Jamie Taylor
Healthcare Medical Management
Queen Creek,AZ
Summary
Dynamic healthcare leader with extensive experience working in the healthcare medical management field, excelling in value-based care strategy, and network governance. Proven track record in contract negotiation and stakeholder engagement, driving quality improvements and compliance. Adept at data analysis and team leadership, achieving significant enhancements in performance metrics and operational efficiency.
Overview
12
12
years of professional experience
Work History
Associate Director, Value Based Contracting & Provider Network Operations Governance & Oversight
OSCAR HEALTH
09.2024 - Current
- Oversaw operations of provider network management to ensure compliance with quality standards and regulations.
- Established and monitored policies governing engagement with contracted providers.
- Developed policies for network contracting activities, ensuring regulatory adherence and best practices.
- Created data standards for VBC, including analytics and reconciliation processes with providers.
- Set long-term governance goals aligned with organizational objectives and regulatory requirements.
- Defined partnerships with internal stakeholders to optimize contract efficiency through improved processes and systems.
- Directed negotiation processes for provider contracts, securing favorable terms while ensuring compliance.
- Led implementation of network governance frameworks, including operational policies and best practices.
Regional Network Contracting Manager, Western Region - FBOP
NAPHCARE
09.2022 - 09.2024
- Established and maintained hospital and physician networks through effective negotiation of reimbursement rates.
- Developed strategic relationships with executive partners to enhance network growth across western and central states.
- Negotiated and executed contracts with hospitals and physicians while achieving financial objectives.
- Coordinated bid proposals, including community healthcare research and fiscal analysis.
- Managed contracting and operational issues throughout contract lifecycles.
- Obtained, negotiated, and settled Service Level Agreements, Letters of Agreement, and claims for non-contracted providers.
- Conducted financial analysis of payer contracts, modeling projections, and providing recommendations based on alternative agreements.
Sr. Provider Network Relations Manager
ONEHOME HEALTH
01.2022 - 09.2022
- Developed and maintained relationships with physician networks, acting as primary liaison among company, payor, and providers for Home Health, DME, and Infusion services.
- Conducted market growth analysis to identify opportunities for existing and new markets.
- Ensured timely and budget-compliant delivery of stakeholder engagement outcomes.
- Collaborated with cross-functional teams to resolve escalated issues for assigned provider systems while monitoring performance against scorecards.
- Achieved monthly, quarterly, and annual activity metrics by analyzing stakeholder engagement effectiveness through digital analytics and key performance indicators.
- Managed client relations, coordinating contracting activities and market launches with Operations, Sales, Marketing, and Implementation departments.
- Facilitated provider contracting processes, including education and business account performance meetings on a monthly and quarterly basis.
Full Time Virtual Student
PMI INSTITIUTE
11.2021 - 01.2022
- Engaged in project management certification coursework
Value-Based Care Program Manager / Quality Improvement Project Manager
BLUE CROSS BLUE SHIELD OF ARIZONA
08.2019 - 10.2021
- Developed and managed programs to enhance patient outcomes while controlling costs.
- Led projects to improve HEDIS scores, ensuring compliance with NCQA standards.
- Established timelines, milestones, and metrics to evaluate program effectiveness.
- Facilitated cross-departmental communication to align initiatives and objectives.
- Maintained PMO policies and frameworks for VBC partners to achieve organizational goals.
- Monitored performance metrics including quality scores, cost savings, and patient satisfaction.
- Coordinated meetings among executive leaders and experts to define project scopes and priorities.
- Analyzed data trends to identify improvement opportunities and success areas.
Sr. Provider Network Manager
OPTUM CARE / UNITEDHEALTH GROUP
01.2016 - 01.2019
- Leveraged quality metrics to drive revenue growth through transition of providers to Accountable Care Organization models for UnitedHealth's Medicare Advantage and Medicaid populations.
- Successfully converted providers from fee-for-service to value-based care, enhancing performance outcomes.
- Monitored provider performance through monthly and bi-weekly data analytic reports, including BUR, PMLs, and chronic condition codes.
- Led provider coding, documentation, quality improvement, and clinical workgroups to enhance education and contract adherence.
- Collected data-driven quality initiatives to support HEDIS, CAHPS, NCQA, and STAR reporting requirements.
