AMANDA ADAMS
Guntersville,AL
Summary
Senior healthcare leader with over 10 years of expertise in provider network operations and value-based care. Currently leads provider engagement team and manages value-based payment agreements at Cigna Healthcare. Proficient in alternative payment models, provider performance management, and quality metrics. MBA-prepared Registered Nurse with strong data analysis skills and a track record of enhancing provider performance and health outcomes.
Overview
13
13
years of professional experience
3
3
Certifications
Work History
Network Operations Senior Manager/ Provider Performance Senior Manager
Cigna Healthcare
07.2024 - Current
- Direct provider performance and value-based contract operations for ACA Exchange (IFP) populations.
- Manage provider engagement team while liaising among providers, markets, analytics, contracting, and clinical teams.
- Oversee value-based financials, including incentives, reconciliations, and performance reporting.
- Serve as SME for alternative payment models and optimization of provider performance.
Network Operations Advisor/ Provider Performance Management Lead
Cigna Healthcare
10.2022 - 07.2024
- Supported provider groups participating in value-based reimbursement arrangements through performance monitoring and operational guidance.
- Partnered cross-functionally to analyze provider performance and support quality, utilization, and cost-improvement initiatives.
- Assisted with value-based contract reporting, financial reconciliation, and provider engagement strategies.
Network Operations Manager/ Provider Engagement Administrator
CareAllies
Huntsville, AL
04.2022 - 10.2022
- Managed provider engagement operations for physician organizations in value-based care programs.
- Analyzed utilization, quality, and risk-adjustment data to enhance population health outcomes.
- Supported contract performance through detailed analysis of healthcare metrics.
Network Operations Lead Analyst/ Provider Engagement Administrator
CareAllies
Huntsville, AL
02.2021 - 04.2022
- Facilitated physician organizations' participation in value-based care through provider engagement, performance analysis, and reporting on utilization, quality, and risk adjustment.
Nurse Case Management Senior Analyst/ Embedded Care Coordinator
Cigna Medicare
Huntsville, AL
06.2017 - 02.2021
- Provided embedded nurse case management and care coordination for Medicare populations, partnering with providers to manage complex cases, improve quality outcomes, reduce utilization, and support value-based care initiatives.
Registered Nurse Case Management Coordinator
Marshall Medical Centers
Guntersville, AL
08.2016 - 06.2017
- Managed team in inpatient case management initiatives, advancing quality improvement, utilization management, and care transitions alongside interdisciplinary clinical teams.
Registered Nurse Utilization Review Case Manager
Marshall Medical Centers
Guntersville, AL
11.2015 - 08.2016
- Executed utilization review and medical necessity assessments to guarantee appropriate level of care, regulatory compliance, and optimal resource utilization across inpatient services.
Registered Nurse
Huntsville Hospital Main
Huntsville, AL
04.2015 - 11.2015
- Delivered direct patient care in a cardiac short-stay unit, managing procedural and acute cardiac patients, while ensuring adherence to clinical quality and safety standards.
Registered Nurse
Palmetto Health Heart Hospital
Columbia, SC
05.2014 - 03.2015
- Provided post-operative nursing care for cardiovascular surgery patients, supporting recovery, patient safety, and evidence-based clinical outcomes.
Registered Nurse
Baptist Medical Center South
Montgomery, AL
05.2013 - 04.2014
- Provided post-operative nursing care in cardiovascular recovery unit, monitoring hemodynamics, managing complex cardiac patients, and facilitating safe recovery and discharge planning.
Education
Master of Business Administration - Analytics Concentration
University of Hartford
Hartford, Connecticut01-2022
Bachelor of Science - Nursing
Auburn University
Auburn, Alabama01-2013
Skills
- Provider network operations
- Value-based care and APMs
- Performance management
- Medicare Advantage and ACA exchange (IFP)
- Physician engagement
- Financial reconciliation for value-based contracts
- Population health and risk adjustment
- Quality metrics and utilization metrics
- Healthcare analytics and reporting
- Cross-functional leadership
- People management and coaching
- Managed care operations and compliance
Certification
Registered Nurse, Alabama Board of Nursing
Timeline
Network Operations Senior Manager/ Provider Performance Senior Manager
Cigna Healthcare
07.2024 - Current
Network Operations Advisor/ Provider Performance Management Lead
Cigna Healthcare
10.2022 - 07.2024
Network Operations Manager/ Provider Engagement Administrator
CareAllies
04.2022 - 10.2022
Network Operations Lead Analyst/ Provider Engagement Administrator
CareAllies
02.2021 - 04.2022
Nurse Case Management Senior Analyst/ Embedded Care Coordinator
Cigna Medicare
06.2017 - 02.2021
Registered Nurse Case Management Coordinator
Marshall Medical Centers
08.2016 - 06.2017
Registered Nurse Utilization Review Case Manager
Marshall Medical Centers
11.2015 - 08.2016
Registered Nurse
Huntsville Hospital Main
04.2015 - 11.2015
Registered Nurse
Palmetto Health Heart Hospital
05.2014 - 03.2015
Registered Nurse
Baptist Medical Center South
05.2013 - 04.2014
Master of Business Administration - Analytics Concentration
University of Hartford
Bachelor of Science - Nursing
Auburn University