VP-health Resume Samples

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D Sawayn

Diana

Sawayn

76604 Armand Court

Chicago

+1 (555) 684 3351

76604 Armand Court

Chicago

Phone

p +1 (555) 684 3351

Experience Experience

Houston, TX

VP Health Services

Houston, TX

Collins, Kunze and Crooks

Houston, TX

VP Health Services

Lead a team of quality improvement, clinical analytics, utilization management, and casement management professionals
Ultimately responsible for ensuring Health Plan services are provided in accordance with state/federal regulations and NCQA standards
Champions health care improvement initiatives internally and externally
Collaborate with other members of Chief Medical Officer’s leadership team on strategic planning for existing and expanding business; recommend changes in program content in concurrence with changing markets and technologies
Participate in risk management, claims administration, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc
Develop response to quality improvement and outcomes studies to ensure an environment providing opportunity for the best possible medical outcomes, in compliance with regulating bodies
Participate on various Health Plan committees, such as the Quality Management subcommittees on Peer Review or Credentialing

Houston, TX

VP Health Plan Service & Administration

Houston, TX

Bernier LLC

Houston, TX

VP Health Plan Service & Administration

Improving the ease of new member onboarding
Manages region IT funding and prioritization process
Identifies and resolves regional issues and risks
Actively engages national and regional stakeholders across the health plan and delivery system in pursuit of service and operational and outside medical cost improvement opportunities. Initiates and influences actions to be taken
Chairs and drives cross-functional joint operating committees that bring an end-to-end, customer- and member-centric approach to operational performance management and decision-making
Drive continuous service and cost improvements: Region executive responsible, in partnership with national and shared service functional leaders, for improving the end to end performance of health plan service and administration
Acts as the voice of the customer and member in the establishment, monitoring and improvement of performance measures, metrics and service level agreements across health plan administrative functions

present

Houston, TX

Emhs Senior VP, Mercy Health President

Houston, TX

Jerde-Feil

present

Houston, TX

Emhs Senior VP, Mercy Health President

present

Complies with EMHS and departmental policies regarding attendance and dress code
A leader that possesses a record of success in leading strong financial and operational outcomes
Submits periodic and other special reports to EMHS indicating the service and financial status of Mercy Health
Committed to being a visible, active community leader and advocate
Prepares and recommends the annual budget showing the expected revenues and expenditures
Represents EMHS and Mercy Health to organizations within the community in the role of representative, and civic leader
Collaborative with the Mercy and system leadership teams to sustain an environment that will encourage the recruiting and retention of highly qualified providers and employees

Education Education

Bachelor’s Degree in Business

California State University, Northridge

Bachelor’s Degree in Business

Skills Skills

Advanced Ability to work independently
Intermediate Ability to create, review and interpret treatment plans
Intermediate proficiency in Microsoft Outlook, Word, Excel, and PowerPoint
Advanced - Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
Advanced - Knowledge of healthcare delivery
Advanced - Knowledge of community, state and federal laws and resources
Ability to effectively present information and respond to questions from peers and management
Ability to implement process improvements
Ability to analyze information and covert related activities into a comprehensive work plan
Ability to influence internal and external constituents

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Associate VP Health Systems Planning & Analytics Resume Examples & Samples

Coordinates, plans, and directs implementation of major clinical services projects with affiliated institutions using effective and efficient project management skills
Recommends priorities for resource allocation among diverse service areas
Engages in long-range strategic planning to ensure establishment of appropriate lines of service
Plans, designs, and implements pragmatic and timely solutions for major designs in large project environment
Reviews and analyzes information to ensure planning is aligned with mission
Establishes Six Sigma, metrics, benchmarking systems and other methodologies for obtaining accurate operational and financial information for effective decision-making
Ensures compliance with applicable laws, regulations, policies, and procedures
Responsible for design, execution, and effectiveness of system of internal controls which provides reasonable assurance that operations are effective and efficient, assets are safeguarded, and financial information is reliable
Determines and establishes work priorities and staffing needs, including staff development and training

VP Unitedhealth Group s Center for Health Reform & Modernization Resume Examples & Samples

