Colleen M. Burgher
Huntingdon Valley,PA
Summary
Seasoned health insurance professional with over 30 years in account management, project management, and provider relations. Cultivated strong relationships with stakeholders while managing provider networks and multiple projects. Optimized program performance and resolved complex issues through effective collaboration.
Overview
30
30
years of professional experience
Work History
Senior Project Leader, Health Value Optimization
Independence Blue Cross
Philadelphia, PA, PA
05.2023 - Current
- Plans, executes, and controls assigned innovation projects with a budget of over $10 million per year, ensuring work performed complies with contractual requirements and drives medical cost reduction and ROI.
- Oversees all aspects of project planning and execution, resulting in on-time and within-budget completions.
- Manages cross-functional teams to ensure timely completion of complex projects.
- Established partnership with our PBM OptumRX, as well as third party vendors such as Evio and Free Market Health facilitating collaboration on large-scale projects and enhancing project outcomes.
- Adjusts project plans to account for dynamic targets, staffing changes, and operational specifications.
- Monitored project progress and identified risks, implementing corrective actions to ensure project alignment with goals.
- Analyzes project performance data to identify areas of improvement.
- Championed change initiatives within organization, fostering culture of innovation and adaptability among teams.
- Formulates strategic plans aligned with organizational goals, ensuring long-term success for projects under leadership.
- Optimizes resource allocation for improved project outcomes and cost savings
Manager, Network Relations
Aetna, Inc. CVS Health
Blue Bell, PA
08.2018 - 05.2023
- Manages an assigned territory of large hospital systems including Lehigh Valley Health Network, St. Luke's Health System, Crozer Health System, and Community Health System consisting of over 35 hospitals, 5000 providers and hundreds of outpatient facilities.
- Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships
- Drives implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency goals.
- Collaborates cross-functionally on high value initiatives to analyze data, identify trends and implement solutions.
- Partners on development of business strategy and programs to support operational plans.
- Coordinates internal and external assistance to resolve escalated issues for assigned health systems.
- Monitored performance and adherence to scorecards and payout schedules, ensuring compliance with established quality, clinical, and risk measures.
- Managed diverse responsibilities effectively within established timeframes.
- Educated internal and external parties to ensure compliance with contract policies, plan design, compensation process, technology, performance measurements, and procedures.
- Assists and supports complex contracting, negotiation discussions and system updates.
Caregiver, Fundraiser and Volunteer
Self
Huntingdon Valley, PA
05.2014 - 08.2018
Senior Project Manager
Aetna, Inc.
Blue Bell, PA
04.2007 - 05.2014
- Primary relationship liaison between Aetna and ActiveHealth Management.
- Oversaw large portfolio of projects, supporting teams and reporting progress to achieve positive outcomes for key stakeholders.
- Subject Matter Expert (SME) for several National Care Management programs including: MedQuery/CareEngine, Personal Health Record, Member Health Engagement Plan, Women's Health, Beginning Right maternity management, Surgery Decision Support, Get Active!, and Patients Like Me.
- Managed multiple projects simultaneously.
- Collaborated cross-functionally with program design, informatics, clinical consultants, sales support, plan sponsor services, medical management, sales teams, vendors, and ActiveHealth Management to ensure effective program functionality.
- Conducted root cause analyses, identifying solutions for complex program operation issues.
- Presented program overviews and training to internal and external audiences.
- Interpreted program outcome reports for account teams and plan sponsors.
- Coordinated simulation and test run reports for new business prospects.
Network Account Manager
Aetna, Inc
Blue Bell, PA
06.1999 - 04.2007
- Established and maintained relationships with physician groups, ancillary providers, and health systems including Penn, Temple, Drexel, and Cardiology Consultants of Philadelphia, enhancing collaboration among hundreds of providers.
- Collaborated with large, high-profile provider groups to find mutually beneficial solutions to issues and disputes.
- Negotiated contracts with key constituents within provider organizations.
- Collected physician credentialing information and medical record data for QM and NCQA.
- Partnered with internal business areas to resolve complex provider issues.
- Monitored medical cost drivers and executed initiatives that aligned with operational objectives, contributing to effective cost management.
- Identified process improvement opportunities and collaborated internally to implement changes, achieving targeted outcomes.
Account Manager
Aetna, Inc
Blue Bell, PA
01.1998 - 06.1999
- Strengthened long-lasting client relationships through prompt, efficient attention and customer-centric solutions.
- Advocated for clients to enhance account retention.
- Facilitated customer and team meetings, and led renewal negotiations.
Marketing Coordinator
Aetna, Inc
Blue Bell
07.1996 - 01.1998
- Created customized marketing reports to enhance client presentations.
- Maintained client accounts by updating information and ensuring accuracy.
- Addressed client requests and inquiries to facilitate smooth program operations.
Education
Bachelor of Science - Marketing & Business Administration
The Pennsylvania State University
University Park, PASkills
Project planning
- Risk management
Project planning and development
Cross functional collaborationIndependent judgment and decision makingExceptional communicationAnalytical problem solvingStrategic planning
Operations management
Contract Management
Improvement initiatives
Client Relations
Personal Information
Title: Senior Project Leader
Computer Skills
MS Project, Visio, Word, Excel, PowerPoint, Access, Quickase, OneNote, Outlook, Teams b
Timeline
Senior Project Leader, Health Value Optimization
Independence Blue Cross
05.2023 - Current
Manager, Network Relations
Aetna, Inc. CVS Health
08.2018 - 05.2023
Caregiver, Fundraiser and Volunteer
Self
05.2014 - 08.2018
Senior Project Manager
Aetna, Inc.
04.2007 - 05.2014
Network Account Manager
Aetna, Inc
06.1999 - 04.2007
Account Manager
Aetna, Inc
01.1998 - 06.1999
Marketing Coordinator
Aetna, Inc
07.1996 - 01.1998
Bachelor of Science - Marketing & Business Administration
The Pennsylvania State University