Nanette De La Torre Email & Phone Number

Jacksonville, Florida, United States

Collaborate with clients to understand their needs and identify opportunities and trends unique to them. Ensure access to health care services by delivering programs and integrating processes that concurrently optimize claim outcomes and mitigate claim costs.

Memphis, Tn

Offering leadership and direction for company in ancillary services with strategic vendor partners; established consistent vendor management protocols and evaluation metrics; created and implemented service level expectations and performance guarantees to support company's position in industry; designed and oversaw management of KPI dashboards; initiated and participated in internal audit review of vendors to ensure continued improvement; mitigate financial exposure as needed; develop strategies, protocols, or programs to mitigate exposure or drive performance

Provided leadership, partnership, and direction for company in PPO, ancillary, and pharmacy benefits management within a highly regulatory environment through focus on innovations and strategy; operational executions to effectively manage medical costs while continuously improving quality, access, and customer satisfaction. Led and partnered with personnel in developing strategies in UR, cost reductions, and pharmaceutical interventions to continually improve and maintain long-term competitive position and profitability.

Responsible for developing the network through contract negotiations, relationship development, and servicing. Primary focus is negotiating contract terms and rates. Typically work with complex providers (systems, large hospitals and medical groups) in areas with significant competition. Contracts involve non-standard arrangements that require a high level of negotiation skills. Assist in preparing financial projections and conducting analysis as required. Responsible for managing the financial and operational performance of the network within a market and to support growth within assigned markets. Understand financial drivers of provider networks and able to identify and implement cost improvement strategies in order to improve overall cost of care and price points. Responsible for total (unit cost and utilization) per member per month costs for an assigned geography.

Reported directly to CEO, and contributing member of Senior Management team, identified strategies to position company into a competitive position within the specialty insurance market; led the network development/management function on a national in scope; directed, led, trained and created vision for staff of 15 within Network Development and Credentialing teams; established market planning standards as well as on-going evaluation process; oversaw strategic network recruitment activities to achieve licensure or contract awards to drive membership growth; drove efficiencies within credentialing unit.Selected Contributions:• Generated savings of more than $500,000 by contracting with selected out of network providers• Through credentialing efficiencies drove more than $100,000 in savings • Increased network access by more than 24% in key market areas• Increased credentialing staff productivity by 200%• Improved credentialing turnaround time from 138 days to 22 days

Manage, evaluate, strategically align and maintain the First Health affiliated networks; develop, maintain and manage the market planning functions driving the First Health networks. Evaluate and quantify brand parity and market progress toward brand parity objectives. Develop and maintain corporate and regional network policies. Improve processes related to contracting, language negotiations, credentialing, and data integrity; participate in the development of new applications to increase productivity and efficiency.Selected Contributions• Authored white paper identifying to Leadership Committee opportunity to save $600,000 annually• Effectively evaluated and improved market planning criteria for respective First Health brands• Creatively participated as a key member in the development of a consolidated provider database that drives pricing, case management and patient channeling platforms• Inventive participant in the on-going development of an electronic workflow

Deliver key leadership and direction for development, negotiation, and maintenance of three provider networks comprised of 300+ hospitals and 24,000+ physicians across Florida and Mississippi. Coach, motivate, and lead team of negotiators in achieving departmental and company goals. Negotiate major hospital/physician contracts and lead network development projects. Create and implement corporate and regional network policies.Selected Contributions: Successfully drove Florida and Mississippi markets, representing $500 million in group health hospital expenditures, to optimal status for The First Health Network. Strategically analyzed configuration of network providers within market areas to develop network strategies and enhancements for exceeding set objectives. Negotiated 100 contracts within a six-month period while managing staff in two separate locations, in two different time zones.

Education record

Mpa, Public Admin, Health Services

Ba, Political Science

Activities and Societies: Bruin Belles - 1976 - 1980

Education record

Education record

Masters

Master Of Public Administration - Mpa, Health Services Administration