Miami-Fort Lauderdale Area
With a demonstrated track record spanning 17+ years in network development, I have proven success in expanding and implementing technology and strategies in the healthcare sector to save time and money. Among my many talents, are an ability to drive organizational growth and cost optimization through innovative strategies, new market development, and trend analysis. ● Managed medical cost trends ranging from $147M to $2.3B, showcasing financial acumen and control over healthcare costs which resulted in cost savings across regions and unit cost contributions nationally. ● Partnered with direct to employer brokerage to migrate 90% of a health system’s employed population to it’s health system owned health plan, resulting in a self-funded membership shift from 40K to 120K+ members. ● Chaired the Value-Based Contracting (VBC) Committee, achieving a 100% contract compliance rate and increasing membership under value-based contracts from 8% to 42%. My exceptional communication skills and ability to nurture long-term relationships with key stakeholders and personnel have been instrumental in maximizing profits and minimizing costs for healthcare organizations. Let’s connect to build community and to discuss a path to eliminate healthcare burnout while fostering fulfilling patient experiences that lead to richness in health and time well spent.
Vizient enables providers to innovate and accelerate the delivery of high-value care by aligning cost, quality and market performance.
At this role, I supervise a team of 20+ diverse professionals responsible for various critical aspects of the healthcare industry. I direct business development by analyzing healthcare trends to develop reports and analytics, enabling informed decision-making. I lead reimbursement strategies such as value-based reimbursement and product/benefit strategy. I negotiate complex value-based contracts (VBC) across multiple states. I lead provider contracting and network development efforts to secure beneficial deals and maintain strong relationships with providers. Some of my key achievements here include: • Managed a medical cost trend on a $147M budget. • Identified $18M+ in cost savings, and remediated $26M+ across 3 regions, contributing $11M+ in unit cost savings year over year in collaboration with Medical Economics & Finance. • Established strong relationships with key population health entities, resulting in a 35% increase in membership and a 15% improvement in EBITDA. • Developed and executed strategies to drive growth and profitability by heading transformative initiatives to enhance affordability and implement shared savings and shared risk (VBC) models, resulting in significant improvements in clinical outcomes and cost-avoidance. • Acquired a network management software for national visibility into the Provider Network Adequacy and Accuracy. • Reduced unit cost by $17M and improved contract administration through negotiations with national hospital systems. • Built a regional team to support health plans in learning medicare reimbursement methodology and improve patient accessibility to providers of their choice. • Established multi-state contracts with value-based physicians and specialty groups like Oak Street Health and CityBlock.
At this role, I directed and coordinated healthcare cost trends worth $1B+ within healthcare delivery system. I led 13 Network Management professionals with all aspects of contracting. I fostered strategic relationships across a diverse range of products, including Commercial, Exchange, Medicare, and Medicaid, spanning 11 counties and 4 islands. Some of my key achievements here include: • Optimized medical cost trends across the healthcare delivery system, ensuring cost-effective operations. • Promoted affordability with best-in-class contracting. • Demonstrated expertise in accountable care, ultimately improving overall healthcare delivery system. 2003-2009 Served in Network Management, Development & Operations.
At this role, I drove growth and facilitated expansion for local, middle-market venture-backed health plans and national pharmacy benefit management (PBMs) in new markets. I guided leaders, enabling connections and prioritization of resources to achieve performance, quality, and compliance-specific targets. I ensured network adequacy and go-to-market readiness for successful market entry. Some of my key achievements here include: • Spearheaded network development and contracting initiatives for Emblem Health, covering 3.1M+ Commercial and 10K + Medicare members, with comprehensive medical and behavioral health networks. • Co-managed network development for AmericasHealth Plan (AHP) and Clinicas Del Camino Real, benefiting 6.5K Medicare and 10K Medi-Cal health plan members, as well as 100K FQHC members in partnership with a managed services organization (MSO). • Led Independent Living Systems (ILS) in providing TPA and MSO services supporting the 5-year ITN re-procurement of SMMC for Physician Specialty Network. • Improved performance-based contracts for clinics and renewed local government contract with the county of Ventura, CA.