10+ years of professional experience, including as a lead author of written deliverables and with external roles in health care policy or industry
Master’s degree or PhD in economics, finance, statistics, mathematics, public policy, public administration, public health, or related field
Expert knowledge and a deep, nuanced understanding of health policy and market issues, including a coherent big-picture vision and the ability to master details at a granular and technical level. Specific expertise will include: The Affordable Care Act of 2010 - key provisions and implementation issues; Structural forces and shifts in health insurance markets; Medicare and Medicaid - current policies and proposed reforms; Patterns and emerging issues in health care spending, provider payment models, care management frameworks, and service delivery redesign
A broad and flexible set of key skills and attributes, including the ability to: construct spreadsheet models, analyze claims data, and interpret and assess the results of empirical studies; independently develop and execute reports and presentations; communicate effectively with business leaders and policy experts, translating policy-relevant analysis into business-relevant analysis and vice versa; write effectively, and think strategically and creatively in a dynamic environment
Expertise in Word, Excel, and PowerPoint
Prior Consulting and/or Investment Banking experience

Emhs Senior VP, Mercy Health President Resume Examples & Samples

Develops definitive business plans identifying performance targets for the attainment of objectives and strategic directions through the effective management of operations
Informs and advises EMHS on all matters relative to the activities and management of Mercy Health, including development of expanding services
Is a member of the EMHS Leadership Council and Operations Council
Assumes full accountability and responsibility for the appropriate allocation of approved capital and personnel resources to attain operational effectiveness and support of strategic directions
Represents EMHS and Mercy Health to organizations within the community in the role of representative, and civic leader
Promotes the image and accomplishments of EMHS and Mercy Health on a local, state and regional level
Monitors performance improvement activities of Mercy Health care providers and the medical staff to provide the highest standards of patient care, education and research
Facilitates open dialogue with all physicians, employees and volunteers by rounding and being available
Prepares and recommends the annual budget showing the expected revenues and expenditures
Submits periodic and other special reports to EMHS indicating the service and financial status of Mercy Health
Maintains confidentiality of all materials handled within EMHS and Mercy as well as the proper release of information
Complies with EMHS and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements
Complies with EMHS and departmental policies regarding attendance and dress code
Ten (10) years' experience in hospital administration with demonstrated administrative competency preferred
Ten (10) years in an equivalent position in a multi-hospital environment preferred

Health Solutions VP of Sales Resume Examples & Samples

Build, maintain, and manage a pipeline of leads and prospective partners, channels and clients in the healthcare ecosystem, focused on providers, payers, and specialties areas
Contribute to the advancement of the go to market strategy to include the development of the BD, Channel and Sales teams
Lead the activities to close the most important contracts and partnerships
Lead response to Requests for Proposals (RFP's) from prospects and consultants
Senior-level contacts within the healthcare industry
In-depth healthcare knowledge, understands important trends and understands U.S. Healthcare system
Demonstrates knowledge of competitor strengths, weaknesses and strategies
Able to travel frequently
Ability to build and maintain strong relationships including prospect and producer relationships as well as internal
Ability to work well in cross-functional teams
Ability to influence and negotiate complex situations
Ability to develop effective plans for achieving business/sales goals
Strong communication skills (written and verbal)
Excellent planning and organization skills
Complex problem solving ability
Ability to work both as a team but also have the personal drive to be a consistent self-starter

