
Who are Jennifer Nightingale's colleagues?
Jennifer Nightingale's colleagues are Kim Mccall, Tami Hart, Tod Williams, Clark Verd, Heather Schillinger.
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Jennifer Nightingale
Primary Care/Cornea And Cl Resident At The Salt Lake City Va Medical CenterSalt Lake City, Ut -
Jennifer Nightingale
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