Vaughn Hurst Email & Phone Number

Southfield, Mi, Us

Princeton, Nj, Us

Responsible for creating a distribution network for Oxygen Health products which includes creating the sales strategy and programs. Nationally recruiting a sales team and distribution network. Brand ambassador to agents, brokers, and businesses and helping them to understand how to achieve fiscal stability and holistic well-being for businesses and individuals. We allow our customers to focus on their well-being by choosing non-insurance health benefits that have no high costs, no annual price hikes, and are always affordable.

Valhalla, Ny, Us

As a Employee Benefits Consultant with USI, my team offers access to sophisticated tools and strategic planning expertise to design optimal plans, negotiate advantageous pricing, deliver preferred services and while keeping clients compliant and continuously aware of market changes. We strive to improve client's employee benefits cost and communication. We inform our clients about legislative and regulatory compliance changes and help them to maintain compliance in cost effective ways.

Valhalla, Ny, Us

Aliso Viejo, Ca, Us

Manager of Account Management Risk Adjustment and Quality.

Long Beach, California, Us

Responsible for the development and maintenance of an effective and efficient broker channel for Michigan and Ohio. Develop a high functioning, high performing broker network which is strategically aligned with Molina’s mission and values. Utilize a combination of recruitment, mentoring, education, and channel management techniques to ensure brokers meet assigned objectives and enrollment targets. Assume accountability for the broker networks contribution to Molina’s enrollment, profitability, and retention goals. Additionally, ensure brokers follow CMS and State Guidelines, along with basic ethical sales practices and adhere to established policies, procedures and industry best practices. Responsible for assisting their channel in the design and implemention of provider and community based relationships and growth campaigns, and monitor and report on their results.

I help employers understand health care reform and how to strategically design a comprehensive cost effective benefits package that includes voluntary benefits to create a win/win for the employer and employee. I oversee the strategic planning, product selection, deployment of enrollment strategy, and support for employer and employees during and after the implementation/enrollment period. Services include one on one benefit education of employees prior to or during the enrollment period.

Jacksonville, Florida, Us

As the Regional Sales Manager in Metro Detroit and Eastern Michigan, I will help insurance producers protect and grow their book of business with Allstate’s voluntary benefits. My job will be to help agents and employers understand health care reform and how to strategically design a comprehensive cost effective benefits package that includes voluntary benefits to create a win/win/win for the employer, employee, and agent. I will oversee the strategic planning, product positioning, deployment of enrollment strategy, and support for clients and prospects. Allstate Benefits is one of the leading providers of voluntary benefits in the nation, with over 60 years of experience.

Louisville, Kentucky, Us

Responsible to recognize and execute on opportunities to retain/grow employer groups and promote additional product offerings for assigned book of 100+ Commercial businesses. Negotiate renewals, build and execute guidance plans, deliver reports on group experience and look for opportunities to promote additional product and benefit service offerings. Manage broker relationships by instituting a strategic relationship management process to ensure that business outcomes meet or exceed expectations.Achieve targets for membership retention, specialty and consumerism targets of assigned book of businessDrive cultivation of Broker and Customer relationshipsAct as a liaison between the Sales and Account Implementation departments, effectively distributing resources to meet enrollment requirements.Achieved President's Club in 2009 and 2010 (Awarded to only the Top 20%).

Dearborn, Michigan, Us

• Improved the Medical Placement Committee’s process of finding work for hourly employees with medical restrictions• Improved the hourly FMLA application and tracking processes by creating a shared spreadsheet of applicants and the status of their application• Review Stage 2 Labor Grievances with Bargaining Committee and negotiate settlements. • Provided Six Sigma Leadership by initiating a Black Belt Project with the goal of reducing Stage 1 Overtime Grievances which is estimated to save $157,000 in two years.

