Elizabeth A. Garcia
San Antonio,TEXAS
Summary
Results-oriented individual aiming for a leadership opportunity that capitalizes on nursing and business leadership skills, dedication, and unwavering work ethic to enhance organizational success and innovation.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Vice President/Market President-Texas
Alignment Health
09.2025 - Current
- Develops and executes the P&L strategy for the state and has shared P&L responsibility for the plan
- Works closely with Medical Officers and collaborates with other departments to ensure overall success of the market. Meets and exceeds budget and operating goals
- Directly responsible for sales and the FMO to ensure optimal enrollment and retention of members
- Assesses, follows up and engages network providers to maximize referrals of patients to Care Centers
- Ensures that all new members are scheduled for and complete a Jump Start Assessment within the first 60 days of membership for proper coding
- Assists in the top-line activities of the market and ensures all market goals are met
- Develops strong relationships with key stakeholders including physician leaders, network physicians, hospitals and ancillary providers
- Develops, coordinates and drives JOC agendas
- Monitors market performance and implements standardized performance report cards and improvement plans for utilization and identified cost outliers; incorporates new, innovative, emerging and/or effective quality and cost control programs
- Conducts monthly market review meetings with corporate leaders
- Executes Health Plan compliance requirements in accordance with CMS regulations
- Develops and implements initiatives to increase patient satisfaction, coding accuracy, STARS, and other quality programs
- Analyzes, negotiates, and drafts contract rate and language proposals in accordance with company requirements
- Supports local provider network contracts and provides input about local requirements to corporate contracting
- Analyzes current and projected network needs from cost/utilization and competitor standpoints; recommends and establishes department metrics and sets clear expectations for staff
- Negotiated, implemented, and managed capitated and fee-for-service agreements with individually contracted Primary Care Physicians (PCP), as well as contracts with medical groups, hospitals, ancillary providers, and specialists. Administered those contracts to achieve anticipated results.
- Works with payors to maximize marketing activities, membership growth and retention; identifies, evaluates, and implements business expansion opportunities; interfaces effectively with payor representatives
- Escalates local member service issues to centralized member services
Market President/COO- Texas
Innovacare Health
06.2023 - 08.2026
- Oversee all operations in the Texas Market including strategizing for new business and growth as the Value Based Organization expands through the state.
- Oversee the Financial procedures, analyzing financial reports to ensure profitability of each service line.
- Identify opportunities for optimization, streamline operations, reduce costs, implement best practices and enhance productivity.
- Enhanced efficiencies in Innovacare’s system-wide processes and organizational development, improving service delivery.
- Collaborated with top executives to contribute to Innovacare’s strategic plan, aligning operational functions to support growth and sustainability.
- Developed and maintained relationships with key stakeholders, fostering collaboration and ensuring alignment with business objectives.
- Review the Managed Care Department Budget/Overhead Expense and identify opportunities for improvement or cost reduction/savings.
- Establish and monitor quality processes to achieve and maintain Quality Patient Measures as set by NCQA.
- Created strategic programs, practices, and policies for Value Based Care.
- Provide oversight to clinical management and collaborate with Providers and Provider leadership.
Regional Manager, Clinical Practice Performance
Healthmap Solutions
03.2023 - 06.2023
- Monitor Key Performance Indicators (KPIs) to identify trends and areas of opportunity that will guide regional strategy. Develop action plans and/or remediation strategies to address areas of opportunity.
- Develop, Monitor and report on team performance and productivity.
- Implemented organizational policies, procedures, workflows, and action plans to enhance team performance.
- Ensured collaboration and communication among multi-disciplinary teams to coordinate efforts for improved customer engagement and member outcomes.
- Developed, coached, and mentored team members, aligning their efforts with company, department, and individual goals.
- Maintain team performance according to NCQA standards including but not limited to appropriate provider and member documentation.
- Monitored practice profiles monthly to verify practices with newly attributed members received appropriate PRT assignments.
Chief Managed Care Officer (CMCO)
Gonzaba Medical Group
09.2020 - 02.2023
- Implement a plan to fuse the GMG Managed Care Department Operations more fully with the GMG Clinical Operations to improve coordination of care and resource planning.
