Led a dynamic and agile team responsible for developing and enhancing Humana Medicaid's standard Provider Support strategy and implementing standard and tailored Provider Support Model solutions in new Medicaid markets. Conducted oversight of the strategic development, delivery, and ongoing refinement of Humana Medicaid Provider Support Model to drive optimal provider experience and performance in alignment with organizational goals. Conducted oversight of the Provider Support Model associated with implementation and operations of Provider Relationship Management model, which included Provider Services, Provider Relations, Provider Engagement, Claims Education, Network Optimization, and Practice Transformation. Drove the development of operational processes, trainings, and KPIs to execute on the Medicaid Provider Relationship Management model, and other strategic initiatives. Developed and implemented various standards, resources, tools, and best practices sharing across the organizati

Managed a team of clinicians (Nurses, Social Workers, and Dental Hygienists) and collaborated with the Medical Directors, Pharmacy Director, and Dental Director for the program. Functioned as the primary contact for the Mississippi Division of Medicaid and managed the day-to-day operations of multiple and diverse lines of services and/or contracts/programs, including Prior Authorization (PA) and Utilization Management (UM) activities (medical, inpatient, outpatient, therapy, advanced imaging, dental, vision, hearing, DME and medical supplies, Katie Beckett Waiver (Disabled Children Living at Home), Behavioral and Mental Health, and long-term care). Also managed the day-to-day operations of the Care Management program. Exercised independent judgment and discretion while overseeing and leading the team in the creation, implementation, evaluation, and ongoing management of strategic plans to ensure contract deliverables, program requirements, and evaluation measures/metrics are met and/or

Worked collaboratively with Operations, MTM support departments, and Transportation Providers to ensure the most appropriate and cost-effective delivery of transportation services. Functioned as the internal liaison between MTM departments and the Mississippi Division of Medicaid (MS DOM) to ensure MTM is fully compliant with contract requirements. Provided leadership and management of direct and non-direct reports. Ensured business outcomes and contract goals were defined and met. Maintained, comprehended, and effectively communicated MS DOM expectations. Established a working relationship with MS DOM and functioned as a liaison to ensure their expectations were met and any requests for information were responded to in a timely manner to their satisfaction and MTM. Tracked and maintained department budget to meet the established financial goals. Conducted quarterly Town Hall meetings with all levels of staff. Maintained a strong working relationship with key MS DOM personnel. Worked w

Directed and managed a staff of Managers, Provider Services Representatives, and Network Contracting Specialists including hiring, training, and evaluating performance. Developed and implemented provider education and training strategies to include creating provider educational materials and tools for all provider types (PCPs, Specialists, FQHCs, Behavioral/Mental Health providers, Ancillary providers, hospitals, etc.). Effectively provided and developed standards and resources to help the organization successfully develop and refine cost effective and high-quality strategic provider networks, establishing both
internal and external long-term partnerships. Worked collaboratively with health plan network management, operations teams, and functional business unit stakeholders to lead and/or support various provider services functions and strategic initiatives with an emphasis on developing and implementing standards, resources, tools, and best practices sharing across the organization.

Led the functions of Provider Services, including developing and/or presenting policies and procedures, training materials, and reports to meet internal/external standards. Managed and directed the Provider Services staff including hiring, training, and evaluating performance. Developed and implemented provider education material and training strategies for various provider types (PCPs, Specialists, FQHCs, Behavioral/Mental Health providers, Ancillary providers, hospitals, etc.)
● Assisted with ongoing provider network development and educated contracted network providers regarding plan procedures and claim payment policies. Served as a resource to support the health plan's initiatives and help ensure regulatory requirements and strategic goals followed contract requirements and were executed appropriately. Developed and implemented strategies to increase provider engagement in HEDIS and quality.
● Key Achievements
• Successfully implemented Provider Services policies and facilitate

Managed the training team and associated activities and processes of the Mississippi Medicaid project, including creating training schedules, assigning classes to trainers, and maintaining departmental procedures. Evaluated effectiveness of training material via feedback from training questionnaires, surveys, and eLearning test results received by the Training team. Developed online training classes using Articulate (PowerPoint-based CBT software). Evaluated training classes using Kirkpatrick's evaluation model.
● Key Achievement
• Streamlined existing processes to enhance the effectiveness of Learning and Development.

Supervised staff training and development for the Operations department and external health plan staff. Managed a staff of five Trainers and a Training Coordinator including hiring, training, and evaluating performance. Developed curriculum and training aids designed to enhance learning in efforts to meet organizational goals. Executed training and multiple projects in the Call
Center and Health Plan, including professional development courses. Managed large-scale projects to execute delivery of training to the health plan and fulfill contract requirements. Partnered with Human Resources to facilitate New Hire Onboarding/Training.
● Key Achievements
• Enhanced department productivity by over 50% due to the creation and development of training manuals (Member Services, Provider Services and Claims) for internal and external staff to reference during classroom training and post training.
• Increased the number of e-learning classes available to the Call Center and Health Plan.

Drove the execution of training and multiple projects in the Call Center and Health Plan. Developed curriculum and training aids designed to enhance learning and meet organizational goals. Partnered with Human Resources to facilitate New Hire Onboarding/Training.
Key Achievements
• Increased staff performance by ensuring over 50% of the Member and Provider Call Center staff received advanced training in Member Services, Eligibility, Benefits, Provider Services, and Claims.
• Achieved Top Quality Assurance scores of 95%-98% out of 20+ health plans for Training at Centene/Magnolia Health Plan.

Performed as a Subject Matter Expert for Provider Relations Specialist I staff. Supervised Provider Relations Specialist I staff including hiring, training, and providing feedback regarding performance evaluation. Educated network and non-network providers via on-site presentations and virtual meetings to ensure compliance with plan policies and procedures. Successfully managed and resolved complex provider claims issues. Collaborated with Contracting, Configuration, Utilization Management and Provider Data Management to provide expeditious resolutions to provider concerns.
● Key Achievement
• Surpassed department goals of educating/servicing sixty provider groups monthly within the assigned territory.