Heather Martinez
Blue Cross Blue Shield of Kansas
Bel Aire,KS
1
Certification
10
years of professional experience
Strategic healthcareleader with 15 + years experience in healthcare strategy, clinical transformation, provider networks, value based care and population health. Provide success driving quality, affordability, growth and enterprise performance.
Work History
Director Medicare Programs
1 Year 9 Months- Oversaw implementation of process improvements, increasing efficiency across departments supporting Medicare Advantage, Part D, Medigap lines of business.
- Analyzed data trends to inform decision-making and drive program enhancements.
- Lead strategic repositioning of Medicare Advantage to a focused performance oriented model centered on core Kansas markets, to build capabilities and sustainability.
- Developed and communicated MA strategic roadmap aligning product, risk adjustment, provider engagement, clinical programs, pharmacy, sales, marketing around common performance goals and financial improvement objectives.
- Established county level strategic frameworks, to guide MA investments, retention, and growth decisions, incorporated framework into bid strategy and market discussions.
- Led cross functional 2027 bid development activities, to evaluate bid, benefit design changes, RAF assumptions and financial recovery levers.
- Advanced Medicare supplement and broker strategy work, development of Med Supp market analyses, commissions strategy discussions, migration modeling, competitive intelligence reviews, and AEP planning to address impact of SARs.
- Led establishment of structured provider engagement strategy focused on Risk adjustment, stars, Annual visits, total cost of care, and provider education.
- Built Medicare market intelligence capabilities, across national MA trends, competitive positioning, Medicare market shifts, star rating changes, V28 impacts, Part D redesign, market share dynamics.
Executive Director
2 Years 5 Months- Led execution of MA market strategy, growth planning and market performance initiatives.
- Developed executive reporting market enrollment, provider engagement, risk adjustment and financial performance.
- Partnered with Sales, Provider Networks, Clinical, Finance, and Operations to align Medicare growth strategies.
- Directed AEP planning, sales performance reporting, and executive presentations
- Evaluated market expansion, service area strategy, provider engagement and value based care opportunities.
- Collaborated with cross-functional teams to align organizational goals with regulatory compliance requirements.
- Analyzed market trends to identify opportunities for program expansion and improved service offerings.
- Developed and implemented operational workflows to streamline processes and improve service delivery efficiency.
Senior Program Manager
3 Years- Led strategy and implementation of accountable care and value based care initiatives acress provider networks.
- Designed and managed value based payment models and alternative reimbursement arrangements.
- Developed and launched provider pilots to improve quality, reduce total cost of care and exchange member outcomes
- Partnered with physicians, health systems, and executive leaders to advance population health and provider performance.
- Drove initiatives focused on quality, risk adjustment, preventative care, utilization management and performance across Government programs .
- Collaborated across network, clinical, finance, operations and provider teams.
- Mentored transformation consultants in education, best practices, fostering professional growth and development.
Senior Clinical Transformation Manager
3 Years 3 Months- Led enterprise clinical transformation initiatives across Commercial, Medicare, Medicaid and Individual lines of business with ACOs.
- Facilitated stakeholder engagement and change management practices with ACOs to implement strategies to improve affordability, reduce medical costs, and optimize total cost of care.
- Partnered with clinical, operational, provider and executive leaders to drive sustainable quality improvement initiatives.
- Developed business cases, performance metrics and implementation plans for clinical transformation programs.
- Used analytics to identify opportunities, monitor performance and measure financial and clinical outcomes.
- Presented recommendations and results to senior leadership, translating complex analysis to actionable strategies.
Education
Master of Arts - Healthcare Administration
Master of Science - Nursing
Skills
Relationship building
Strategic planning
Verbal and written communication
Decision-making
Operations management
People management
Team management
Creativity and innovation
Strategies and goals
Market analysis
Competitive and Market intelligence
Certification
Registered Nurse
Certified professional coder
Certified risk coder
Timeline
Director Medicare Programs
Blue Cross Blue Shield of Kansas
01.2025 - CurrentRead More
Executive Director
Unitedhealthcare Medicare & Retirement
08.2022 - 01.2025Read More
Senior Program Manager
UnitedHealthcare Clinical Services
08.2019 - 08.2022Read More
Senior Clinical Transformation Manager
UnitedHealthcare Clinical Services
05.2016 - 08.2019Read More
Wichita State University
Master of Science from Nursing
Read More
Capella University
Master of Arts from Healthcare Administration
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