John Tobin, Jd Email & Phone Number

Smithfield, Rhode Island, United States

Manage the Contract Oversight, Process Development and Compliance for Multiple Regulated Products. Responsible for contractual accountability relationships with regulators and all impacted business areas. Accountabilities include contract execution, compliance, development of policies and procedures, implementation of corrective action plans, contract interpretation and training, regulatory reporting oversight, vendor and subcontract management, quality monitoring/validations, highly visible presence and accountability.

Watertown, Ma

Responsibility of leading all aspects of network management strategy including value-based contracting strategic initiatives, reimbursement model development and analysis, new product network development and network contract evaluation and support. Partnering with Provider Community, Finance, Medical Economics and Clinical areas to develop and implement strategic initiatives.

Boston, Ma

BCBSMA Provider Network strategic development and implementation tied to network requirements related to Health Care Reform and specific market segment needs. Worked closely with Sales, Marketing, Actuarial, Finance and Operations to align the vision with implementation. Work included: Creating Limited Network, Tiered Network re-alignment, Alternative National Network development, Reference based pricing initiatives, AQC contract development and modification of Nationally aligned BCBSMA Centers of Blue Distinction (Centers of Excellence).

Senior Leader with full accountability for the following areas/functions: Hospital and Physician Contracting, Provider Relations, Contract Analytics, Contract Monitoring/Audit, Provider Enrollment and Credentialling. Developed and executed the first global payment contracts between BCBSRI and RI hospitals, instituted a radiology managment vendor program saving BCBSRI membership over $14million after one year, contracted patient centered medical homes, developed electronic medical record incentives and worked with the State of RI to improve efficiencies between hospitals, providers and Plans.

Boston, Ma

Developed non-core business opportunites to expand portfolio of offerings and enhance revenue generation channels. Migrated a local dental network to a national dental network, and leveraged a partnership venture with BCBSRI to institute network reciprocity between Plans for Dental Members. Developed business plans/opportunites for long term care, senior link, 401k products and other new business models.

Doctor Of Law (J.D.), Law

Bachelor Of Science (Bs), Marketing