Suzanne Pierce Email & Phone Number

Dynamic managed care executive available to provide consulting and interim leadership for managed care organizations, payers and healthcare providers/systems on a variety of initiatives. Areas of expertise include public sector programs, new product implementation, growth strategies, provider network strategy/build-out, and operations excellence.Example Engagements: Blue Cross and Blue Shield Association, Chicago, and Passport Health Plan, Louisville, KY (retained to provide provider network, transplant contracting and vendor strategy expertise), FluidEdge Consulting (assigned to a Medicaid payer administration firm), Mercy Health of Ohio and Kentucky, WellPoint/Amerigroup of Texas, Health Alliance of Greater Cincinnati, Ohio, (retained to serve as interim Vice President of Payer Relations), Children’s Hospital Medical Center of Cincinnati, OH, TriHealth of Cincinnati, OH, Children’s Hospital of Columbus, OH, Health Inventures, a national ambulatory surgery management company, and RehabSolutions, a startup Workers Compensation Rehabilitation Organization (retained to serve as Interim President)

United States

As a consulting executive and a Managed Care Public Sector Program subject matter expert, provides operations excellence leadership for Gainwell’s National Product Innovations Team, serving on the teams responsible for the implementations of the new managed care ystems in both the States of Kansas and currently, Oklahoma; previously served as the Managed Care Domain Lead for Gainwell's portfolio of MMIS services for the State of Ohio's Medicaid Department (ODM)

Greater New Orleans Area

Responsibilities: Directed all operational initiatives of this statewide Medicaid managed care organization including claims, member and provider call centers, IT, provider network and marketing/community outreachAccomplishments:• Directed growth of 250,000 members within sixteen months of operations; (organization’s go live date was 2/1/2012)• Established needed operational infrastructure of this newly formed managed care organization, including, but not limited to claims and IT• Accountable for direct oversight of Network Strategy, Marketing and Community Outreach• Accountable for direct oversight of both the member and provider call centers• Assured adherence to all State and Federal requirements

Responsibilities: Directed all provider network initiatives, including contracting and services of a Medicaid and Medicare managed care organization with approximately 120,000 members in 46-county service area, comprised of 122 plus hospitals and 17,000 plus physician and ancillary providers; Hired by Unison Health Plan, which was acquired by UnitedHealthcare in 2008Accomplishments:• Successfullydirected the expansion efforts into 18 new counties, including contracting of 20+ hospitals and affiliated physicians• Spearheaded the development of a 5 county Medicare provider network, including 19 hospitals and over 3,000 physicians within 3 months; led successful CMS application development and submission• Successfully led the integration of all Unison network contracting, service and operations into the UnitedHealthcare family• Established needed provider operations infrastructure of this newly formed managed care organization

Responsibilities: Accountable for provider contracting, provider services, marketing, sales, communications, community relations, regional offices oversight, call center operations, member services, member retention, provider credentialing and provider database managementAccomplishments:• Directed membership growth of 60,000 to over 285,000• Managed provider network that comprised of over 70 hospitals, 7,000 physicians, and ancillary vendors; Accountable for all network contracting, provider services, credentialing, provider information integrity and network operations• Expanded services into six additional counties, including a four-county service area that resulted in an immediate growth of over 150,000 members • Facilitated the transformation of the call center into a 24/7 service unit; including the integration of a clinical interface, while ensuring compliance with URAC standards• Instrumental in the development of the management company affiliate, including development and Board adoption of its first business plan• Oversaw the creation of a new corporate identity including identification of new name and logo, along with redesign of all collaborative materials; Organized all advertising/promotional activities, leading to successful rollout of new name/identity

Responsibilities: Retained to finalize startup activities and integrate the operating systems for a managed care organization; Directed development activities including provider and member services, call center operations, medical management, finance, information systems, claims and marketing/salesAccomplishments:• Recruited management team and supporting staff• Developed the regulatory framework for operations and compliance with Medicaid requirements• Spearheaded the development and integration of the claims and medical management components of the organization

Bachelor Of Arts (Ba), Public Administration

Licensed Ohio Real Estate Agent

Master Of Business Administration (Mba) - Completed Significant Coursework, Towards Degree