- Managed a team of over 15 employees, coaching and delegating tasks effectively.
- Conducted monthly or quarterly partner meetings to evaluate performance and create targeted action plans for quality score improvement.
- Implemented a new document management system to boost RAF scores, AWV participation, and overall quality ratings for physician practices.
HEDIS/STARS Project Manager
HEALTHCARE SUPPORT with CENTENE / BRIDGEWAY HEALTH SOLUTIONS
01.2015 - 01.2016
- Drove improvement of quality measures and Star Ratings through data analysis and team management.
- Collaborated with departments, stakeholders, and vendors to enhance data collection and quality initiatives.
- Achieved first-ever 3.0 star rating out of 4.0 in company history.
- Directed team of over 20 members across multiple territories in Phoenix.
- Monitored progress of quality initiatives, providing regular performance reports to leadership.
- Oversaw data collection, analysis, and reporting for HEDIS and STARS measures, identifying trends and gaps.
- Ensured compliance with NCQA, URAC, and CMS requirements for accurate HEDIS submissions.
- Developed processes to measure and collect data for HEDIS/Stars indicators.
Sr. Clinical Administrative Coordinator
OPTUM / UNITEDHEALTH GROUP / AVETA AZ
01.2014 - 01.2015
- Facilitated delivery of medical services for network managers, physicians, and hospitals.
- Formulated annual health assessments, attestations, charts, and clinical documentation.
- Authorized and reconciled AHA log for Aveta provider payments and nurse practitioners.
- Guided coding staff in obtaining HEDIS/STARS measurements at provider locations.
- Uncovered 1,500 medical records resulting in $2 million profit for IPA after CMS submissions.
- Increased productivity by 20% and saved $50K on temporary staffing within six months.
- Collaborated with clinical personnel to enhance quality, risk management, and compliance objectives.
Education
Bachelor’s - Applied Management
GRAND CANYON UNIVERSITY
Phoenix, AZSkills
- Effective communication
- Coaching and mentoring
- MS office
- Google Workspace Apps
- Process Map Software
- Operations management
- Accountable Care Organizations
- Systems development
- Process improvement
- Network governance
- Contract negotiation
- Value-based care strategy
- Policy development
- Healthcare compliance
- Data analysis
- Project management
- Risk assessment
- Provider relationship management
- Stakeholder engagement
- Cross-functional collaboration
- Team leadership
- Change management
- Performance monitoring
- Work Planning and Prioritization
- Critical thinking
- Relationship building
- Strategic leadership
- Regulatory compliance
- Staff management
- Technical implementation
- Data collection
- Verbal and written communication
- Hiring and training
- Project methodology
- Analytical thinking
Websites
Achievements
- Delta MU Delta Member - International Honor Society in Business
- Alpha CHI Honors Society Member - Grand Canyon University AZ Chapter
- Project Management Course Completion – Udemy, 2019
- Project Management Professional (PMI) Certification – In Progress
Milestones
- Warrant Officer / Avionics Technician & Rotary Wing Aviator - US Army
- Certified Personal Trainer
- IFFB Professional Women’s Physique Competitor, International Federation of Bodybuilding - Earned IFBB Pro Card
References
References available upon request.
Timeline
Associate Director, Value Based Contracting & Provider Network Operations Governance & Oversight
OSCAR HEALTH
09.2024 - Current
Regional Network Contracting Manager, Western Region - FBOP
NAPHCARE
09.2022 - 09.2024
Sr. Provider Network Relations Manager
ONEHOME HEALTH
01.2022 - 09.2022
Full Time Virtual Student
PMI INSTITIUTE
11.2021 - 01.2022
Value-Based Care Program Manager / Quality Improvement Project Manager
BLUE CROSS BLUE SHIELD OF ARIZONA
08.2019 - 10.2021
Sr. Provider Network Manager
OPTUM CARE / UNITEDHEALTH GROUP
01.2016 - 01.2019
HEDIS/STARS Project Manager
HEALTHCARE SUPPORT with CENTENE / BRIDGEWAY HEALTH SOLUTIONS
01.2015 - 01.2016
Sr. Clinical Administrative Coordinator
OPTUM / UNITEDHEALTH GROUP / AVETA AZ
01.2014 - 01.2015
Bachelor’s - Applied Management
GRAND CANYON UNIVERSITY
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