Robin Ricketts Neuss Email & Phone Number

Sterling Heights, Mi

Responsible for management and implementation of Quality Programs including CPC+, Tessellate, PDCM and PCMH. Strategic implementation of VBR Quality Metrics to significantly improve financial performance. Facilitate Transitional Care Management processes to reduce admissions. Developed and implemented Risk Stratification model. Monitor analytics, utilization, quality and cost trends including high-risk member identification and opportunities for improvement. Coordinate activities between cross-functional teams and departments to ensure continuous improvement in clinical quality programs.

Greater Detroit Area

Senior PO Consultant responsible for day to day operations of Professional Medical Corporation PO. Responsibilities included management of quality programs,finances, physician engagement, performance improvement, provider relations, contracting, network development and clinical integration. Quality Performance – Focused and targeted performance improvement plans based on BCBSM reporting and MAG performance data. Developed chronic disease management strategies with prevention and wellness protocols and evidence-based guidelines to deliver on goals. Financial Performance – Develop yearly budget, oversee monthly MAG and health plan financials, and population health analytics for financial optimization. Managed care plan surpluses and PGIP payments that exceeded expectations over 4 years. Improved medical billing and coding to maximize physician reimbursement.PGIP and PCMH – Establish benchmarks, goals and action plans at PO and practice levels that included coaching, workshops, best-practice behaviors and verification. ..For three (3) consecutive years, PMC physicians earned additional 20% uplift from BCBSM for cost and utilization.Established, organized and implemented procedures to ensure compliance with Health IT Strategic plan which included a comprehensive registry, Organized Systems of Care and clinical integration.Demonstrated ability to lead and direct large scale transformative change in healthcare at organizational level and work effectively with organization, team and individuals. Performance excellence and lean principles improved quality and reduced medical costs.Risk Plans – Manage risk plan contracts, cost and utilization and P4P HEDIS incentives.Hospital and Physician Relations – Cultivate strong relationships with hospital administrators and physicians to work together with respect and honesty to improve quality of care for the community. Clinical oversight and integration working with Care Teams to reduce readmissions.

Greater Detroit Area

Management and oversight of Network Development services; contracting, provider services, credentialing and reimbursement. Responsible for developing and implementing numerous strategic initiatives that delivered value to physician membership and improved the UP brand.Provider Service - Responsible for hiring, training and mentoring staff, Design of educational programs, training materials, and policies and procedures. Performance improvement of HEDIS scores, design and implement programs and communications that built positive relations with providers to ensure compliance and sustainability of goals.Project Manager for Critical Programs - Henry Ford Macomb Hospitals, managing implementation of Chronic Disease Registry, PGIP and PCMH programs as well as developed and facilitated physician recruitment and health plan contractingVaccine Purchasing Program – Creation of vaccine purchasing program at discounted prices, which had sales of approximately $2.9 Million with 250 participating physicians in the first year.Plan Administrator who interfaced with 14 health plans to identify provider education opportunities, network analysis of plan data, contracting, credentialing, enrollment, fee schedule analysis and Joint Operating CommitteesQuarterly Educational Meetings - Developed curriculum and led Quarterly Educational meetings and workshops for physicians, clinical and office managersAs a Health and Life Insurance Agent grew the Group Health Plan (United Physicians Health Insurance Plan) membership by 20% as well as the liaison between United Physicians Doctors and US Health and Life.Ancillary contracting for Beaumont Urgent Care, Radiology and Oncology groups and contracting for group purchasing programs to provide discounts and savings for physician practices.

As Manager, Provider Services I supervised the Provider Service Representatives, developed training and education for staff and physicians and managers. As well, I was the Plan Administrator that interfaced with 14 health plans, managed health plan analytics, contracting, physician recruitment, fee schedule analysis and Joint Operating Committees.Development and implementation of strategic plan for technology adoption.

Education record

Diploma