VP Health Plan Service & Administration Resume Examples & Samples

Support KP Consumer Strategy: Senior region executive accountable for supporting the development and implementation of several elements of a program-wide consumer strategy focused on attraction, enrollment, engagement and retention of members in partnership with regional, national and shared services leaders across health plan and delivery system. This accountability includes
Improving the ease of new member onboarding
Improving the ease and experience for when members need answers to questions and issues
Improving the member experience when accessing service and care away from home
Improving the experience of our members in understanding and paying for care
Implement and streamline digital capabilities that improve care and service experiences
Drive continuous service and cost improvements: Region executive responsible, in partnership with national and shared service functional leaders, for improving the end to end performance of health plan service and administration
Acts as the voice of the customer and member in the establishment, monitoring and improvement of performance measures, metrics and service level agreements across health plan administrative functions
Proactively identifies issues and opportunities to improve the customer and member service experience
Actively engages national and regional stakeholders across the health plan and delivery system in pursuit of service and operational and outside medical cost improvement opportunities. Initiates and influences actions to be taken
Accountable for service recovery within the region – leading the resolution of day to day customer and member issues – and leading lessons learned and root cause analysis to reduce future issues
Chairs and drives cross-functional joint operating committees that bring an end-to-end, customer- and member-centric approach to operational performance management and decision-making
Support regional and program wide health plan initiatives: Region executive sponsor of major initiatives related to building the organization’s insurance and health plan administration capabilities (e.g., consumer strategy, implementation of new claims systems, membership administration and system strategy, repositioning of customer-facing capabilities, public and private exchange administration, member retention programs, development and deployment of a program wide shared services strategy for Health Plan Service Administration)
Manages region stakeholder engagement in support of strategies
Leads change management activities within region
Identifies and resolves regional issues and risks
Manages region IT funding and prioritization process
Provides regional context (strategies, goals, competitor trends, etc.) to appropriately influence national strategies and initiatives
Implement new products and benefit policies: Responsible for leading multidisciplinary teams to successfully implement new products/benefits across health insurance and delivery operations in partnership with region and shared service Marketing, Sales, and Business Development executive, region Chief Financial Officer and Health Plan Operations executives. Ensures new products/benefits can be administered efficiently, compliantly and that meet our customers’ and members’ service expectations
Manage health plan functions and support transition to shared service model: Direct responsibility for some health plan administrative functions, and responsible for the transition to and oversight of other functions to a national shared service model. Direct and indirect functional responsibilities include; claims administration, membership administration, member service call centers and local member services, case installation, benefits administration, member and provider appeals and grievances, member, provider and customer issue resolution
Call Center Strategy: Region executive will be leading the strategy and driving execution across the Region related to $1M Call Center Strategy program. Direct responsibility will be to develop and implement technology, solutions and best practices for the Region. Provides strategic guidance and leadership, and is responsible for all short- and long-range planning and execution of plans for this initiative
Minimum ten (10) years of experience in operations in a large scale health plan and /or care delivery system; preferably in an integrated system

VP Health Equity Resume Examples & Samples

Determine and lead the vision, development and execution of the Affiliate Health Equity/Multicultural Initiatives plan, including detailing strategies and tactics for community engagement targeting diverse communities affiliate-wide, that supports the national business plan. Plan includes specific priorities, markets and issues to support the accomplishment of the organization’s 2020 Impact goal
Supervise the development and execution of regional Health Equity plans detailing strategies and tactics for community engagement affiliate-wide
Direct the identification, cultivation and engagement of prospective community partners, business executives, key influencers and strategic alliances for priority channels and initiatives, including hypertension management programs such as Target: BP™ and Check.Change.Control, women’s health programs such as Go Red Por tu Corazon and Vestido Rojo events, as well as policies for building tobacco-free, clean air, healthy food access, and healthy living environments
Direct efforts to drive recruitment and award progression of hospitals serving high-risk/diverse communities in the Get With The Guidelines Stroke and Heart Failure programs, affiliate-wide
Responsible for the identification of local sponsors that could or should be elevated to a regional or affiliate-level sponsorship
Supervise, coach, and train the Affiliate Health Equity/Multicultural Initiatives staff to ensure that their work supports the national Health Equity/Multicultural Initiatives business plan and the Association’s 2020 Impact Goal, including building their capacity to serve as subject matter experts on population-specific trends
Staff the volunteer-led SWA Health Equity Committee and facilitate achieving the goals of this committee
Identify local Health Equity/Multicultural Initiatives committee members for Affiliate and national board and committee positions
Ability to interact across multiple acculturation levels and socio-economic groups
Demonstrated advanced knowledge of advocacy initiatives, community engagement strategies, development/fundraising and volunteer leadership
Demonstrated solid strategic thinking skills. The ability to problem solve and identify possible consequences of ideas, thoughts and actions on a multi-state execution. Ability to develop and execute a strategic plan in a collaborative business environment based on on-going assessment of current and future community health landscape
Proven ability to recruit, mobilize, recognize and manage volunteers
Proven effective collaboration skills with internal and external partners
Strong Interpersonal skills
Proven ability to conduct and lead effective meetings with internal and external clients
Self-motivated with highly effective organizational and analytical skills
Skilled negotiator who shows managerial courage
Effective oral and written communicator
Ability to build effective teams
Demonstrated ability to manage through change leadership
Ability and willingness to travel as position demands including early morning, late evenings and overnight
Satisfactory background and reference checks

VP-health Plan Analytics Resume Examples & Samples

Develop and execute a Go-to-Market Strategy to hit revenue targets
Work closely with functional practice leaders within EXL to drive financial goals of EXL Analytics practice
Be a key intermediary between the service delivery team and the customer

