Roland G. Roybal-Sanchez
Albuquerque,NM
Summary
Dynamic healthcare executive with 20+ years of experience in multi-site operational leadership, delivering measurable success in P&L oversight ($21M+), market expansion, and financial performance. Proven expertise in business development, risk management, and program optimization. Excel at building strategic partnerships, achieving cost savings of $2M+, and exceeding EBITA targets. Open to nationwide travel (25-50%).
Overview
15
15
years of professional experience
Work History
Director of Clinical Operations, West Division
Optum Home and Community Care Transitions
04.2022 - Current
- Direct operations across 26 states, managing 7 health plans, with 5 direct reports and 80 Care Coordinators
- Implement utilization management initiatives to ensure compliance with Chapter 8 Medicare guidelines, optimizing length of stay metrics and achieving targeted appeals goals
- Manage initiatives reducing patient readmissions below the contractual target goal and improving client Net Promoter Scores
- Partner with cross-functional teams (Medical Directors, Data Analysts, and Product Design) to drive performance improvements
- Deliver 100% compliance with workflow standards while serving over 50,000 patients annually
Executive Director, West Division
naviHealth
02.2019 - 04.2022
- Managed 4 large health plan accounts, ensuring accountability to service level agreements and contractual expectations, serving over 1.3M patients
- Collaborated on strategic business plans, impacting member appeals, and reducing annual targets to
- Directed multi-state client accounts, leading to a $2M+ cost savings for one health plan client
- Partnered with internal and external leaders on market contract launches, including multi-state hospitals and health plans
Senior Clinical Manager, West Division
naviHealth
04.2014 - 02.2019
- Oversaw 22 hospitals in 4 states, focusing on Bundled Payments for Care Improvement (BPCI) to drive value-based care
- Directed operational meetings, achieving a hospital readmission rate below the contractual target of
- Guided post-acute providers on compliance with Medicare guidelines, improving post-acute utilization and reducing rehospitalization rates
- Partnered with post-acute providers to implement care redesign initiatives, reducing length of stay variance and improving outcomes
Division Vice President, West Division
Life Care at Home, Life Care Centers of America
03.2011 - 02.2014
- Oversaw 9 homecare agencies and Executive Directors across 4 states, ensuring operational excellence and strategic alignment
- Managed a $21M+ P&L portfolio, achieving financial targets and implementing cost-saving measures, demonstrating strong fiscal management and P&L responsibility
- Negotiated contracts with third-party payers and staffing agencies, maintaining an EBITDA margin >10%
- Directed the Quality Assurance Performance Improvement (QAPI) program, achieving 100% compliance with ethical and clinical standards
- Led risk management efforts, resolving 100% of complaints, grievances, and incidents in collaboration with legal and compliance teams, ensuring a safe and compliant operational environment
Director of Therapy Services
Life Care at Home, Life Care Centers of America
02.2010 - 03.2011
- Managed therapy services for 16 homecare agencies with 200+ clinicians across 9 states, ensuring high-quality service delivery and compliance
- Designed and taught a 16-hour continuing education course, enhancing clinician knowledge and skills
- Achieved 100% therapy utilization goals through effective collaboration on utilization management and strategic planning, driving impact on a $21M+ P&L portfolio
- Increased referral sources by 36% through targeted sales and marketing strategies, expanding the client base and revenue opportunities
- Managed procurement of therapy medical equipment, ensuring clinicians had the necessary tools to deliver quality care
Education
Master - Business Administration
University of Phoenix
Albuquerque, NM06.2007
Bachelor of Science - Physical Therapy
University of New Mexico
Albuquerque, NM10.1992
Skills
- Commitment to Service Level Agreements
- Organizational Change Management
- Effective Strategic Planning
- Customer-Centric Service Delivery
Personal Information
Title: Senior Executive | Healthcare Operations | Strategic Growth Leader
Signatureachievements
- Directed operations across 26 states, managing 7 health plans, with 5 direct reports and 80 Care Coordinators.
- Partnered with cross-functional teams (Medical Directors, Data Analysts, and Product Design) to drive performance improvements resulting in appropriate utilization management.
- Implemented utilization management initiatives to ensure compliance with Chapter 8 Medicare guidelines, optimizing length of stay metrics and achieving targeted appeals goals.
Languages
English
Native or Bilingual
Spanish
Full Professional
Timeline
Director of Clinical Operations, West Division
Optum Home and Community Care Transitions
04.2022 - Current
Executive Director, West Division
naviHealth
02.2019 - 04.2022
Senior Clinical Manager, West Division
naviHealth
04.2014 - 02.2019
Division Vice President, West Division
Life Care at Home, Life Care Centers of America
03.2011 - 02.2014
Director of Therapy Services
Life Care at Home, Life Care Centers of America
02.2010 - 03.2011
Master - Business Administration
University of Phoenix
Bachelor of Science - Physical Therapy
University of New Mexico
Similar Profiles
Brandy YoakBrandy Yoak
Medical Manager of Clinical Operations at Optum Home and Community Care TransitionsMedical Manager of Clinical Operations at Optum Home and Community Care Transitions
Taylor CarrierTaylor Carrier
Provider Relations Manager at Optum Home and Community Care TransitionsProvider Relations Manager at Optum Home and Community Care Transitions
Melinda DejeuMelinda Dejeu
Senior Manager, Provider Relations at NaviHealth/Optum Home & Community Care TransitionsSenior Manager, Provider Relations at NaviHealth/Optum Home & Community Care Transitions