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Open To Work
Sandra Scalf-Corbitt
Director, Contracting
Riverside,CA
Summary
Results-driven leader with a proven track record of steering high-performing teams and executing strategic initiatives that drive organizational growth. Expertise in independent decision-making and sound judgment consistently contributes to enhanced company success. Recognized for adaptability and effective collaboration, delivering measurable outcomes in fast-paced environments. Strong communication and problem-solving skills, along with a commitment to cultivating a productive and positive team culture, drive sustained performance excellence.
Overview
23
23
years of professional experience
Work History
Director, Contracting (Key Provider Contracts)
Health Care Service Corporation (Cigna MA Acquisition)
Remote
03.2025 - Current
- Directed contractor staff management, ensuring effective oversight of contract strategy and performance in western region.
- Managed personnel operations for direct and indirect reports, focusing on hiring, training, performance enhancement, salary reviews, scheduling conflicts, and fostering a positive team environment.
- Established strategic goals for the department to enhance market competitiveness and organizational alignment.
- Evaluated and authorized rate and language changes for FFS value-based and hospital system contracts, enhancing operational efficiency in West region.
- Oversaw review and approval processes for financial settlements, detailing terms of value-based contracts and ensuring compliance with reconciliation standards.
- Spearheaded development of alternative reimbursement methodologies, focusing on value-based and incentive-based payment structures.
- Directed strategic network initiatives to optimize performance and promote cost-effective solutions.
- Guided team members through contract negotiation processes, emphasizing skill development for future advancement opportunities.
- Managed all aspects of contract negotiations for delegated risk providers in western region, focusing on strategic alignment and operational efficiency.
- Engaged in intricate negotiations with key providers to establish favorable contract agreements.
- Assured alignment of non-standard language with enterprise strategy to uphold governance processes.
- Analyzed ROI and implications of non-standard financial terms in market contract discussions to support strategic partnership decisions.
- Facilitated negotiation and resolution of hospital system disputes, addressing escalated issues that required legal intervention and settlement discussions.
- Assisted teams in addressing complex problems and navigating challenges. Supported team performance through collaborative efforts and strategic planning.
- Evaluated issues, interpreted information, and proposed strategic solutions to address complex problems.
- Contributed to contract language review board efforts aimed at enhancing clarity and compliance of template language.
- Oversaw resource management initiatives to boost operational efficiency. Facilitated decision-making by delivering critical insights to stakeholders. Drove productivity improvements to advance organizational goals.
- Achieved exceptional results by addressing diverse challenges with innovative solutions. Delivered impactful outcomes through technical expertise in problem-solving. Contributed to process improvements that advanced organizational objectives.
AVP, West Region MA Contract Enablement
Cigna Medicare Advantage
Remote
07.2024 - 03.2025
- Directed contractor staff management, ensuring effective oversight of contract strategy and performance in western region.
- Managed budget oversight to optimize resource allocation and support financial goals.
- Established strategic goals for the department to enhance market competitiveness and organizational alignment.
- Evaluated and authorized rate and language changes for FFS value-based and hospital system contracts, enhancing operational efficiency in West region.
- Evaluated and authorized financial settlements for value-based contracts, detailing reconciliation processes and payment terms to enhance provider relationships.
- Guided and cultivated management staff, instilling a culture of continuous improvement and accountability.
- Spearheaded development of alternative reimbursement methodologies, focusing on value-based and incentive-based payment structures.
- Directed strategic network initiatives to optimize performance and promote cost-effective solutions.
- Collaborated with legal and compliance teams to interpret contracts and navigate complex negotiations.
- Provided expertise in contract template revisions to enhance facility professional ancillary and value-based agreements.
- Managed comprehensive contract negotiations for delegated risk providers in western region, focusing on strategic alignment and operational efficiency.
- Engaged in intricate negotiations with key providers to establish favorable contract agreements.
- Reviewed and analyzed non-standard language in contracts to guarantee conformity with governance processes and organizational objectives.
- Analyzed non-standard financial terms in market contracts and contributed insights on ROI and partnership effects in review meetings.
- Facilitated negotiation and resolution of hospital system disputes, addressing escalated issues requiring legal intervention and settlement discussions.
- Contributed to contract language review board, ensuring clarity and compliance in template language revisions.
Director MA Contracting
Cigna Medicare Advantage
Remote
06.2021 - 07.2024
- Engaged with market presidents to formulate strategies and establish value-driven partnerships in targeted expansion areas such as California, Nevada, Washington, and Oregon.
- Led cross-functional teams in executing strategic initiatives to optimize operational efficiency.
- Engaged with senior leadership to formulate strategic organizational goals and establish key performance metrics.
- Managed comprehensive negotiations for complex hospital systems and value-based providers, ensuring alignment and collaboration across seven states: California, Nevada, Utah, New Mexico, Arizona, Oklahoma, and Texas.
- Collaborated with legal team on California state filings with Department of Insurance and Department of Managed Healthcare.
- Spearheaded negotiations with strategic partners to establish value-based agreements, enhancing relationship dynamics and driving financial and quality performance.
