Lori Powers Email & Phone Number

Washington, United States

Greater New York City Area

Responsible for contracting and re-negotiating existing hospital contracts on behalf of TriWest Health Alliance with hospital systems in 22 states.

Greater New York City Area

Responsible for developing relationships and negotiating contracts with transportation providers throughout the country to build a robust Medicaid transportation network on behalf of United Healthcare.

N.Y.C, N.Y.

Evaluate and negotiate contracts on behalf of Skilled Nursing Facility with 6 large Managed Care Organizations. Represent large multi-specialty physician group in evaluating, strategizing and negotiating contracts with Managed Care Organizations. Develop, strategize and negotiate contractual relationships with MCO's on behalf of large mental health provider.

Nyc

Consultant to Centerlight Healthcare formerly Comprehensive Care Management. Responsible for building Adult Day Health Care network, Social Day Care network, ALP's, physician and ancillary recruitment for MLTC, FIDA and all other lines of business. Additional contracting including skilled nursing facilities, dialysis, laboratory, home infusion, and chiropractors. Also, Consultant to 23 person PCP/Specialty physician group. Responsibilities include negotiating/renegotiating contracts on their behalf with key Managed Care Organizations.

Bronx, N.Y.

Responsibilities included evaluating and negotiating exclusive lab contract as well as maintained ongoing working relationship with Vendor. Negotiated and contracted relationship with new dental vendor. Also, contracted with Skilled Nursing Facilities, home infusion vendors, homecare companies, DME vendors as well as all other Providers to meet Medicaid Redesign Initiatives as dictated by New York State. Participated in the network build of the Qualified Health Plan, MLTC and FIDA network as well as Medicare expansion. Also, negotiated shared savings arrangements with FQHC's.

Ny, Ny

Consultant to Touchstone Health Partnership, Inc. to launch new PSO product. Responsibilities included developing marketing strategy, network development with focus on physician, hospital and ancillary contracting and preparation of documents for New York State license. Helped to develop hospitalist program for Inpatient Care Management. Targeted physicians in the New York City area. Assisted in the development and start-up of ATBALANCE Solutions. Built network of providers including physicians, nurses, and ancillary providers and offered onsite wellness services including health fairs and screenings to fortune 500 companies. Sales experience as well.

Responsible for all ancillary contracting. Including negotiating rates and contract language with Skilled Nursing Homes, Dialysis Facilities, Radiology Facilities, Homecare Companies, Vision Providers, Chiropractors, Physical Therapists, and Occupational Therapists throughout New York State.Account Manager and key liaison for all vendor relationships including Mental Health, Dental, Vision and all other ancillaries. Developed entire New York State Ancillary Provider Network to meet CMS and DOH requirementsPrepared documents for submission to Department of Health and CMS in order to get HMO licensing Work closely with Medical Management, Sales/Marketing, and Provider Services to identify and target specific ancillary services as requested and resolve internal and external issues.Develop, educate and manage relationships with contracted vendors ensuring a positive working relationship.Responsible for compiling information relating to quarterly Performance Guarantees and annual Desk Review Audits for all Ancillary Vendors.

Touchstone Health Partnership, Inc. New York, N.Y. 3/04-10/06Network Development Specialist-Physician Recruitment Participated in start-up of Medicare PSO (only one other in country) bringing company from pre-operational to operational in downstate and upstate counties.Responsibilities included development, creation and implementation of documents and materials in preparation for launch. Strategize and recruited specific “gap” doctors and ancillary providers in Staten Island, Brooklyn, Bronx and Queens with an emphasis on completing network in preparation for CMS site visit and licensure.Prepared all documentation related to CMS site visit including tables and charts. Weekly meeting with Chief Medical Officer to present, review and strategize next steps.Worked to create and develop system to track and identify provider network and capture all pertinent information.

Developed relationships with managed care organizations on behalf of 21 skilled nursing facilities, collectively known as the Alliance Continuing Care Network.Assessed payor market and determined targets for contacting. Negotiated contract language and rates with 12 payors. Staff liaison to the managed Care Committee: offered guidance, support, and direction in matters relating to payors.Worked directly with outside counsel in review and discussion of contract language.Primary contact to all 21 facilities as related to managed care

Developed relationships with managed care organizations on behalf of 21 skilled nursing facilities, collectively known as the Alliance Continuing Care Network.Assessed payor market and determined targets for contacting. Negotiated contract language and rates with 12 payors. Staff liaison to the managed Care Committee: offered guidance, support, and direction in matters relating to payors.Worked directly with outside counsel in review and discussion of contract language.Primary contact to all 21 facilities as related to managed care

Key participant in start-up of Company contracted and educated both Beth Israel/ St. Lukas Roosevelt physicians for participation in Global Risk deals.Assisted in development of all marketing materials for providers participating in global risk arrangements. Supervised intern in all areas of Provider Relations and Network Development. Presented at monthly meetings to several committees including Benchmark Board of Directors, the Network Development Committee, and the Contracts/Negotiations/Finance Committee.

Participated in start -up of company, contracted with hospitals, physicians, ancillary providers, IPA’s and PHO’s.Key liaison between plan and all contracted Manhattan facilities.Maintained positive working relationship with over 2000 participating Manhattan physicians.Educated providers to ensure delivery of appropriate medical care.Contact person for 5 NYC premiere hospitals as well as account manager for mental health and substance abuse services.Prepared, developed and managed team in submission of Medicare application to New York State.

Masters In Social Work

Bachelors, Social Work