Amanda Edmondson
Heath,USA
Summary
Healthcare executive with over 20 years of experience leading network strategy, payor contracting, and value-based care development for national payors and integrated delivery systems. Known for driving performance through innovative contracting strategies, high-stakes negotiations, and operational excellence. Demonstrated success in managing multi-billion dollar portfolios, leading high-performing teams, and navigating the complexities of payor-provider dynamics to maximize revenue and align with organizational objectives.
Overview
24
24
years of professional experience
Work History
Vice President, Network Management North Texas and Oklahoma
UnitedHealthcare
12.2019 - Current
- Lead strategy and execution of payor contracting initiatives for $5B+ portfolio of providers.
- Oversee a 27-member team, aligning efforts across all lines of business to optimize network performance, unit cost and value-based care delivery.
- Spearhead development and implementation of market-specific narrow networks, driving growth in commercial, Medicare, Medicaid and Individual and Family sectors to enhance organizational performance and drive revenue growth.
- Structured and executed value based care strategies and agreements including Performance Based Compensation, Accountable Care Organizations, and Global Capitation agreements.
- Cultivated strong payor-provider relationships with major health systems, hospitals and physician groups across North Texas and Oklahoma.
- Fostered cross-functional collaboration to align departmental objectives with overall business strategy.
- Mentored leaders, cultivating talent and enhancing leadership capabilities across departments.
- Analyzed market trends to inform strategic decision-making and resource allocation.
Vice President, Network Management South and Central Texas
UnitedHealthcare
12.2019 - Current
- Maintained oversight of staff (26) for South and Central Texas managed care activities, guiding development of competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management for all lines of business.
- Developed strategies and negotiate agreements with all Tier 1 providers (In excess of $4 Billion), as well as provide guidance to team members on all agreements throughout the Texas markets.
- Develop and implement market specific narrow networks to support both commercial and Medicare line of business strategies.
- Led strategic initiatives to enhance operational efficiency and drive organizational growth.
- Developed and implemented policies that improved team performance and employee engagement.
- Execute Value Based Care strategies and agreements including Performance Based Compensation, Accountable Care Organizations, and Global Capitation agreements.
- Establish and maintains strong business relationships with System, Hospital, Physician and Ancillary provider partners across Texas.
System Director, Managed Care
CHRISTUS Health
12.2017 - 12.2019
- Oversaw South Texas and Louisiana ministries, including market-specific negotiations and performance analysis for contracts valued at $175M+.
- Directed payor strategy for Blue Cross Blue Shield of Texas and Cigna contract exceeding $600M, including a landmark renegotiation yielding $100M in incremental system revenue.
- Modeled financial and utilization impacts of proposed agreement and collaborated with executive leadership to align payor strategy with health system priorities.
Network Management Director
Blue Cross Blue Shield of Texas
12.2014 - 12.2017
- Oversaw all Tenet and HCA managed care contracts system wide (In excess of $1.4 Billion). Analyzed data and focusing on areas in need of improvement such as stop loss, commercial transplant, hospital outpatient surgery and ER case rates.
- Led North and West Texas hospital and physician managed care contracting(In excess of $2.7 Billion) either through direct contact or through staff oversight.
- Managed team of 13, executed strategic planning, and drove payor-provider engagement to enhance network quality and financial returns.
Managed Care Director – Payor Strategies
Tenet Healthcare
07.2007 - 12.2014
- Oversaw Tenet’s national managed care contracts with Humana (In excess of $500M in revenue). Ensured that contracting methodologies were consistent across all Tenet hospitals (68), ASC’s (37), Imaging Centers (21), Urgent Care Centers (37), and employed physicians (1,800).
- Played integral role in business planning, revenue forecasting, and contract transition for new acquisitions.
- Acted as the liaison between the managed care team and the hospital CEOs, CFOs and Senior Leadership Team. Participated in hospital business planning sessions to ensure that managed care was focused on strategic initiatives of the hospitals, outpatient centers and physicians.
Managed Care Manager – Central Region
BlueCross BlueShield of Texas
07.2006 - 07.2007
- Managed 32 North Texas facilities with total allowed dollars of $140M.
- Developed internal best practices that improved negotiation efficiency and transparency.
Senior Contract Manager
PacifiCare of Texas
02.2001 - 07.2006
- Managed rural Texas contracting department, including 2 direct reports and 161 counties, resulting in the addition of 90 hospitals and 700 physicians to the PPO network, which resulted in an increase in the facility discount by 5% and the physician services discount by 8%.
- Collaborated in the completion of the proprietary PPO network in the Southwest Region, which included the contracting of an additional 140 hospitals and 7,500 physicians during 2004 and 2005.
- Increased the management and oversight of the admissions and discharges from hospitals reimbursed on a DRG/APC methodology by developing and implementing a shared strategy with medical management to contract with preferred hospitalists groups, SNFs and LTAC.
- Coordinated the provider education strategy regarding the necessary coding and data submission by providers to support CMS’ move from geographically adjusted Medicare payments to risk adjusted Medicare payments. This provided an additional $12 million in Medicare Advantage revenue in 2005 for the Southwest Region.
Contract Manager
PacifiCare of Texas
02.2001 - 07.2006
- Negotiated hospital, ancillary, and physician contracts resulting in a $40M savings.
- Directed PPO network expansion moving entire state of Oklahoma off rental network onto a PacifiCare proprietary network.
- Prepared and conducted presentations, such as provider training and orientation, network analysis, company-wide initiatives and quarterly reports.
Education
Master of Public Health - Health Administration and Policy
University of Oklahoma Health Sciences Center
Oklahoma City, OK01.2000
B.S. - Exercise and Sport Science
Phillips University
Enid, OK01.1997
Skills
- Payor Negotiations and Network Development
- Payor Revenue Strategy
- Value-Based Care & Risk Models
- Financial Performance Management
- Executive Leadership & Cross-Market Oversight
- Health Plan Stakeholder Engagement
- Strategic Planning & Execution
- Contract Performance Evaluation
Timeline
Vice President, Network Management North Texas and Oklahoma
UnitedHealthcare
12.2019 - Current
Vice President, Network Management South and Central Texas
UnitedHealthcare
12.2019 - Current
System Director, Managed Care
CHRISTUS Health
12.2017 - 12.2019
Network Management Director
Blue Cross Blue Shield of Texas
12.2014 - 12.2017
Managed Care Director – Payor Strategies
Tenet Healthcare
07.2007 - 12.2014
Managed Care Manager – Central Region
BlueCross BlueShield of Texas
07.2006 - 07.2007
Senior Contract Manager
PacifiCare of Texas
02.2001 - 07.2006
Contract Manager
PacifiCare of Texas
02.2001 - 07.2006
B.S. - Exercise and Sport Science
Phillips University
Master of Public Health - Health Administration and Policy
University of Oklahoma Health Sciences Center
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