Open To Work
JANICE HINKLEDIRE
Senior Provider Partnership Manager (Strategic Provider Engagement & Performance)
Bumpass,VA
Work Preference
Summary
Accomplished healthcare professional specializing in provider performance analytics and value-based care initiatives. Expertise in analyzing claims and operational data to identify risks and drive quality improvements, leading to successful outcomes in shared-risk payment arrangements and enhanced compliance across multiple markets.
Overview
1
1
Certification
17
17
years of professional experience
Work History
Senior Provider Partnership Manager
MAGELLAN HEALTH
11.2020 - Current
- Serve as a strategic liaison between behavioral health providers and internal stakeholders, leveraging claims, utilization, quality, and operational data to improve provider performance, support organizational initiatives, and enhance healthcare outcomes.
- Manage strategic relationships with behavioral health providers across multiple markets, serving as a trusted advisor to executive, clinical, and operational leadership.
- Lead implementation and oversight of 18 value-based care contracts, including shared-risk payment arrangements focused on quality improvement and cost containment.
- Partner with commercial and behavioral health providers to analyze claims, quality, utilization, and readmission data to improve performance outcomes.
- Successfully supported a California commercial provider in achieving all quality performance targets while reducing readmissions by 2.9%, resulting in a shared-risk incentive payment of $12,800.
- Successfully supported a second California commercial provider in reducing readmissions by 12.8% while achieving all quality performance targets, resulting in a shared-risk incentive payment of $20,000.
- Analyze claims, authorization, utilization, and performance trends to identify operational risks, quality gaps, and opportunities to improve efficiency and cost management.
- Conducted performance reviews using readmission, utilization, quality, and value-based care metrics to inform provider improvement initiatives.
- Present complex healthcare and operational data to executive provider leadership, translating findings into actionable business strategies.
- Conduct claims validation and correction reviews to improve reporting accuracy and support successful value-based payment outcomes.
- Collaborate with claims, training, credentialing, quality, and network operations teams to develop provider billing resources and corrected claims guidance.
- Identified recurring claims and authorization error patterns and collaborated with internal departments to enhance reporting capabilities, root cause analysis, and operational workflows.
- Support audit activities, credentialing reviews, compliance initiatives, and provider performance improvement efforts.
- Developed and delivered provider education programs targeting billing practices, documentation requirements, operational workflows, and quality improvement strategies.
- Chosen for Magellan's DEI Council and acted as an Ambassador Committee member.
- Named Finalist for the One CenTeam Inclusive Leadership Award.
Practice Clinical Specialist
UNITEDHEALTH GROUP
09.2009 - 11.2020
- Served as behavioral health subject matter expert, facilitating provider engagement and supporting utilization management and quality initiatives to ensure compliance with regulatory standards.
- Collaborated with providers, care management teams, and operational stakeholders to improve service delivery, healthcare outcomes, and regulatory compliance.
- Participated in audit activities and claims reviews to identify provider performance gaps and contributed to operational improvement efforts, leading to enhanced service delivery.
- Supported Virginia Medicaid behavioral health programs through claims review, provider engagement, compliance monitoring, and quality improvement initiatives, enhancing overall program effectiveness.
Education
Master of Social Work -
West Virginia University
Morgantown, WVSkills
- Healthcare Program Integrity
- Payment Integrity Support
- Claims Analysis
- Claims Resolution
- Provider Performance Analytics
- Utilization Management
- Value-based care
- Quality Improvement
- Readmission strategies
- Process Improvement
- Audit & Compliance Support
- Root Cause Analysis
- Quality assurance
- Provider Education & Training
- Authorization Review
- Data analysis
- Technology & Analytics
- Microsoft Excel
- Tableau
- Claims Systems
- Provider Portals
- Healthcare Reporting Platforms
- Performance Dashboards
- Cross-Functional Leadership
- Stakeholder Engagement
- Strategic relationships
- Performance Dashboards
- Data analysis
Professional Recognition
- Outstanding Performance Rating, Magellan Health, 2025
- Finalist, One CenTeam Inclusive Leadership Award
- DEI Council Member
- INSPIRE Co-Lead
- Presenter, Association for Ambulatory Behavioral Healthcare (AABH) Conference
Certification
- Licensed Clinical Social Worker (LCSW), Virginia, 0904008337, 06/30/28
- Licensed Clinical Social Worker (LCSW), Pennsylvania, CW016987, 02/28/27
Professional Highlights
- 20+ years of healthcare and managed care experience spanning behavioral health, provider operations, quality improvement, claims oversight, and value-based care.
- 5 years supporting commercial payer initiatives and value-based payment programs.
- Managed and supported 18 value-based care agreements, including shared-risk payment models.
- Supported approximately 200 behavioral health providers with claims, billing, authorization, and operational issue resolution.
- Achieved provider engagement rates exceeding 90% across assigned provider networks.
- Successfully partnered with California commercial providers to achieve measurable reductions in readmissions and earn shared-risk financial incentives.
- Recognized as a trusted subject matter expert in provider operations, performance improvement, claims resolution, and healthcare transformation.
- Outstanding Performance Rating recipient and Finalist for the One CenTeam Inclusive Leadership Award.
Timeline
Senior Provider Partnership Manager
MAGELLAN HEALTH
11.2020 - Current
Practice Clinical Specialist
UNITEDHEALTH GROUP
09.2009 - 11.2020
Master of Social Work -
West Virginia University