VP, Health Data Management Resume Examples & Samples

10+ years of experience in consulting with focus on big data, or tech product management, preferably in healthcare
Experience leading medium-to-large tech or product development teams (50+ colleagues)
Experience leading data management operations including ETL and data ops; offshore experience is a must
Experience leading software development teams in Agile and SCRUM environments
Experience with healthcare data (e.g. claims, EHR/EMR, patient data) or at minimum, sensitive personal data
Strong knowledge of Big Data technologies (e.g. Hadoop, HBase, Redshift), ETL packages (Talend, Alteryx), cloud infrastructure (e.g., AWS, Azure, Rackspace)
Strong knowledge of user-facing tech product development (e.g. platform design and launch, Software as a Service)
University degree in business, engineering or computer science and excellent academic record required; advanced degree preferred
Exceptional internal and external stakeholder management skills
Ability to work collaboratively in a team environment
Experience managing multiple timelines and teams in a deadline-driven environment
Exceptional ability to effectively communicate with technical and business colleagues and make complex ideas understood

VP-accident & Health Resume Examples & Samples

Bachelors Degree and 9 or more years of experience in the Risk Management or Underwriting or Broker or Carrier or Market Facing area within the Commercial Insurance industry
CPCU
Strong managerial, team building, and organizational skills
Strong presentation skills and a solutions and service orientation
Ability to interact with the C-Suite
Knowledge in risk selection and assessment
Ability to manage complex portfolios
Technical knowledge of insurance industry operations and processes
Strategical component of assessing/anticipating market environment
Knowledge of loss trends, triangles, and ratemaking

VA Ltss VP Health Services Resume Examples & Samples

Develops and communicates health services team objectives
Establishes performance goals for health services staff and ensures continuous feedback regularly, throughout the year. Manages attrition effectively
Implements and manages cost-effective and high quality utilization, care, disease management and other clinical programs, including health plan performance reviews, corrective actions and plans
Sets performance standards and implements processes to regularly and consistently measure qualitative performance
Implements processes to identify developmental needs of team members and a means of addressing those needs
Manages cost of care, and utilization to achieve the most effective financial performance while ensuring appropriate quality of care. Manages financial performance on a unit cost and operating basis
Develops and manages clinical operating budget. Participates in strategic planning and clinical model and policy development as requested by leadership
Avoids payment of performance penalties and optimizes opportunities to earn incentives
Participates in underwriting process
10 + year's clinical experience in a healthcare, human service or long-term services and supports
7+ year's previous experience in a leadership position with a behavioral health and/or managed care organization

Senior Account Director / VP, Health Resume Examples & Samples

Bachelor’s Degree (preferably in marketing, communications, or a related field)
8-12 years’ communications experience (previous agency experience preferred – ad or PR)
Pharmaceutical or consumer health experience
Excellent communication/presentation skills; verbal and written
Strong writing, project management and organizational skills; and ability to multi-task to meet deadlines in a fast-paced environment without sacrificing quality
Knowledge of analytics platforms and the ability to tell stories with data

VP, Field Health Services Resume Examples & Samples

Provides operational and strategic leadership for field clinical programs
Provides subject matter expertise to support operations, product development, and growth initiatives
Work collaboratively with medical directors and market leadership to deliver clinical programs that support the business objectives
Develops value propositions for clinical programs through quantitative analytics, ROI, and evidence-based data
Supports corporate Quality Improvement plan and market Quality Improvement plan to achieve target HEDIS results
Manages and develops direct reports who include directors and/or managers. Sets direction, allocates, and reallocates utilization of resources as required
Determines operational tactics to implement policies and strategies. Establishes reporting systems and controls to ensure compliance with company requirements
Provides oversight of and integration with vendors that touch on health service operations and serve market enrollees
Sets overall goals, performance standards, and operational priorities for one or more functions and manages resources to operational goals and budget
Creates a motivated customer-service driven environment
Makes recommendations on matters of policy and approve changes in area of expertise
Provides leadership, oversight, direction and guidance of operations in Health Services clinical field management. Ensures that activities are carried out in a timely manner
Established market Health Services clinical management goals, strategy and objectives
Develops strategic plans with the ultimate goal to improve the health status of our members, measure outcomes, improve outcomes and subsequently reduce cost, consistent with the corporate and market goals and objectives of WellCare
Provides oversight of program analysis, which includes ongoing strategic planning of the clinical management programs
Develops and manages activities to ensure compliance with Federal, State, and NCQA accreditation standards
Oversees and participates in Performance Improvement Activities
Plans annual operating budget and monitors budget performance
Manages the development of policies and procedures, ensures implementation and adherence of same
Participates in information management and demonstrates proficiency in gathering, and accessing information
Represents WellCare Health Services at various meetings and conferences on an ongoing basis
Recognizes and observes all company and departmental policies and procedures
Focuses on achieving departmental and organizational objectives
Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace
Preforms other duties as assigned
Required Bachelor's Degree in Nursing
Required 10+ years of experience in managed care industry
Required 8+ years of experience in Leadership and management , preferably in a managed care environment
Required Other Demonstrated expertise in Health Services, such as prior authorizartion, intake, concurrent review, case management, discharge planning including development and management of government programs experimence
Preferred Other Solid understanding and leadership experience with managed care quality improvement
Advanced Ability to work independently
Ability to represent the company with external constituents
Intermediate Microsoft Excel
Intermediate Microsoft Word
Intermediate Microsoft PowerPoint
Required Healthcare Management Systems (Generic)

