Robert S. Email & Phone Number

Florida, United States

Director for strategic growth and initiatives assisting National Payor organizations.

Philadelphia, Pennsylvania, United States

Responsible for working with national payers and organizations to determine growth opportunities, strategies and operational priorities.

North Carolina, United States

Provide guidance for North Carolina Lead organizations for implementation activities around Medicaid Transformation Pilot. Managed implementation of MCO and Cherokee Indian Health Authority data exchange. Assisted in development of response to North Carolina DHHS deliverable’s.

Responsible for leading implementation for CommuniCare Advantage (CCA) as part of an integrated delivery system, the CommuniCare Family of Companies (CFC), that specializes in post-acute care solutions.CommuniCare Family of Companies (CFC) include Long Term Acute Care hospitals, Psychiatric hospitals, Substance Use Disorder facilities, Senior Living Apartment complexes, Personalized Health Partners, a medical practice focused on support to nursing facilities, Convergence, a telemedicine joint venture, and Healing Partners, a wound care provider practiceOversight of teams in a matrix environment working internally and with vendors to implement health plan operations for enrollment, claim operations, call center, provider contracting, credentialing and marketing.Responsible for identifying key milestone activities and timeframes to ensure operational readiness.

Columbia, South Carolina Area

Health Plan President and Executive for Health Blue partnership with Blue Cross Blue Shield of South Carolina's Blue Choice Plan. Responsible for leadership and management of the operational, administrative, fiscal, and team leadership objectives of the Health Plan. Achieved 38% member growth moving from fourth to second largest MCO in first 10 months of position. Maintained a 58% member self selection rate and 96% retention rate of membership. Additional responsibilities include representing Anthem in all related partnership matters.

Wisconsin, United States

Grew plan to 72 counties statewide to support additional membership and benefit types to become the first statewide Managed Care plan in Wisconsin. Responsible for fiscal and operational management of state Health Plan. Develop, direct, plan and evaluate the goals and objectives for health plan operations working with various stakeholders and partners. Establish state/regional strategic plans and objectives to meet business unit goals. Provide leadership in implementing corporate initiatives, including special project planning and budget management. Manage projects and issues across departmental and divisional lines to facilitate timely resolution. Manage local provider network including network assessment and development, issue identification and contractual issues (PCP, specialist, hospital, and ancillary). Plan, direct, and secure the resources (people, material, data and support) for staff to effectively accomplish operational needs and strategic initiatives.

Virginia Beach, Virginia

Responsible for projects and budgets that encompass company expansion in new or existing markets, new lines of business and products. Manage and coordinate implementation activities among various stakeholders and areas of business within the company and external partners. Supported Kansas, New York and New Jersey markets for implementation and growth. Provide guidance to project team members and manage projects within the Project Management Body of Knowledge.

Virginia Beach, Virginia

Managed financial operations interpreting regulations and policy for Medicaid and Medicare programs in 11 states.Provided leadership for the redesign of returned payments for health care operations in 11 states resulting in a 78% improvement in processing time and cost savings of 70%.Managed day to day operations for cash disbursements to providers in eleven states under Medicaid and Medicare programs.Provided oversight and approval of all financial entries and general ledger activities associated with payments.

Richmond, Virginia

Chairman for the Virginia Board of Social Services serving with 10 additional members from throughout the Commonwealth responsible for promulgating regulations for all of the programs that fall under the Department of Social Services. Provide direction and oversight to the Department of Social Services Temporary Assistance for Needy Families, Medicaid, Food Stamps, Foster Care, Child Protective Services, Domestic Violence and Child Support Enforcement Programs.Work with legislators in both the Senate and House, elected state officials, regulators and state agency officials enacting regulations promoting the Governors Health and Human Service positions.Prior tenure includes the time periods of 1997- 2005

Califirnia Healthy Families, Folsom, Ca

Managed financial operations for the California Healthy Families program covering 785,000 clients. Responsible for department budgets, reconciliations, forecasts and variance analysis. Managed operations for statewide claim reimbursements.

Bachelor’S Degree, Business Management

Political Science And Government

Political Science And Government