- Enhanced efficiencies in GMG system-wide processes and organizational development to support operational excellence.
- Evaluate and identify departmental processes needing improvement, to include sub-departmental unit processes.
- Oversaw GMG managed care department to align operations with future MSO delegated services and clinic growth objectives.
- Maintained relationships with CMS managed care/insurance plans and MSO delegated contractors to ensure alignment and compliance.
- Review the Managed Care Department Budget/Overhead Expense and identify opportunities for improvement or cost reduction/savings.
- Developing plans for the Clinical Operations to meet the current and future needs of the GMG Clinic Systems for patient care.
- Ensured all utilization management, quality improvement, case management, network management, claims payment, and other operational processes complied with NCQA standards and state and federal guidelines.
- Create strategic programs, practices, and policies and procedures as it pertains to GMG Medicare Advantage Risk agreements.
- Supervised completion of RAPS goals and processes to ensure timely and accurate reporting.
- Oversee the HEDIS committee and ongoing HEDIS measures.
- Work in collaboration on all Delegation Audits- Utilization Management Network and Claims payment.
- Provide oversight to clinical management and collaborate with Providers and Provider leadership.
Director of Nursing Services- Primary Care/Urgent Care Programs
Presbyterian Healthcare Services
02.2018 - 08.2020
- Supported clinical effectiveness and integrated nursing activities within Primary Care/Urgent Care Programs through direct and indirect approaches.
- Oversaw the quality and sustainability of nursing services. Maintained adherence with Joint Commission regulations and CMS Conditions of Participation.
- Coordinate PMG wide and Service Line specific strategic direction for Primary Care nursing in coordination with the Administrator, Medical Director and COO of Primary Care.
- Collaborated with service line team to develop patient-centric care processes across care continuum, enhancing patient experience and outcomes.
- Maintain relationships with Lead Physicians, and Directors of Business Operations/Directors of Clinical Operations in the coordination and planning of activities related to nursing services and disease management in the Primary Care Service Lines.
- Coordinate PMG wide policies and procedures related to nursing clinical practice within the Specialty Care Service Programs/Regional PMG Clinics and develops in conjunction with DPOs and appropriate site leadership, specialty or regional specific policies and procedures.
- Participate actively in recruitment, selection, orientation, and evaluation of Clinic Managers.
- Collaborate with Clinic Managers to assess learning needs of clinical staff and development of nursing orientation, training, and educational programs.
- Led and facilitated project teams to develop clinical redesign and implementation for future health care needs.
- Seek opportunities to develop clinical teams by nurturing, advising and guiding peers and others.
- Evaluated the clinical team with Primary Care/Urgent Care Program Directors, Directors of Clinical Operations, and Regional Practice Administrators.
- Use clinical reasoning, which includes clinical decision-making, critical thinking, and a global grasp of the patient care situation, coupled with nursing skills acquired through a process of integrating formal and informal experiential knowledge and evidence-based guidelines to manage patient care.
- Collaborate with Health Plan to ensure compliance with Medicare Star/HEDIS measures.
- Develop action plans to close gaps on quality measures.
- Foster communications between the Health Plan and Delivery system to ensure alignment of measures.
- Ensure compliance with NCQA regulations and gather evidence to support Level III accreditation of all Primary Care sites.
Director of Practice Operations- Primary Care
Presbyterian Healthcare Services
02.2014 - 02.2018
- Responsible for the Daily Operations and financial performance of PMG Family Practice, Internal Medicine and Pediatric & Multi Specialty sites including administrative focus for the service across the insurance, primary care, specialist, inpatient and aftercare continuum.
- Worked collaboratively with the clinical and clerical staff within clinics, Service Line, Quality Management and Care Coordination services in order to achieve optimal utilization of clinic services and to achieve performance targets.
- Accountable for the customer loyalty results.
- Collaborated with service line team to develop patient centric care processes across the care continuum.
- Developed and prioritized key focus areas (Org, Business Units, and various depts.).