VP, Clincal Health Solutions Resume Examples & Samples

Superior communication, consulting, facilitation, negotiation, conflict management, problem resolution, change management skills and consensus building skills
Ability to adapt to constantly changing priorities in managing a wide range of projects
Demonstrated subject matter expertise in health care operations and care delivery
Demonstrated ability to lead professionals through influence and collaboration, facilitating change management
Demonstrated proficiency in complex analytic problem solving and project management
Demonstrated ability to define the strategy of and provide overall direction to a specified service offerings
Understanding of US healthcare delivery operations, challenges; competitors, economic, social, and legal environment
Leverages clinical expertise to guide customers in solving difficult clinical issues
Willingly takes accountability for activities and also fosters local accountability across both external and internal customers. Performs work independently and accurately, minimal oversight required
Demonstrates strong knowledge of performance improvement principles, processes and methods
Demonstrates ability to effectively lead/facilitate multidisciplinary teams to achieve targeted results
Demonstrates ability to communicate effectively and collaboratively; possesses strong presentation skills
Demonstrates effective project management including team management, strong negotiation and problem solving skills
Demonstrates ability to build and maintain effective working relationships, throughout all levels of the system
Demonstrates ability to mentor or conduct training sessions on improvement principles, processes and methods
Demonstrates ability to function at a high level of self-direction
Demonstrates literacy with Microsoft Office Suite

VP Health Asia Resume Examples & Samples

Together with Country GMs, establishes profit, growth and customer engagement and satisfaction objectives, and resource plan for the Health business
Monitor profit and growth performance and coordinates strategies with Marketing, Product, Pricing, Underwriting, Distribution, Claims and other departments to achieve these objectives
In partnership with Marketing, Product, Lumenlab, Digital, IT, Data Analytics, Distribution, Communication design Health product and services and go to market strategies for markets across Asia
Generate and implement new sales and marketing initiatives to increase Health Insurance sales and profitability
Provide expertise on current Healthcare and Health Insurance industry best practices. Consult on cross-functional projects to ensure Health business principles are incorporated
Identify new areas of Health Insurance opportunities beyond the current organizational thinking
Act as a strategic advisor to the Head of Strategy, Product, Health
Co-ordinate with countries in the region to plan their Health organisation as well as identify areas of support required and provide required region level support
Represent the Asia Health business at MetLife global forums and working groups
Strong affinity for Health
Knowledge of Asia markets, especially Japan, Korea and China
Ability to drive sales in a regional role through Direct, Digital and Retail sales force
Significant Healthcare and Health Insurance industry experience
Health Insurance product knowledge
In-depth understanding of Health Insurance business and best practises
Experience in cross channel distribution for a Health business in Asia
Managing partners (e.g. Reinsurers)
Managing vendors e.g. service providers
Marketing and go to market strategy experience
Community Management and the development of loyalty programmes
Experience leading and managing cross-functional teams
Experience in plan and business case development
Ability to compile and analyse data and metrics and make decisions regarding business, go to market campaigns and ongoing marketing initiatives in new markets
Excellent interpersonal skills; ability to work across Asia, cultural dynamics and the ability to develop strong working relationships

