What I do best is help organizations respond to opportunities, solve problems and achieve goals. For 30 years, I have worked in the managed care industry at the C-Suite Executive level, as a State Regulator, and as a Principal with a national consulting firm. My experience covers the full spectrum of the industry including Commercial, Medicare Advantage, Medicaid, MLTSS, Behavioral Health, Dental and Self-funded/Third Party Administration. My experience also runs deep with the organizations and institutions that support, contract with and accredit managed care plans from PBMs, BPOs, MSOs, BHOs, IPAs, post-acute care managers, ACOs, CVOs, actuaries, Enrollment Brokers, IT systems, fulfillment, call center, transportation, NCQA, URAC… and the list goes on and on.I have extensive experience engaging and working with government branches and agencies, trade and professional associations, advocacy groups and stakeholders of every type.What I have done and what I can do for your organization: Successful CMS bundled payment applications and programs Wining RFP responses for Medicaid and MLTSS Approved Physician gainsharing arrangements and agreements Compliant grievance and appeals process and operations State licensure of HMOs, PPOs and Certified Utilization Review Entities Acceptable corrective action plans and on-going monitoring programs Successful navigation of state and federal regulations and reporting programs
Listed skills include Managed Care, Healthcare Consulting, Health Policy, Healthcare, and 19 others.