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Rebecca McSwain
Vice President, Medical Management
Lago Vista,TX
Overview
25
25
years of professional experience
7
7
years of post-secondary education
Work History
Senior Vice President, Enterprise Care and Value
Wellmed medical management, inc.
, Texas
06.2024 - 10.2025
- Provide strategic direction and enterprise-wide oversight for Medical Management programs, ensuring alignment with organization goals and values.
- Lead Utilization Management (UM) and Care Management (CM) functions, driving performance through multiple layers of leadership and operational teams.
- Accountable for program outcomes, quality metrics, and operation efficiency across diverse healthcare delivery models.
- Direct long-term planning initiatives to integrate departmental activities into the broader strategic vision of the organization.
- Ensure compliance with regulatory standards while promoting innovation and continuous improvement across clinical and administrative functions.
- Foster a culture of collaboration and engagement across multidisciplinary teams within a complex matrix organization.
- Accountable for budgetary planning and fiscal management for UM/CM program, supporting financial sustainability and growth.
- Leverage data analytics tools such as Tableau and Power BI to monitor performance, identify trends, and inform strategic decisions.
Senior Vice President, Medical Management Ops, Greater Texas Region
Wellmed medical management, inc.
, Texas
06.2020 - 06.2024
- Oversight of a regional multidisciplinary team comprising of care management, business analysts, and hospitalist operational staff.
- Accountable for planning, organizing, and directing the administration of all Medical Management Programs, such as Population Management, Utilization Management, and Quality programs.
- Accountable for budget and resource management for Greater Texas Region-encompassing Austin, Corpus Christi, El Paso, Rio Grande Valley, San Antonio, and Southwest New Mexico.
- Member of a matrix leadership team accountable for departmental and regional performance metrics.
- Accountable for implementation and monitoring regional and market care and value initiatives.
- Utilize data analysis for performance tracking, enabling Plan-do-study-act (PDSA) model to ensure successful implementation of One Team Model.
- Successful implementation of One Team Model concept to improve patient experience and enhance care coordination.
Vice President, Medical Management Operations, SWTX Region
Wellmed medical management, inc.
, Texas
02.2017 - 06.2020
- Responsible for planning, organizing, and directing the administration of all Medical Management Programs, such as Population Management, Utilization Management, and Quality programs.
- Oversight of three direct reports and 118 indirect reports to ensure adherence to CMS and Delegation requirements for all delegated functions under care management and utilization management activities.
- Accountable for budget and resource management for Southwest Texas sub region-encompassing El Paso, Corpus Christi, Rio Grande Valley, and Southwest New Mexico.
- Accountable for implementation and monitoring SWTX Care and Value initiatives.
- Operational liaison for Regional and Market Vice Presidents to implement care and value initiatives.
- Managed and optimized departmental relationships with acute and post-acute care facilities.
- Successful implementation of Care Management redesign to improve patient experience and outcomes during their healthcare journey.
- Promoted to SVP, Medical Management Operations for Greater Texas Region.
Director, Care Management-SWTX Region
Wellmed medical management, inc.
, Texas
05.2014 - 02.2017
- Responsible for planning, organizing, and directing regional operations for Care Management services in El Paso, Corpus Christi, and Rio Grande Valley.
- Maintained compliance with approved standardized guidelines, government mandated regulations and contractual agreements, to include NCQA, URAC and CMS.
- Participated in development of process improvement initiatives for care management programs.
- Developed and implemented policy and procedures and job aids to enhance operational efficiencies.
- Collaborated with market leadership, clinic operations and network management.
- Generated monthly reports and identified trends, barriers and collaborated with direct and indirect reports to implement action plans.
- Annual Budget preparation.
- Participated in forecasting and long-term planning initiatives to ensure alignment with the mission and values of the Company.
- Promoted to VP, Medical Management Operations for Southwest Texas sub-region.
Manager, Care Management-El Paso
Wellmed medical management, inc.
El Paso, Texas
02.2013 - 05.2014
- Oversight of care management functions to include transition management and complex care management in the El Paso market.
- Maintained compliance with approved standardized guidelines, government mandated regulations and contractual agreements, to include NCQA, URAC and CMS.
- Collaborated with WellMed Market Medical Director, Regional Clinic Managers and Network Management to ensure processes are in place to facilitate accomplishing defined goals and quality metrics.
- Generated monthly metric reports and identifies trends, barriers to meeting established goals and implements action plans.
- Participated in process improvement planning and implementation.
- Assisted with facilitation of weekly Patient Care Conference meetings in the El Paso market.
- Reported to Senior Management on the status of organizational goals for the El Paso market.
- Promoted to Director of Care Management.
Timeline
Senior Vice President, Enterprise Care and Value
Wellmed medical management, inc.
06.2024 - 10.2025
Senior Vice President, Medical Management Ops, Greater Texas Region
Wellmed medical management, inc.
06.2020 - 06.2024
Vice President, Medical Management Operations, SWTX Region
Wellmed medical management, inc.
02.2017 - 06.2020
Director, Care Management-SWTX Region
Wellmed medical management, inc.
05.2014 - 02.2017
Manager, Care Management-El Paso
Wellmed medical management, inc.
02.2013 - 05.2014
Master of Arts - Healthcare Administration
Webster University
09.1997 - 08.2000
Bachelor of Science - Nursing
The University of Texas At El Paso
08.1981 - 05.1985
Summary
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance. Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Education
Master of Arts - Healthcare Administration
Webster University
St. Louis, MO 09.1997 - 08.2000
Bachelor of Science - Nursing
The University of Texas At El Paso
El Paso, TX 08.1981 - 05.1985
Skills
Strategic plans
Strategic goals
Corporate presentations
Process improvements
Organizational development
Strategic leadership
Operations management
Partnership development
Operational excellence
Budget preparation
Policies and procedures
Work Preference
Work Type
Full TimeLocation Preference
RemoteHybridImportant To Me
Career advancementWork-life balanceCompany CultureHealthcare benefitsWork from home optionPaid time offPersonal development programs401k matchStock Options / Equity / Profit SharingPaid sick leaveAffiliations
- National Association for Healthcare Quality
- American Association of Managed Care Nurses
Software
Power BI
Tableau
Languages
Spanish
Professional Working
Quote
The way to get started is to quit talking and begin doing.
Walt Disney
Interests
Traveling, boating, watching Hallmark Christmas movies and listening to true crime pod casts
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Certification
- Licensed Registered Nurse in the State of Texas - August 1985 to current
- Certified Professional in Healthcare Quality (CPHQ) - January 1996 to current
Accomplishments
- Supervised team of 300 staff members.
- Achieved improved patient experience and care coordination by implementing One Team model with accuracy and efficiency.
- Achieved meeting key performance metrics through effectively helping with enabling Plan-do-study-act (PSDA) model.
- Collaborated with team of three (3) in the development of Facility Care Model Dashboard.