Jayden Vu
Anaheim,CA
Summary
Dedicated and results-oriented Provider Relations Manager with 10 years of experience in cultivating and managing relationships within the healthcare industry and start-up environment. Seeking the Director of Provider Network Operations to leverage expertise in fostering mutually beneficial partnerships, optimizing network performance, and contributing to the strategic success of Cal Optima serving the underserved population in Orange County.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Sr. Manager - Provider Relations & Contracting
Clever Care Health Plan
01.2020 - Current
- Responsible for both contracting and overseeing provider network maintenance, business development, and provider relations across Orange, San Diego and Los Angeles, including all provider types such as IPAs, ancillaries, supplemental vendors, and individual providers in total of over 2500 PCPs and 15,000 specialists
- Conduct multiple IPA onboarding orientations and Joint Operating Committee (JOC) sessions to ensure proper communication and set clear expectations for all involved organizations, resulting in positive and successful partnership with more than 50 contracted IPAs
- Facilitate C-level executives and Vice Presidents (VPs) on specific projects, engaging in high-level discussions with provider partners and key stakeholders on various topics related to growth, provider satisfaction, quality enhancement, gap closures and product designs
- Coach and guide a team of 4 Field Representatives to proficiently carry out key responsibilities, ensure proper provider service quality and effective collaboration with other departments such as Community Engagement, Sales & Marketing, Utilization Management (UM), Quality/HEDIS and Compliance
- Developed the inaugural playbook for community-based initiatives, strategically designed to elevate brand awareness, foster a positive organizational presence, and enhance community health and wellness including health fairs, informative doctor talks, and collaborations with provider partners and local non-profit organizations to amplify outreach efforts and patient education
- Pioneered and successfully organized the company's first joint provider/broker/stakeholders events, marking a significant milestone in fostering interest, success, and growth across multiple levels of the organization
- Represent the organization at various community and provider events, conducting TV/Radio interviews to ensure positive engagement and reinforcement of Clever Care's message and values throughout the 3 counties
- Assist internal departments (IT, Quality, Compliance, Sales & Marketing, Community Engagement) on developing successful system/process throughout different stages to further improve efficiency
- Analyze diverse member and provider reports, extracting key insights and develop targeted efforts aimed at minimizing member disenrollment, maximizing growth while enhancing member satisfaction
- Conducted performance evaluations, compensations and hiring to maintain appropriate staffing requirements.
Network Manager
Regal Medical Group
12.2017 - 01.2020
- Responsible for recruitment and contract negotiation with PCPs in Orange county, converted standard contracts to semi/exclusivity by presenting different propositions, financial impact reports to streamline practices effectively
- Educate and assist providers on different lines of business under Regal, including Medi-Cal line of business with CalOptima
- Successfully brought in 17 contracts/conversions with over 30 PCPs in 2019
- Responsible for network maintenance and growth for the Vietnamese market by being liaison between internal departments and 100+ PCPs, ensuring seamless provider clinic operations while enforcing HIPPAA/ DHCS/ DMHC/ IPA guidelines
- Collaborated with multiple health plans, FMOs and community organizations to develop business and marketing strategies, build strong presence in the market and improve brand recognition
- Oversight of database maintenance and accuracy through different resources, main contact for all escalated issues regarding contracts, claims, eligibility, quality and utilization management
Associate Network Manager
Regal Medical Group
12.2016 - 12.2017
Network Specialist
Regal Medical Group
03.2016 - 12.2016
- Responsible for complete onboarding process for both PCP/specialist offices to ensure office staff adhere to IPA important guidelines, policies and procedures, and fluent at navigating portal system
- Provided support and performed as a liaison to resolve any issues regarding claims, eligibility, credentialing, contracting and grievances between all providers (PCPs, specialists, ancillary, hospitals) and internal departments
- Ensured proper completion from providers on all CMS and IPA initiatives such as FDR Attestations, Cal Optima Attestations and other annual training requirements
- Attended Medicare 101 and sales meetings to educate prospects on benefits during AEP/OEP, and performed onsite visit to over 80 clinics monthly in North Orange county region
First Impression Specialist
Regal Medical Group
08.2014 - 03.2016
- Assisted members with issues regarding authorizations, eligibility, benefits, and services to maintain member satisfaction
- Assisted providers with any questions during off-site projects (PCP exclusivity, Open Enrollment Period, PCP Termination ) and performed as a liaison to ensure proper care coordination
- Hosted New Member Orientations and Medicare 101 Meetings to educate members about benefits, missions, and values of the organization
- Trained newly hired employees by demonstrating how to properly perform job responsibilities and provided support as requested
Front Desk Admin
Sleep Medicine, John Saito
04.2012 - 08.2014
- Implemented and maintained office policies and procedures to enhance clinic workflow
- Coordinated patient scheduling, registration and assistance on general questions
- Managed insurance verification, collaborated with billing staff and ensure accurate documentation and invoicing, oversight of authorization process including urgent requests and appeals
- Most patients were Cal Optima Medi-Cal and dual beneficiaries
Education
Bachelor of Science - Health Care Administration
California State University
Long Beach, CA2013
Associate - Arts, Liberal Studies
Orange Coast College
Costa Mesa, CA2011
Skills
- Effective communication
- Bilingual (Vietnamese)- Professional level
- Teamwork
- Creativity
- Adaptability
- Project management
- Attention to details
- Partnership Development
- Strategic Planning
- Start-up experience including process design and implementation
Accomplishments
- Implemented a successful process for contracting and onboarding activities within the provider network during the startup phase, which added multiple IPAs and ancillaries spanning across three counties. The outcome ensured network adequacy, laying a solid foundation for Clever Care's initial launch in 2021.
- Led the initiation and growth of the Acupuncture network from its inception to a current count of over 900 providers and still expanding.
- Collaborated closely with C-level executives and VPs to devise strategies and plans focused on driving network growth and provider satisfaction, specifically tailored to the needs of our targeted population. Achieved a remarkable growth of membership year over year, progressing from 0 to currently 15,000 lives over the last 4 years.
- Successfully rebuilt the brand of Regal/ADOC medical group within North Orange county region by improving the service quality, optimizing provider engagement and support with all PCP/specialist clinics throughout the community
Certification
• Spring 2012 & 2013 Dean's Honor List for Outstanding Scholastic Achievement from CSU Long Beach
• UCLA Student Association Recognition for Community Partnership in 2017, 2018 & 2019
• First Aid / CPR certified by the American Heart Association
Timeline
Sr. Manager - Provider Relations & Contracting
Clever Care Health Plan
01.2020 - Current
Network Manager
Regal Medical Group
12.2017 - 01.2020
Associate Network Manager
Regal Medical Group
12.2016 - 12.2017
Network Specialist
Regal Medical Group
03.2016 - 12.2016
First Impression Specialist
Regal Medical Group
08.2014 - 03.2016
Front Desk Admin
Sleep Medicine, John Saito
04.2012 - 08.2014
Bachelor of Science - Health Care Administration
California State University
Associate - Arts, Liberal Studies
Orange Coast College
• Spring 2012 & 2013 Dean's Honor List for Outstanding Scholastic Achievement from CSU Long Beach
• UCLA Student Association Recognition for Community Partnership in 2017, 2018 & 2019
• First Aid / CPR certified by the American Heart Association
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