Dearborn, Michigan, Us

• Project Manager for 2007 Salaried Benefit changes; estimated to save $70 million in 2007• Provided leadership and management of medical, dental, and pharmacy audit by outside vendors• Researched and provided leadership in implementing Health Reimbursement Accounts for Medicare Salaried Retirees• Organized and implemented communications strategy for conveying 2006 Salaried Benefit changes• Researched and lead team decisions on medical and pharmacy benefits changes• Learned report writing and data structure of MedStat Heath Care Claims Data Warehouse to identify over $900,000 in overpaid claims• Performed technical reviews of benefit designs to identify possible areas of over utilization and overpayment• Ad Hoc health care data reporting

Dearborn, Michigan, Us

•Lead analyst in sourcing bid and purchasing of salaried medical and vision benefits •Liaison with Healthcare suppliers to understand costs and develop strategies to reduce expenses.•Developed profit/loss forecasts for self-insured Traditional Indemnity and PPO health plans.•Provided financial oversight of self-insured plans through comparison of forecast to actual performance of health plans.•Developed standardized reports for use in comparing utilization and cost performance between plans.•Team member in the acquisition of health care claims data warehouse.•Provide ad hoc reports on healthcare trends.

(Contract position working for Ford Motor Company)•Lead analyst in sourcing bid and purchasing of salaried PPO health plan. •Analyzed alternative plan re-bidding opportunities. •Liaison with Healthcare suppliers to understand costs and develop strategies to reduce expenses.•Provided financial oversight of self-insured HMO and PPO plans.•Helped in the development of profit/loss forecasts.•Provided ad hoc reports on healthcare trends.

Warren, Michigan, Us

• Responsible for providing leadership and management of special projects for two community hospitals. • Conducted patient demand analysis and feasibility study of new services, forecasted profit and loss projections, developed budgets for these services (i.e., Wound Care, Sleep Study, DSME). • Implemented an Outpatient Diabetic Education Program with projected revenues over $35,000 a year.• Reviewed ambulatory practice charges resulting in an additional $20,000 of revenue.• Conducted financial analysis of hospital-based vs. non-hospital based practices to increase revenues.• Reviewed physician contracts to ensure market parity, compliance with Stark laws, other federal regulations, and helped to negotiate expired or non-existing contracts. • Served as Interim Director of Medical Affairs office and oversaw credentialing of 240 physicians. Ensured compliance with state, federal, and JCAHO regulations. Directed a staff of 4 personnel.

• Directed the Medical Staff credentialing and privileging activities for over 250 providers.• Reduced the credentialing process from 6 months to 3 months.• Supervised the management of employed and contracted providers including the development and management of a $15 million salaried & contractual expense budget. • Lead contracting efforts with health plans and physicians to increase revenue by over $70,000.• Developed strategies that positioned the hospital to better manage its risk contracts by saving $250,000, through the development of relationships and contracts with community physicians• Worked with senior management in the development of the Mercy Detroit IPA and the development of the Greater Detroit Health Care Network (an organization that negotiates and administers risk contracts on behalf of the hospital and multiple IPAs).• Established delegated credentialing function with some local health plans.

• Responsible for creating and analyzing reports that tracked utilization and financial expenses of managed care members through database software. • Tracked statistics for over 20,000 members with the majority of them being in full risk contracts. • Served as Project leader for the privatization of an ambulatory clinic saving $500,000.• Created and maintained data files to ensure accuracy of reports Created reports to track and detail capitated medical expenses of patients and create provider profiles of participating physicians.

Hartford, Connecticut, Us

• Developed, maintained and enhanced relationships with physicians, medical groups, IPAs and facilities.• Developed financial analysis of potential business to aid in the recruitment of providers.• Contracted over 100 physicians to become providers in new HMO, PPO, and indemnity products.

Us

Orgainzed the summer orientation program for interns, externs, and administrative fellows to meet the leadership of Henry Ford Health Systems.Helped in the development of variable budgeting for the hospital.

Reviewd HEDIS results for network physicians and developed recommendation for improvement.

Bachelors, Economics

Mhsa, Health Management And Policy