Leigh G. Hayden
Kansas City,MO
Summary
Results-driven, passionate, and decisive managed care leader with experience in service area expansions, program development, regulatory compliance, contract negotiation, employee development, and provider data system implementation. A detail-oriented leader with strong interpersonal skills to develop and maintain relationships within a fast-paced, high demand environment.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Associate Director, Provider Contracting
Independent Care Health Plan (iCare), Humana
02.2020 - Current
- Oversight of the contracting, credentialing, and data management departments ensuring compliance with state and federal regulations, leading service area expansions, and facilitating implementation of strategic organizational initiatives focusing on growth and innovation
- Analyze network adequacy and develop strategy to execute Medicare and Medicaid service area expansion in over 30 counties over a six year period
- Present as a subject matter expert to executive leadership, regulators, and community stakeholders
- Direct departmental prioritization to accomplish organizational goals and milestones
- Negotiate, implement, and oversee value based payment arrangements cost savings initiatives with internal stakeholders and external vendors
- Review and implement policies to procedures to support regulatory requirements
- Lead audit interviews, certifications and compliance reporting to state and federal regulators
- Support NCQA Health Plan Accreditation for Network and Credentialing implementing process improvements and creating departmental efficiencies
- Trained and developed department leaders and management staff for specific projects and ongoing operational needs.
- Leveraged data and analytics to make informed decisions and drive departmental and organizational improvements.
Network Development Systems Manager
Independent Care Health Plan (iCare)
08.2018 - 02.2020
- Provided oversite of 11 end users following my role as business lead for the implementation of a new cloud-based provider data system
- Designed staff training and provided oversight of the provider data management system
- Managed provider directory functionality and provider demographic updates
- Drafted and revised policies and procedures to maintain compliance with regulatory contracts
- Developed business requirement documentation for IT system configuration
- Facilitated departmental preparation and participation in regulatory audits
- Implemented audit programs to maintain departmental effectiveness and consistency
- Generated Health Service Delivery Tables for CMS network expansion
- Executed cost saving initiatives for residential provider contracts
- Developed and maintained network adequacy evaluation tools to identify opportunities for proactive interventions
- Led team development and assisted in project management coordination.
- Analyzed and produced recommendations on continuous system improvements.
- Developed network test and validation processes to maintain alignment with solution design.
Network Development Contract Professional
Independent Care Health Plan (iCare)
09.2015 - 08.2018
- Secured contracts with multiple target provider systems leading to multi-county expansions
- Established and maintained effective communication with network providers and community organizations to promote high quality patient care
- Developed a forum for interdepartmental collaboration and process improvement
- Analyzed network adequacy for service area expansion opportunities
- Implemented a new provider data management system, Symplr - eVIPs
- Participated in developing and negotiating quality-based readmission prevention programs
Intake Care Coordinator
Independent Care Health Plan (iCare)
09.2014 - 09.2015
- Educated Medicare and Medicaid enrollees about plan benefits and services
- Effectively engaged enrollees to participate in their personal health outcomes
- Completed health risk assessments in accordance with state and federal regulations for Medicare and Medicaid enrollees
- Advocated and coordinated care for enrollees experiencing difficulties navigating the health care system.
- Monitored, tracked, and conveyed important enrollee information to healthcare providers to help optimize treatment planning and care delivery
Permanency Case Manager
KVC Behavioral Healthcare
06.2013 - 07.2014
- Facilitated best interest staffing for permanency placements such as adoption or guardianship
- Evaluated foster and adoptive placements by completing home studies
- Developed court reports and testified on behalf of minors in state custody
- Provided orientation and training for new staff
- Recruited and interviewed adoptive resources for children in the foster care system
- Developed and implemented comprehensive case management plans to address needs and goals
- Utilized trauma-informed approach to promote healing and empowerment of minors
Education
Bachelor of Science -
Southeast Missouri State University
Skills
- Database Coordination
- Budget Development
- Project Management
- Process Improvement
- Key Relationship Development
- Strategic Leadership
- Recruiting and Interviewing
- Internal and External Audits
- Business Operations
- Compliance Reporting
- Presentations
- Internal Policy Implementation
Certification
MRA Frontline Leadership Certificate
Motivation and Trust Building
Communication Skills
Effective Training Techniques
Conflict Resolution
Community Leadership
Courage MKE Board of Directors
Board Secretary 2020-2022
Timeline
Associate Director, Provider Contracting
Independent Care Health Plan (iCare), Humana
02.2020 - Current
Network Development Systems Manager
Independent Care Health Plan (iCare)
08.2018 - 02.2020
Network Development Contract Professional
Independent Care Health Plan (iCare)
09.2015 - 08.2018
Intake Care Coordinator
Independent Care Health Plan (iCare)
09.2014 - 09.2015
Permanency Case Manager
KVC Behavioral Healthcare
06.2013 - 07.2014
Bachelor of Science -
Southeast Missouri State University
MRA Frontline Leadership Certificate
Motivation and Trust Building
Communication Skills
Effective Training Techniques
Conflict Resolution
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