VP Health Services Resume Examples & Samples

Lead a team of quality improvement, clinical analytics, utilization management, and casement management professionals
Ultimately responsible for ensuring Health Plan services are provided in accordance with state/federal regulations and NCQA standards
Champions health care improvement initiatives internally and externally
Collaborate with other members of Chief Medical Officer’s leadership team on strategic planning for existing and expanding business; recommend changes in program content in concurrence with changing markets and technologies
Assure plan conformance with legal and regulatory requirements; support NCQA qualification activities, including site visits and response to accrediting and regulatory agency feedback
Participate in risk management, claims administration, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc
Develop response to quality improvement and outcomes studies to ensure an environment providing opportunity for the best possible medical outcomes, in compliance with regulating bodies
Monitor member and provider satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants
Participate on various Health Plan committees, such as the Quality Management subcommittees on Peer Review or Credentialing
Promote wellness and ensure programs of prevention, education and outreach to members and providers consistent with company’s mission, vision, and values
Contribute to the development of strategic planning for existing and expanding business; recommend changes in program content in concurrence with changing markets and technologies
Participate in key marketing activities and presentations, as necessary, to assist the marketing effort
Performs other position appropriate duties as required in a competent, professional, and courteous manner as directed by management
Must have at least 7 years’ health plan or case management experience, with at least 3 years being in a management capacity
Strong leadership and communication skills to effectively operate in the complex environment of an integrated health system
Knowledge of quality improvement and UM practices in a managed care environment
Knowledge of regulatory and accreditation agencies and requirements
Demonstrated ability to manage multiple priorities and deadlines in an expedient and decisive manner
Demonstrated ability to manage difficult peer situations arising from medical care review
Appreciation of cultural diversity and sensitivity towards target population
Strong expertise on the application of technology to Health Plans, to include Care Management Platforms

Division VP of Finance Carest Health Plan Resume Examples & Samples

Problem analysis and critical decision-making, including the ability to independently formulate and implement solutions
Ability to work independently to achieve objectives and resolve issues in ambiguous circumstances is a must
Ability to work in high-pressure situations while maintaining good leadership and reasoning ability
Strong collaborator who can effectively work across an organization to encourage others in planning and execution
The ability to influence across a matrixed environment and lead people through change is required
Understanding overall managed care organization, business strategies and financial metrics is required
An undergraduate degree is required. An advanced degree, accounting experience, and/or a CPA are preferred
Medi-Cal or Medicaid experience required, and Medicare experience is desirable

VP, Health Systems Sales Resume Examples & Samples

Attain sales, gross profit, gross margin, AR, freight expense, compensation and operating expense objectives for Health System based business
Provide thought leadership, vision, support and oversight to the Health Systems team, based across the country, responsible for calling on Health System customers
Develop and sustain the Health System value proposition designed to sustain existing Health System customers as well as gain new customers from competitors
Work with Sales Regional Vice Presidents, Area Sales Managers, and selected Account Managers, to meet sales goals and gross profit dollar growth within the Health Systems customer segment
Responsible for working cross functionally with the legal, marketing, sales support, pricing, reimbursement services, McKesson Brand, accounts receivable, customer systems and operational teams to effectively deliver the McKesson value proposition while maintaining profitability and corporate compliance
Understand the emerging trends within the Health Systems industry. Stay ahead of the competition as it relates to gaining new business within emerging markets
Responsible for managing the teams’ sales funnel and execution of new business. Take ownership of customer profitability. Create effective sales reporting tools and management of these tools to include SalesForce
Create value proposition for customers through innovative service offerings. Builds key executive relationship with health systems and vendors to enhance profitability
Responsible for not only working cross functionally with the legal, marketing, sales support, pricing, reimbursement services, McKesson Brand, accounts receivable, customer systems and operational teams to effectively deliver the McKesson value proposition while maintaining profitability and corporate compliance but also across the various McKesson business units on strategic opportunities that expand beyond the Primary Care Health Systems market
Develop strategies and coordinate attendance at national trade shows
Demonstrated success selling to the “C-Suite” of large health systems
Working knowledge of a professional selling processes and model
Deep working knowledge of SFDC (Salesforcedotcom)
Demonstrated negotiation skills and success in complex contracting through legal and finance environments
Must possess high level communication skills, verbal and written
Strong collaboration skills required
Demonstrated strategic thinking skills and strong planning and execution skills a must
Successful track record of selecting, hiring, developing and managing high performing sales teams
Demonstrable track record of success with consultative selling and as a closer
Proven ability to work well with colleagues and influence cross-functional teams
Ability to manage multiple projects at a time

