Racheal Angel
Summary
Results-driven and strategic healthcare professional with a proven track record in optimizing provider network performance. Offering extensive experience in developing and implementing initiatives to enhance operational efficiency, drive cost savings, and improve overall network quality. Adept at fostering collaborative relationships with healthcare providers and stakeholders to ensure seamless delivery of services. Skilled in data analysis, contract negotiations, and performance metrics to achieve and exceed organizational goals. Possess a comprehensive understanding of healthcare regulations and industry trends. Committed to driving continuous improvement in provider relations and network optimization to deliver exceptional value to both the organization and its stakeholders.
Overview
13
13
years of professional experience
Work History
Director of Provider Network Performance
Centene
01.2023 - Current
- Strategic Leadership: Develop and execute a comprehensive strategy for value-based payments, aligning with the organization's mission and objectives.
- Program Design and Implementation: Design, implement, and manage value-based payment programs, ensuring alignment with industry best practices and regulatory requirements.
- Stakeholder Collaboration: Collaborate with internal stakeholders, including executives, finance, and clinical teams, as well as external partners such as payers and providers, to drive successful program adoption and implementation.
- Performance Monitoring: Establish metrics and KPIs to measure the effectiveness and success of value-based payment initiatives, regularly analyzing and reporting on performance.
- Compliance and Risk Management: Stay abreast of relevant regulations and guidelines, ensuring compliance with healthcare laws and regulations. Mitigate risks associated with value-based payment programs.
- Educational Initiatives: Develop and deliver educational programs to ensure internal and external stakeholders understand value-based payment concepts, benefits, and implications.
- Continuous Improvement: Identify opportunities for improvement in existing programs, processes, and systems, and drive initiatives to enhance efficiency and effectiveness.
- Market Research: Stay informed about industry trends, market dynamics, and emerging technologies related to value-based payments, and incorporate insights into strategic planning.
- Relationship Management: Cultivate and maintain strong relationships with healthcare providers, including physicians, hospitals, clinics, and other healthcare entities.
- Strategic Partnerships: Develop and execute strategies to establish strategic partnerships with providers that align with organizational goals and enhance the overall healthcare ecosystem.
- Contract Negotiation: Lead contract negotiations with providers, ensuring favorable terms and conditions while maintaining compliance with regulatory requirements.
- Issue Resolution: Act as a primary point of contact for provider-related issues, addressing concerns, resolving disputes, and ensuring a positive and collaborative working relationship.
- Communication and Education: Communicate organizational policies, initiatives, and expectations to providers, and provide education on relevant industry changes, ensuring alignment and understanding.
- Provider Network Development: Collaborate with internal teams to identify, recruit, and onboard new providers, expanding and optimizing the provider network to meet organizational needs.
- Performance Monitoring: Establish key performance indicators (KPIs) and metrics to evaluate provider performance, working closely with quality improvement teams to enhance outcomes and satisfaction.
- Cross-Functional Collaboration: Collaborate with other departments such as finance, legal, and operations to ensure seamless coordination and alignment in provider-related initiatives.
Executive Director/Compliance Officer
Corus Health
07.2015 - 11.2022
- Manage all business and clinical operations with multiple divisions and functions across the company
- Direct reports include Director level positions
- Develop and implement annual budgets and financial goals for the agency which includes Home Health Care, Hospice Care, Personal Care, Billing services, Human Resources and Physician services
- Developed and implemented agency wide emergency preparedness practice guidelines to ensure patient and employee safety thought a worldwide pandemic
- Review and approve annual policy and procedures and ensure alignment with Medicare, Medicaid, and state regulations
- Prepared agency for department of health surveys and received a passing survey audit on Covid safe practices
- Participate in New Mexico Home Health and Hospice Association to guide and move towards policy changes to help New Mexico get the community-based care needed
- Develop and implement business development goals and strategies with a focus on growth and innovation within the healthcare systems
- Negotiated new annual contracts and service agreements with vendors to achieve prime pricing.
- Provided exceptional counseling, case management, education and job training to diverse client base.
- Established new customer service and problem resolution processes to improve client satisfaction rates.
- Fostered work culture of collaboration and inclusion to increase morale and reduce turnover.
- Drove strategic improvements to enhance operational and organizational efficiencies.
- Developed Payment innovation strategies example Developed a white paper for NMMIP to allow for a Palliative care payment model.
- Aligned department vision, goals and objectives with company strategy to achieve consistently high results.
- Spearheaded matrix organizational plan with clear roles and responsibilities to enhance processes, maintain quality and enforce regulatory compliance.
- Spearheaded successful business development initiatives aligned with company's strategy and core competencies.
- Negotiated contracts with vendors, securing favorable terms while adhering to budgetary constraints.
Director of Operations
Atrinea Health
01.2011 - 01.2015
- Improved operational efficiency by streamlining processes and implementing innovative solutions.
- Identified opportunities for cost reduction and process improvement, implementing changes that resulted in significant savings.
- Established strong partnerships with vendors, suppliers, and key stakeholders to improve collaboration and ensure alignment with business requirements.
- Conducted regular performance reviews to assess team progress, providing constructive feedback and guidance for continuous improvement.
- Delivered exceptional customer experiences by implementing strategies focused on meeting evolving needs and expectations by creating a centralized inbound call center with national metrics.
- Developed a outbound contact center focused on engaging patients who are in need of annual wellness visits. Used this strategy to create successful strategies to improve CMS STARS along with medicaid HEDIS scores with several large payor groups.
- Growth focused mission with growth from 4 clinical in New Mexico to 14
- Achieved NCQA certification in 3 clinics
Education
Bachelor of Business Administration -
University of New Mexico
Albuquerque, NM04.2022
Certification in Health, Wellness and Public Safety -
Central New Mexico Community College
Albuquerque, NM04.2021
Associate of Applied Science - Integrated Studies
Central New Mexico Community College
Albuquerque, NM04.2019
Skills
- Team Oversight
- Policy and Procedure Adherence
- Team Leadership
- Conflict Resolution
- Program Leadership
- Stakeholder Relations
- Project Management
- Financial Management
- Marketing
- Strategic planning
- Business Development
- Budgeting
Timeline
Director of Provider Network Performance
Centene
01.2023 - Current
Executive Director/Compliance Officer
Corus Health
07.2015 - 11.2022
Director of Operations
Atrinea Health
01.2011 - 01.2015
Bachelor of Business Administration -
University of New Mexico
Certification in Health, Wellness and Public Safety -
Central New Mexico Community College
Associate of Applied Science - Integrated Studies
Central New Mexico Community College
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