Danielle McDonald
Tampa,FL
Summary
Experienced healthcare professional with a solid track record at Humana, specializing in client relations and negotiation. Achieved 100% accuracy in contract rebids while enhancing provider networks and ensuring compliance. Expertise in community outreach and relationship development, underpinned by strong analytical skills and cultural sensitivity. Consistently aims to improve healthcare delivery through strategic partnerships and innovative solutions.
Overview
20
20
years of professional experience
Work History
PROVIDER CONTRACTING PROFESSIONAL 2
Humana
12.2022 - Current
- Resolved concerns raised by providers about health plans.
- Facilitated prompt escalation of claim disputes.
- Managed compliance initiatives for State and Humana guidelines in LTC providers.
- Oversees network adequacy across five counties in Region 6.
- Coordinate regular meetings with key providers to oversee service levels.
- Conducted 4 to 8 field visits to par and non-par providers weekly.
- Negotiated rates to finalize contracts with providers.
- Conducted thorough audits upon contract completion.
- Help manage and repaper multi-regional agreements at a rate of 25 per month.
- Coordinated and processed 40 provider re-credentialing cases across various regions each month.
- Facilitated interactions between provider and claims/billing staff.
- Completed the 2023 ITN contract rebid for the state of Florida with 100 percent accuracy
FLORIDA LTC MANAGER
Humana
11.2018 - 12.2022
- Supervised team of 11-14 employees.
- Managed multi-regional Florida counties with a client base exceeding 2,000.
- Handled client conflict resolution and day-to-day operations.
- Performed field visits to determine appropriate service provisions.
- Supervised staff to ensure adherence to state and HIPPA regulations.
CLINICAL CARE COORDINATOR
Kepro
10.2017 - 10.2018
- Ensured resolution of care plan concerns through direct client and family advocacy.
- Reviewed clients’ medical history and provide care and placement options
- Encouraged constructive interactions between clients, families, and healthcare teams.
- Collaborated with providers and plans to enhance Person & Family Engagement efforts.
- Provided guidance to clients, families, and providers on accessing community resources.
- Identified high-risk target populations in coordination with data analysts.
SOCIAL WORKER LEAD
Evolution Health
01.2016 - 06.2017
- Assessed needs of clients to create customized care plans and identify resources.
- Reviewed clinical assignments for third-party payor compliance.
- Established and sustained relationships with external agencies.
- Created a comprehensive statewide resource guide for healthcare providers and clients.
CARE MANAGER SUPERVISOR
Humana-American Eldercare, Inc.
08.2004 - 10.2015
- Oversaw performance and development of 15 staff members.
- Oversaw daily operations with a focus on efficiency.
- Ensured compliance with organization policies, state mandates, and HIPAA regulations.
- Conducted monthly audits of client charts to ensure compliance with AHCA contract requirements.
- Facilitated networking between care management staff and service providers.
- Revamped training manuals for new hires to ensure statewide consistency.
- Coordinated grassroots initiative with local and state officials.
Education
M.S.W - Social Work
University of South FLorida
TampaSkills
- Client Relations
- Negotiation
- Community Outreach
- Administration & Policy Development
- Compliance Training Oversight
- Talent Enhancement
- Candidate Interviewing
- Long Term Care/Medicaid
- Client Needs Identification
- Effective Response Communication
- Analytical and critical thinking
- Remote office availability
- Decision-making
- Cultural awareness
- Recordkeeping/Data Entry
- Problem resolution
Timeline
PROVIDER CONTRACTING PROFESSIONAL 2
Humana
12.2022 - Current
FLORIDA LTC MANAGER
Humana
11.2018 - 12.2022
CLINICAL CARE COORDINATOR
Kepro
10.2017 - 10.2018
SOCIAL WORKER LEAD
Evolution Health
01.2016 - 06.2017
CARE MANAGER SUPERVISOR
Humana-American Eldercare, Inc.
08.2004 - 10.2015
M.S.W - Social Work
University of South FLorida
Similar Profiles
Monifah CocroftMonifah Cocroft
Healthcare Customer Service Representative at HumanaHealthcare Customer Service Representative at Humana
Jacqueline AugustinJacqueline Augustin
Lead Medical Assistant 4 at HumanaLead Medical Assistant 4 at Humana
Adeshola K Adewunmi, M.DAdeshola K Adewunmi, M.D
Regional Medical Director at HumanaRegional Medical Director at Humana
Neva LouisNeva Louis
DMS Sales Agent at HumanaDMS Sales Agent at Humana
Dylan WhitneyDylan Whitney
Lead Landscaper at Sweet William Garden & DesignLead Landscaper at Sweet William Garden & Design