Michael W. Email & Phone Number

Florida, United States

Florida, United States

Us

Responsible for the full range of provider relations and service interactions, including working on end-to-end provider claim and call quality, ease of use of physician portal and service enhancements, and training & development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Leads contracting efforts across several states with major care coordination organizations to meet performance metrics. Primary liaison between United Health Group and our network of long-term care providers. Through open lines of communication, I work closely with providers to identify and swiftly resolve any obstacles they may encounter. My ability to seamlessly manage multiple tasks and projects while adhering to strict deadlines allows me to effectively prioritize and address urgent issues in a timely manner. Additionally, I collaborate with cross-functional teams to develop and implement cutting-edge strategies aimed at optimizing provider network performance.Ensure the seamless operation of our provider network and managing the expectations of our long-term care providers. Effectively fosters strong, collaborative relationships with our network partners. Responsible for the oversight and resolution of complex issues within the provider network, including contracting, negotiation and accreditation. Proactively mitigates network challenges and exceed provider expectations.Builds and sustains robust relationships with key stakeholders, both internally and externally Evaluates provider network performance, identifies opportunities for enhancement and expedite necessary interventions. Actively participates in the recruitment and onboarding of new network providers, meticulously ensuring their alignment with our contractual obligations and stringent compliance requirements.

Us

In this role I evaluate and negotiate federal and commercial contracts, reimbursement standards and other key process controls to drive results for both external and internal customers and stakeholders. I am accountable for contract management, customer relationship management, pricing, and negotiation of our provider network across several states. I also collaborate with third party service provider to support client initiatives, manage performance target setting, performance reporting. I am responsible for driving network growth and guide the development of geographically competitive and broad access.• Leads contracting efforts across several states with major care coordination organizations to meet performance metrics. • Analyzes contracts to translate subcontractor and fee agreements to providers• Serves as Project Manager, and SME leading enterprise project teams in process improvement initiatives to address administrative, operational and performance initiatives• Increases network revenue and development by negotiating care contracts with healthcare providers and vendors, including ancillary facilities. • Supports implementation of strategies relating to the development and management of the provider network

Tampa, Fl, Us

Developed and oversaw behavioral health provider network accessed by participants in the AMIkids program for at-risk youth in need of mental and behavioral health managed care services. Responsible for system enhancements to payor pricing, accreditation survey process, implementation plan and negotiation practices. Credentialed providers to ensure active state licenses with no disciplinary actions and ensure continued compliance with accreditation standards, HIPAA and contractual requirements, along with Virginia statutes governing behavioral health. Reviewed provider utilization, charges, and payments to control costs, mitigate risks and optimize efficiency. Recruited additional behavioral health professionals to network and expanded service areas, increasing access and customer engagement. Negotiated and managed new contracts, resolved disputes, and updated network lists and individual provider files. Continuously monitored network members for clinical quality, best practices, and patient experience. Supervised participating provider marketing and communication.• Expanded network by 40% over three years, adding 60 providers.• Improved provider retention 10% annually.• Formulated quality assurance utilization monitoring tool that determined risk opportunity/potential by provider; identification each point of review and approval streamlines audits.

Tallahassee, Fl, Us

In this Analyst role, I scrutinized contracts and documentation related to state's Medicaid program. I suggested revisions, terms, conditions, and other new language to better align with plan objectives and solidify compliance with regulatory and statutory requirements. In addition, I traced Medicaid clients, processed invoices, and reviewed client insurance monthly. I advised my team on technical matters associated with expansion of public health response programs.

Tallahassee, Fl, Us

As a consultant, I assessed the impact to DOH on operations from existing and proposed administrative policies and procedures, legislation, and regulatory changes. I collaborated with cross-functional teams to analyze service programs and operational problems on-site; devised strategic and tactical resolutions. I also advised administrators and guided operational teams in remediation initiatives.

Masters Of Arts In Public Admnistration, Public Administration

Bachelor Of Arts - Ba, Communication And Media Studies