VP, Behavioral Health Resume Examples & Samples

Plan, lead, organize, direct and evaluate the delivery of behavioral health services within Orlando Health including inpatient and outpatient services and collaborating with behavioral health physician practices
Manages the operations of South Seminole Hospital behavioral health inpatient hospital; responsible for meeting volume, clinical, quality and financial goals
Leads development of behavioral health management structure
Develops behavioral health service line in accordance with strategic plan, leading all initiatives and strategies, including development of outpatient services and services located in primary care practices
Works closely with Medical Director to address all physician leadership, practice and recruitment needs. Participates in the recruiting and onboarding of new behavioral health physicians, mid-level providers and allied health professionals
Develop all BH business development/ community relations initiatives, including strategic partnerships with local behavioral health organizations to facilitate coordination of services and the meeting of community needs
Maintains compliance with all Federal, State and JCAHO regulations and requirements
Overall resource to health system related to behavioral health opportunities and issues, including behavioral health - ED strategies
Ensures that programs are planned, evaluated, and modified as appropriate to meet the needs of patients consistent with organizational needs and the requirements of payors
Oversees and coordinates the development of the operations budget for the service line. Monitors budget compliance and assures that improvements are made when performance indicators are not met
Remains abreast of major reimbursement changes and works with corporate finance to determine overall impact to the service line
Represents Orlando Health on various boards, community committees and task forces which address mental health and substance abuse issues
In cooperation with leadership and corporate marketing staff, develops and implements marketing plans to meet budget targets
Participates in contract negotiations, affecting behavioral health. Monitors compliance of contracts
Ensures the professional development of personnel
Promotes and ensures patient safety through the implementation of policies, procedures and standard clinical practices across the organization
Stays current with industry services strategic trends, practice models and other outcome measurements
Remains knowledgeable of legal issues related to behavioral health; manages situations to reduce risk to patients, staff and organization
Maintains high quality care through continuous improvement of standards and protocols; partners with the quality department to achieve/maintain behavioral health standards / accreditation requirements
Educates OH leadership and staff on behavioral health matters / services
Advances clinical practice through participation in professional organizations, publications and presentations
Demonstrates leadership ability and project management skills to include effective partnerships with physicians and staff
Maintains confidentiality of data and information in compliance with HIPPA regulation and Orlando Health policies
A minimum of 5 years prior Administrative experience in management of Inpatient Psychiatric Services, including responsibility for all areas related clinical, operational and financial performance
Experience working with business development, community relations and strategic partnerships to achieve goals

Senior VP, Health / Biotech Resume Examples & Samples

Provide strategic counsel, guidance and leadership to staff, supervising several staff members, and ensuring the team's success by managing work quality and productivity levels
Collaborate with internal teams as needed to provide strategic thinking and programming support across multiple practice areas
Provide staff with strategic counsel, guidance and leadership and mentor team members to ensure constant development of their skills related to understanding issues facing the biotech, pharma, health IT or medical device industries
Partner with internal teams to develop and execute successful, creative digital and social marketing campaigns
Provide multi-stakeholder communications counsel, planning and strategy
Ensure team's success by managing work quality and productivity levels; manage staff utilization to meet profitability targets
Demonstrate behaviors consistent with Edelman’s values (Quality, Integrity, Respect, Entrepreneurial Spirit, Mutual Benefits) and Code of Ethics and Business Conduct

Service VP-careplus Health Plans Resume Examples & Samples

Member Services Inbound/Outbound Call Centers – servicing all member inquiries regarding health plan benefits and how to use/access health plan services; manage several outbound call campaigns including the new member Welcome Call
Medicare Grievance & Appeals process, Congressional Inquiries and Medicare CTM Complaint Resolution
Provider Inbound Call Center – servicing provider inquiries related to member eligibility/benefits, referral/authorization status and claim payment status
Dual Eligible Outreach & Social Services Support – oversight of internal dual eligible outreach and assistance program focused on assisting members in obtaining State and Federal financial and medical assistance, such as Medicaid and/or Low Income subsidy
5 or more years of managed care leadership experience in operations
Prior experience developing business relationships with leadership, including the ability to analyze/interpret complex data and use “outcomes” to influence
Competencies in public speaking, project management and change management
Medicare experience is essential in this role; standards and regulations
Travel flexibility (25%) to successfully execute the requirements of this role

