Jackie is a Managed Care professional with 20 years of experience marked by excellence in leadership. This experience is underscored by a deep and comprehensive knowledge of strategic provider network development to ensure optimal access, network operations and ongoing network management. This background also includes credentialing, modeling and monitoring of network financial performance as well as an in-depth understanding of regulatory compliance with local, state and federal requirements. Has successfully built collaborative, cross functional teams comprised of enthusiastic, motivated individuals. Strongly supports employee development consistent with organizational values, mission and purpose. Has direct experience with business planning, developing budgets and adhering to those budgets. Actively forms partnerships, both internal and external to optimize resources. She is a cutting-edge authority in the areas of healthcare administration and provider network development. She has served as a C level executive and senior manager with several major health insurers. As a health care executive with successful experience in start-ups, organic growth strategies, acquisition and turn-around performance with top line and bottom line improvements, her achievements include:
As a consultant with Aemerus contracted with California based firm as a health plan surveyor for DMHC and DHCS routine and follow up surveys. Consulted with health plans and providers on contracting strategies and contract negotiation. Expanded firm’s reach into focused, high performance provider network development. Consulted with plans and IPAs to establish contracting strategy, credentialing process and contract negotiations.
As President of One Health Plan (wholly owned subsidiary of Great West Life) took business from $425mm in sales to $700mm while reducing medical costs $42mm (reduced medical loss ratio from 84% to 78%). Built HMOs from ground up in California and Arizona. Developed and implemented strategy to recontract 125,000 providers across four states increasing net effective discounts by 32%.
In the role of President Horizon Behavioral Health Services Inc, in 18 months led a $4.4mm turnaround, taking the $52mm division from $1.3mm in losses to $3.1mm in profit while positioning the business for sale at a value of $12mm. Guided the consolidation of five acquisitions onto a single systems platform and consolidated five regional provider networks into a single national network
While Vice President of Network Development for HealthNet, revitalized and restructured key provider contracts whose loss would have put $500mm of business at risk. Positioned HealthNet to grow and sustain market share and expand into multiple product lines by guiding the development and renegotiation of restrictive legacy contracts. Successfully developed a provider contracting strategy to expand the company’s product line.
During her tenure as Executive Director and Director of Medicare Operations, led the integration of an acquisition and it’s Medicare membership into HealthNet’s operations while building HealthNet’s first senior products service center. Structured operations to accept $300mm in new revenue in one year.