Lead national network expansion and management efforts. IHCS serves managed care plans and members through a unique hybrid care model consisting of owned and proprietary delivery of care and an expansive, contracted third-party provider network. The unique care model provides significant value to payer customers and patients by delivering:A vertically integrated model that streamlines hospital discharges, simplifies care-coordination across services and reduces medical costs.A value-based model which aligns incentives between payers and IHCS while driving meaningful savings to health plan customers through efficient utilization and unit cost management

Leads payer and provider contracting teams developing strategy, contract negotiations and contract management for integrated healthcare system [51 hospitals, over 1,000 clinics] operational in seven states. Accountable for over $18b in contracted revenue through commercial, Medicare Advantage and Medicaid contracts. Develops market level contracting strategy with hospital system Chief Executives, Chief Financial Officers and other market or shared services leaders. Leads contracting transition to move to greater levels of risk increasing the number of accountable lives serviced through alternative payment models.

Plans and leads execution of large complex provider network expansion projects. Consistently overseeing and managing provider contracting and network management staff to meet or exceed health plan network adequacy goals.• Builds and maintains trusted advisor relationships with health plan leaders• Develops overall network strategy for provider networks to meet requirements for new markets and existing market expansion. • Leverages the commercial network contracts to build networks in new markets for Medicaid/Duals expansion.• Has oversight to ensure networks meet contractual requirements, reviews network gaps, recruitment and contracting targets and provider directory and portal search option demographics.• Reviews reporting requirements with Data Analytics team to establish reporting requirements for provider performance to support value-based programs.• Partners with Medical Economics to review MLR, unit cost performance and SAI/Scoreable Action Items and sets goals for economic performance• Oversees vendor contracts for Specialty/Ancillary network services for Behavioral Health, Dental, Radiology and Vision to meet contractual deliverables for network access and services.• Leads and manages teams of contracting and network management staff across multiple health plans and markets to integrate emerging and transformative strategies that included value-based contracting and population health adoption, HEDIS/Medicare Star ratings/quality improvement measures, and implementation of a standardized contract management system.• Oversees and participates in the negotiation of complex contracts to support competitive pricing guidelines and targets.• Partners with Medical Economics to identify cost outliers and develop strategies to support medical cost improvement and profitable growth.• Collaborates with Shared Services to ensure complex contract configuration set-up met the terms of the negotiated agreements.

Plans and leads the execution of large complex provider network expansion projects. Consistently overseeing and managing provider contracting and network management staff to meet or exceed health plan network adequacy goals.• Builds and maintains trusted advisor relationships with health plan leaders• Develops overall network strategy for provider networks to meet requirements for new markets and existing market expansion. • Oversees health plan/vendor contracts to ensure sub-contracted activities meet the terms of the contractual deliverables for network access and services.• Leads and manages teams of contracting and network management staff across multiple health plans and markets to integrate emerging and transformative strategies that included value-based contracting and population health adoption, and implementation of a standardized contract management system.• Oversees and participates in the negotiation of complex contracts to support competitive pricing guidelines and targets.• Partners with Medical Economics to identify cost outliers and develop strategies to support medical cost improvement and profitable growth.• Collaborates with Shared Services partners to ensure complex contract configuration set-up met the terms of the negotiated agreements.• Leads preliminary discovery, internal processes, assessments of new business implementation, policy administration, compliance and state contractual compliance related to provider network operations.• Coordinates service and payment resolution for national/complex key provider contracts.

Provided leadership to national contracting/network development team and external consultants in the development of provider networks*Partnered with Business Development and Providers to implement network strategies for new markets including plans to meet network access and unit cost objectives. *Established and cultivated relationships with provider associations and key stakeholders in the markets.*Led provider contracting activities supporting network needs, gap analysis; build-out commitments; education, outreach and relationship development; negotiation of rates and agreement resolution of reimbursement issues, agreement modifications; finalizing and boarding of contracts. *Maintained expert knowledge of regulatory requirements, industry trends and reimbursement models*Identified resources needed to develop the network and assembled the contracting teams across all business functions. Monitored performance and implemented business solutions to address process and/or quality gaps. Communicated strategy and progress updates with senior leadership and across business functions.* Negotiated and prepared provider contracts establishing guidelines and financial boundaries meeting unit-cost targets for market-specific reimbursement strategies. * Managed the implementation of provider contracts for new network products including the ongoing progress reporting within the company and to the state.* Collaborated with internal departments to implement provider contracts to include actuaries, medical economics, claims and IT, credentialing and operations.

Served as Principal Consultant/Consultant to health plans for new health plan licensing, regulatory filings and provider network contracting for expansion activities.*Served as Principal Consultant to new Medicaid health plan in California, completed filings for licensing and provider network contracting for the hospital, specialty and ancillary network.*Served as Principal Consultant to dental MSO to respond to RFP from the Department of Defense to develop and manage dental offices on military bases.*Completed regulatory submissions for health plans for new product filings, service area expansion, product development and scheduled regulatory reporting.*Served as a provider network contracting consultant for national and regional health plans in project-based network build-out for Medicaid [TANF/Chip/ABD/SPD] and Medicare Advantage networks. *Led market development and advocacy efforts for health plan clients to secure State Medicaid and Medicare Advantage contracts.

Served as Plan President and provided strategic leadership for dental plan operations including business development, sales, group services and multi-site provider healthcare operations. • Had P&L responsibility for the dental plan operations. • Led government relations efforts and managed lobbyist resources at the state level and was successful in the procurement of Medicaid and CHIP contracts.• Managed federal lobbyist resources and was successful in the procurement of contracts with the Department of Defense to build and manage dental offices on military bases.• Led revenue growth teams to sell dental, vision, life, AD&D, and stop-loss products to individual, small group and Taft-Hartley groups through appointed broker and consultant networks.• Managed MSO operations to include revenue/sales growth, claims, customer service, contracting and credentialing, and third-party financing options for consumers and equipment leasing.• Managed fund-raising opportunities to support professional education events and healthcare education symposiums

• Provided strategic leadership for the health network operations including health networks, quality management, call center and claims operations, regulatory affairs, government programs and compliance to support dental and vision products.

• Provided strategic leadership for dental operations in eleven western states. Worked collaboratively with national accounts, mid-market and small group accounts through the healthplan distribution segments. Had direct oversight of functional areas for the west region including health networks, call center operations, claims processing, field-based sales and group services operations, regional accounting, finance and underwriting operations, and human resources.