VP of Operations Covenant Health Resume Examples & Samples

Responsible for all identified outcome measures as denoted on Performance Assessment
Manages all aspects of designated areas within Covenant Health adult outpatient product lines to include
Periodically engages in public speaking and in making presentations
Performs other duties as assigned by the Chief Executive Officer
Takes administrative call
Evaluates new business opportunities and develops business and operational plans, including financial analysis. Works with attorneys to develop necessary legal documents for projects. Communicates opportunities to physicians and Board, as necessary
Develops and implements facility plans to meet the strategic objectives of the organization
Evaluates opportunities for process redesign and assists or coordinates implementation
Knowledgeable in the principles of human resources administration, quality improvement, and JCAHO standards
Budgetary planning and administration
Strong management/supervisory skills
Able to establish and maintain effective relationships within and without the organization
Effective public speaking skills, as well as ability to develop and conduct effective presentations
Knowledge of and ability to use accounting methods and interpret statistical data
Computer skills (Windows-based software)
At least four [4] years in the health care field or closely related industry
Master’s Degree in Health Care Administration, Master’s Degree in Business Administration, or equivalent from an accredited college/ university
Certified Public Accountant (CPA)

VP of Health Plan Operations Resume Examples & Samples

Policies and procedures are reviewed for accuracy in regards to regulator requirements
Streamlined processes to ensure accurate and timely payment to providers and appropriate medical services to patients
Reporting is within regulator guidelines
Appropriate and timely response to regulator inquiries
Cohesion of interdepartmental processes and hand-offs, when appropriate
Current knowledge of departmental policies and procedures is maintained
Continuous quality improvement plans and procedures are developed and implemented
Sufficient resources are allocated
Ongoing communication is provided
Assure staff is trained in measuring, assessing, and improving performance
CPT, HCPCS, ASA and ICD-10 coding schemes
Claims billing- 1500s, UB92s and dental
Managed health plan functions and responsibilities
Medicaid and Medicare requirements and procedures
Provider contract and fee schedules
Plan benefits
Encounter submission
Proficient in Excel and Word applications
Claims processing systems
Ability to logically analyze and solve problems
Attention to detail and ability to multi-task
Ability to create innovative ideas
Ability to establish and maintain good communications with all levels of interpersonal relations
Ability to implement and follow through

VP, Field Health Services Resume Examples & Samples

Works collaboratively with medical directors and market leadership to deliver clinical programs that support the business objectives
Establishes market Health Services clinical management goals, strategy and objectives
A Bachelor's Degree in Nursing required
10+ years of experience in managed care industry required
8+ years of experience in Leadership and management, preferably in a managed care environment required
Demonstrated expertise in Health Services, such as prior authorizartion, intake, concurrent review, case management, discharge planning including development and management of government programs experience required
Solid understanding and leadership experience with managed care quality improvement preferred
Advanced - Ability to work independently
Intermediate - Ability to create, review and interpret treatment plans
Advanced - Demonstrated organizational skills
Advanced - Demonstrated time management and priority setting skills
Advanced - Demonstrated leadership skills
Advanced - Demonstrated written communication skills
Advanced - Ability to effectively present information and respond to questions from peers and management
Advanced - Ability to implement process improvements
Advanced - Ability to analyze information and covert related activities into a comprehensive work plan
Advanced - Ability to influence internal and external constituents
Advanced - Ability to represent the company with external constituents
Advanced - Ability to work as part of a team
Advanced - Ability to lead/manage others
Advanced - Knowledge of community, state and federal laws and resources
Advanced - Knowledge of healthcare delivery
Advanced - Knowledge of medical terminology and/or experience with CPT and ICD-9 coding

VP-health Resume Examples & Samples

Provide staff with strategic counsel, guidance and leadership; mentor team members to ensure constant development of their skills related to understanding issues facing the biotech, pharma, medical device and public health industries; manage work quality and productivity levels
Maintain relationships with client contacts and internal colleagues
Collaborate with internal teams to provide strategic thinking and programming support in partnership with multiple practice areas
Partner with internal teams to develop and execute successful, creative integrated communications marketing campaigns
Grow business prospects with existing clients; expand scope of work using Edelman network capabilities; lead new business outreach process and win business for market
Participate in the development and adoption of new products/services; leverage IP with clients
Commit to continuous learning and improvement of professional and leadership skills; set and pursue stretch goals
Seek and suggest process improvements and support positive change initiatives
Demonstrate behaviors consistent with Edelman’s values (Quality, Integrity, Respect, Entrepreneurial Spirit, Mutual Benefits); Code of Ethics, and Business Conduct