Managed Care Executive Resume

by Kimberly Sarmiento


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JANET SMITH, MSN, RN
Phone • City & State
Email • LinkedIn Address

 

MANAGED CARE EXECUTIVE

A proven healthcare leader offers a track record of achievement in developing and executing financial strategies that positively impact top/bottom-lines while driving operational excellence. Delivers leadership in operations, contracting, marketing, business development, auditing, and regulatory compliance. Specializes in maximizing reimbursement and cost containment while ensuring excellence in patient outcomes. Areas of expertise include:

Managed Care Leadership – Contract Negotiations – Relationship Management – Cost Controls – Risk Management – Project Management – Regulatory Compliance – Business Development – Budgeting – Product / Program Development – Team Building – Training & Development – Process Improvement


SELECT CAREER HIGHLIGHTS

  • Opened revenue streams that resulted in $10M overall revenue impact and ensured all contracts achieved a sustainable profit margin of 20% or higher for Company Name.
  • Recovered $20M in revenue of unpaid managed care claims in the field for Company Name.
  • Developed startup operations, including the implementation of EMR systemwide to include remote access for doctors and other key clinical leaders at Company Name.
  • Achieved 90%+ return to home rates at Company Name while cutting return to acute care to less than 10%.
  • Designed and implemented training on managed care policies, processes, and tools as well as software applications and state and federal regulations; delivered training to dozens of staff in classroom settings.


PROFESSIONAL OVERVIEW 

Company Name (2012 – 2017)
Vice President of Managed Care Operations
Managed day to day operations while completing due diligence on prospective sites, negotiated Managed Care contracts, developed standard operating procedures, and developed Managed Care training for staff.

  • Led development of corporate infrastructure and reporting at corporate office and site locations; standardized all policies and procedures systemwide as well as job descriptions and evaluation processes.
  • Launched cardiac programs, pulmonary programs, and stroke recovery programs in multiple states.
  • Introduced quality improvement program at five hospitals, improving patient satisfaction an average of 15%.
  • Created and trained department heads and line staff on management, mentorship, and guest services models.
  • Negotiated collaborative agreements with physician extenders and medical directors; also negotiated and implemented contracts at all sites for pharmaceutical, supply, therapy, and DME vendors.
  • Oversaw construction, renovation, open houses, and event planning for new facilities.
  • Implemented EMR upgrades systemwide to include remote access for doctors.
  • Developed and implemented AR collections / billing practice manuals for the business office.

Professional Overview Continued…


Company Name (2008 – 2012)
Managed Care Operations Director
Developed a cardio/pulmonary program, negotiated contracts, and managed the survey process.

  • Negotiated national contracts with multiple healthcare providers, achieving a 15% increase in revenue.
  • Decreased days out of accounts receivable by 20 days in the first 45-day period.
  • Lifted patient satisfaction 20% and exceeded benchmarks for the remainder of the year.
  • Led a 10-member team and a college internship program.

Company Name (2004 – 2008)
Regional Director of Managed Care
Negotiated all contracts with Managed Care partners, vendors, and physician networks and directed all Medicare, Medicaid, and Managed Care audits for a 10-state region. Led contract implementation, developed strong relationships, and created training manual and tools used by more than 2,000 employees organization-wide.

  • Increased overall occupancy from 60% to 92% at the facility level.
  • Improved revenue generated by Managed Care 30% by ensuring all carve outs were utilized.
  • Provided revenue recovery of unpaid claims in the field, collecting more than $500K in one year.
  • Installed onsite wireless evaluation/cost management tool for field use by nurse liaisons and marketing staff.


EDUCATION & CREDENTIALS

MSN, Healthcare Management / BS, Nursing – University Name

Nursing Home Administrator License – State of XXX / Registered Nurse – State of XXX

Director of Nurses Certification / Certified Case Manager / Certified Rehabilitation Registered Nurse


PROFESSIONAL & COMMUNITY ASSOCIATIONS

Chamber of Commerce / Rotary Club – City Name

National Association of Directors of Nursing Administration / American Nursing Association

American Cancer Society / Board Member, National Institute of XXXXX


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