Karen Grant Email and Phone Number

Manage 24 team members responsible for Illinois provider recruitment and contracting of all provider types for Medicaid, Medicare Advantage, MMP and Marketplace lines of business. Key tasks include ensuring network adequacy, medical cost reduction, network expansion, continuous process improvement, cross-functional collaboration, and ensuring compliance with regulatory requirements.• Successfully recontracted 100+ skilled nursing facilities and ancillary providers to reduce rates. Medical cost savings over $20M.• Implemented 11 new process improvement initiatives including standardization of many team processes and the rollout of new applications.• Built out the Medicare network to allow expansion into 52 counties.

Oversee network recruitment and contracting activities for behavioral health providers in 14 Midwestern states, including commercial, Medicare Advantage, dual-eligible, and EAP products. Supervise a team of 12 employees. Key contributor to department strategy, including setting goals, ensuring compliance with regulatory requirements, and collaborating across departments to ensure the needs of providers and members are met.• Constructed the behavioral health network from the ground up – it now encompasses 238,000 practitioners and 7,700 facilities nationwide.• Built out the Medicare Advantage and dual-eligible network to support product expansions resulting in prime positioning for the salesforce. The 2020 expansion added 232 Midwest counties. • Established the value-based contracting program for behavioral health providers in conjunction with a small group of colleagues. Nationwide implementation, currently in excess of 200 providers, demonstrates quantitative metrics such as prevention of re-hospitalization and diminished non-participating provider leakage. • Reduced medical costs by competitively negotiating provider rates, and spearheaded an initiative structurally changing how claims are paid to a provider group. Cost savings are estimated at $2.2 million per year. • Improved departmental efficiency and staff satisfaction through multiple process improvement initiatives, most recently a team reorganization which optimized staff output.

Managed network and recruitment activities for behavioral health providers in 17 Midwestern states while supervising a team of six employees. Ensured geographic access for members by meeting or exceeding quality management standards. Negotiated competitive contractual relationships with behavioral health facilities and organizational providers. • Led departmental integration efforts for a company acquisition.

Provided ongoing product support to all center staff while ensuring compliance with performance guarantees. Managed the implementation of new initiatives and directives for the vendor relationship.• Developed a startup program partnering with high-volume facilities to streamline operations.

Partnered with the finance division on performance penalty tracking and the accrual process while performing account management. Coordinated initiatives involving clinical, claims, and IT for system access related issues. Provided ongoing operational support to all care management Centers.• Consolidated service centers from seven to three, re-branded the division and implemented 14 new markets.

Supported HMO operations in 16 states. Prepared HMO financial and utilization reports for the budget and prepared HMO rates for proposals and renewals. Audited HMO payments to company for accuracy. Documented and standardized HMO workflows in all service centers. • Increased revenue approximately 5% by identifying an issue with the capitation payment structure being utilized.