Jessica Yasher
Harrisburg,Pa
Summary
Ambitious healthcare leader and nurse, skilled in a diverse background of clinical nursing; health insurance utilization management, provider network management and operations/administration for over 20 years. Quickly learned the skills and industry to build teams, achieving a high level of success. Dedicated healthcare professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
21
21
years of professional experience
Work History
Director, Health Plan Operations and Administration
AmeriHealth Caritas Pennsylvania
04.2019 - Current
- Oversight of day-to-day health plan operations for AmeriHealth Caritas PA and AmeriHealth Northeast
- Ensure compliance of state program contractual and regulatory requirements (benefit and payment rules, data and information submission specifications, performance and service level requirements, etc.)
- Act as a liaison between the state, health plan and enterprise functions
- Proactively identify risks that would impact the Plan’s ability to meet enterprise and local strategic and financial goals and develop strategies to mitigate the risks
- Convene regular operational meetings at the plan to include management team and stakeholders related to quality, case management, provider network management, compliance, and community outreach, to facilitate coordination of plan activities.
Director, Provider Network Management
AmeriHealth Caritas Pennsylvania
01.2014 - 04.2019
- Developed new provider contracts that support innovative services for high risk members based on the Community Based Care Model with the Pa Department of Human Services
- Strategically planned, developed and successfully completed provider networks in ACP and AHN (Medicaid), VIP Cares (Medicare) and AmeriHealth Community Health Choices products in all Pennsylvania regions with the exception of the Philadelphia region
- Excellent understanding and implementation of all local, state and federal regulations related to Health Choices including provider network adequacy; care management of members; contracting, policies and processes
- Responsible for all provider communication and education needs; liaison with provider community
- Active member in all quality committees and management of initiatives such as HEDIS; CAHPS; NCQA; ensured development of process improvements to meet identified needs through provider satisfaction surveys.
Director, Utilization Review
AmeriHealth Caritas Pennsylvania
01.2011 - 01.2014
- Led new business expansion three times (Three county expansion; New West; Northeast) over a period of 12 months for Utilization Management Department including engagement for all business requirements; interviewing, hiring and training coordination for all UM functions (additional 20+ FTE's); RFP submission; and reference and resource creation
- Knowledgeable of Medicaid state regulatory requirements; assisted with RFP submissions and worked collaboratively with other program directors for new business/growth opportunities for the company
- Developed UM standards, workflows and policies to achieve best outcomes by monitoring utilization trends from both the regional and corporate perspective
- Continually evaluated the congruence and alignment between health management programs and related medical practice guidelines, UM criteria and case management programs.
Manager of Utilization Management
01.2006 - 01.2010
Clinical Care Nurse
Milton S. Hershey Medical Center
01.2003 - 01.2005
Education
MBA - Health Care
Clarion University of Pennsylvania
Clarion, PA06.2024
Masters of Nursing Administration -
University of Phoenix
01.2017
Business classes -
Shippensburg University
01.2012
Bachelors of Science in Nursing -
Penn State University
01.1998
Skills
- Business Administration
- Staff Development
- Contract Management
- Staff Management
- Operations Management
- Project Coordination
- Project Management
- Legal and Regulatory Compliance
- Contract and Vendor Management
Personal Information
Title: RN, MSN
References
References available upon request
Timeline
Director, Health Plan Operations and Administration
AmeriHealth Caritas Pennsylvania
04.2019 - Current
Director, Provider Network Management
AmeriHealth Caritas Pennsylvania
01.2014 - 04.2019
Director, Utilization Review
AmeriHealth Caritas Pennsylvania
01.2011 - 01.2014
Manager of Utilization Management
01.2006 - 01.2010
Clinical Care Nurse
Milton S. Hershey Medical Center
01.2003 - 01.2005
MBA - Health Care
Clarion University of Pennsylvania
Masters of Nursing Administration -
University of Phoenix
Business classes -
Shippensburg University
Bachelors of Science in Nursing -
Penn State University
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