- Develop and accountable for the financial outcome of areas of accountability. This includes, leading the planning and budgeting processes and accountabilities for budget administration and outcomes.
- Assist in the development of FTE budget and staffing plans.
- Develop action plans for employee satisfaction.
- Oversee required results/ enforce accountability.
- Manage physician integration.
- Assist in development of recruitment plans.
- Foster communications among management.
- Oversee turnover trends and reasons.
- Reinforce manager engagement.
- Responsible for the operations of the Intel Clinic- Joint venture between Presbyterian Healthcare system and Intel Corporation.
- Work collaboratively with Connected Care Program to provide employees more personalized, evidence based, coordinated care with convenient access to for their members to a primary care site.
- Manage financial aspects of the clinic construction.
- Responsible for initiating, planning, executing, and controlling all aspects of the construction.
- Assign tasks of assembling support teams, identifying resources, assigning individual responsibilities, and developing a schedule to ensure timely completion of clinic construction.
- Review Project deliverables and ensure adherence to quality standards, communicate with Primary Care leadership regarding the status of the clinic construction.
- Interface with all areas affected by the project including radiology, laboratory, and pharmacy services as well as end users and vendors.
- Adhere and promote the core expectations of the Patient Centered Medical Home.
Education
Master - Business Administration
University of Phoenix
Phoenix, AZ01-2011
Bachelor of Science - Nursing
University of New Mexico
Albuquerque, NM01-2007
Associate Degree - Nursing
Luna Vocational Technical Institute
Las Vegas, NM01-1998
Skills
- Managing information technology
- Value Based Practice
- Fee for Service knowledge
- Nursing background
- Inpatient clinical operations
- Ambulatory clinical operations
- Managing clinical projects
- Strategic planning
- Resource management
- Cost management
- Quality measurement
- Managed Care
- Population Health
- Health Plan Contracts
- Communication skills
- Customer service skills
- Detail oriented
- Well organized
- Leadership skills
- Ability to handle multiple tasks
- Relationship building
Certification
Active RN License, Texas, Multi-State Licensure
Hobbies and Interests
Executive Leadership Committee, Recruitment/Retention Committee, Clinical Operations Committee, Medical Director meeting, Monthly Health plan meetings, Quality Committee, HEDIS Committee meeting, Leadership Albuquerque, Class of 2020, Presbyterian Promise PMG Implementation Team, Meaningful Use sub-committee, Primary Care Leadership Team, PCMH Implementation Committee, HealthFinch, Scope of Practice Committee, Nursing Leadership Council, Urgent Care Operational and Section meetings, Population Health Initiatives, NMONE, Medical Director Forums, Executive Leadership Committee Ambulatory Management Council, Ambulatory Quality Committee, PCMH Implementation Team, PCMH Guideline Task Force, PCMH/NCQA Sub-Committees, Atrisco Heritage Project Committee, Chair of Ambulatory Management Council, Co-Chair Nursing Management Council, Co-Chair of Ambulatory Management Council, Infection Control Committee (Lovelace), Co-Chair Surgical Department Committee, Product Standards Committee, Adult Religious Ministries, Member of ACT Missions Board of Directors, ACTS Core, Eucharistic Minister, Liturgical Minister, Spending time with family, Reading, Traveling
References
Available upon request
Languages
Spanish, speak, read, write
Timeline
Vice President/Market President-Texas
Alignment Health
09.2025 - Current
Market President/COO- Texas
Innovacare Health
06.2023 - 08.2026
Regional Manager, Clinical Practice Performance
Healthmap Solutions
03.2023 - 06.2023
Chief Managed Care Officer (CMCO)
Gonzaba Medical Group
09.2020 - 02.2023
Director of Nursing Services- Primary Care/Urgent Care Programs
Presbyterian Healthcare Services
02.2018 - 08.2020
Director of Practice Operations- Primary Care
Presbyterian Healthcare Services
02.2014 - 02.2018
Master - Business Administration
University of Phoenix
Bachelor of Science - Nursing
University of New Mexico
Associate Degree - Nursing
Luna Vocational Technical Institute