- Acted as subject matter expert for global risk and dual risk agreements within California jurisdiction.
- Collaborated with stakeholders on new delegation service agreements, acting as primary business relationship owner during delegation audits.
- Developed comprehensive market insights and presented findings to market president for strategic review and decision-making on expansion opportunities.
- Facilitated and maintained contractual agreements with hospital systems and value-based providers to ensure compliance and operational efficiency.
- Led comprehensive quarterly market review meetings with executive leadership, emphasizing contract successes to optimize performance and achieve market growth objectives.
- Supported market contractors by addressing inquiries and resolving issues related to market expansions.
- Coordinated efforts with matrix partners to address and resolve hospital system disputes, focusing on escalated issues requiring legal oversight and settlement discussions.
- Analyzed market trends and presented alternative reimbursement strategies, focusing on value-based opportunities for stakeholder consideration.
- Facilitated relationship-building with strategic partners during expansion efforts, ensuring ongoing partnership optimization.
- Collaborated with regional VP to formulate and implement expansion strategies, focusing on tools for provider performance evaluation.
- Cultivated relationships with clients to enhance overall satisfaction and loyalty. Championed exceptional service delivery to ensure client needs are met. Advocated for a collaborative work environment that fosters positive interactions.
- Cultivated strong relationships through respectful interactions and readiness to assist colleagues.
- Facilitated professional services and support to enhance operational efficiency in a dynamic setting.
Provider Contracting Executive
Humana Inc.
02.2019 - 05.2021
- Managed contract negotiations and renewals for Medicare commercial hospital value-based and delegated groups across California, Nevada, and Hawaii to optimize operational efficiency.
- Contract negotiation: fee schedule rates, language changes, DOFR, Amendments, performance incentives, and delegated activities
- Orchestrated negotiations and finalization of value-based agreements to expand Medicare Advantage network in Nevada, ensuring comprehensive access to specialists and hospitals.
- Engaged with leadership to formulate and implement strategic initiatives for market growth, emphasizing network expansion and key provider relationships.
- Conducted comprehensive analysis of contracts, focusing on financial forecasting and performance metrics to optimize cost-benefit outcomes.
- Facilitated collaboration among diverse teams to drive process improvement and streamline workflows.
- Delivered comprehensive analysis of performance metrics to senior leadership, facilitating resolution of identified deficiencies.
- Established and optimized high-performing provider networks for existing and expansion markets.
- Analyzed claim issues and negotiated recovery or recoupment strategies to optimize financial outcomes for the organization.
- Collaborated with provider engagement team to address and resolve provider issues.
- Facilitated approval process for value-based contracts by outlining essential terms and analyzing market effects for senior leadership.
- Supported operational efficiency and productivity through seamless teamwork and communication.
- Championed initiatives to leverage analytical expertise in addressing complex challenges. Fostered an environment of collaboration to elevate team performance and drive overall business outcomes.
- Cultivated strong relationships through respectful interactions and readiness to assist colleagues.
Provider Network Manager II
Elevance Health, CareMore Health Plan
Cerritos, CA
06.2015 - 01.2019
- Managed contractual agreements with Medicare Advantage and Medicaid programs, ensuring compliance across three states: California, Nevada, and Arizona.
- Contract negotiation: fee schedule rates, language changes, DOFR, Amendments, performance incentives, and delegated activities
- Conducted comprehensive analysis of contracts, focusing on financial forecasting and performance metrics to optimize resource allocation.
- Conducted thorough assessments of cost increases across specialties and established a targeted plan for enhancement, including measurable deliverables.
- Conducted thorough assessments of network adequacy, addressing gaps through strategic provider recruitment and contract management.
- Facilitated collaboration among diverse teams to drive process improvement and streamline workflows.
- Presented performance findings to senior leadership, emphasizing actionable insights for improvement.
- Established and optimized high-performing provider networks for both existing and expansion markets.
- Analyzed and addressed provider claim discrepancies, facilitating compliance with contractual obligations and optimizing recovery processes.
- Managed documentation processes to recognize discrepancies and ensure prompt resolution actions.
- Identified and resolved issues to optimize operations and ensure exceptional customer service.
- Assessed issues, conducted thorough analysis, and proposed actionable solutions to address organizational challenges.
Manager Network Relations
Elevance Health (CareMore Health Plan)
Cerritos, CA
04.2011 - 06.2015
- Oversaw contractor teams to enhance contract strategy and performance metrics across the western region.
- Managed direct reports through comprehensive personnel strategies, ensuring effective training, performance evaluations, and conflict resolution.
- Supervised a vast geographical network, facilitating coordination and communication among over 250 primary care providers and 750 specialists and ancillary providers.
- Achieved favorable contract terms with providers by effectively negotiating rates and conditions. Streamlined contract processes by implementing timely amendments for rate changes and language adjustments.
- Conducted comprehensive analysis of contracts, focusing on financial projections and performance monitoring to enhance cost-benefit outcomes.
- Facilitated termination of PCP and specialist services by coordinating data gathering and liaising with internal teams to uphold continuity of care.
- Ensured network adequacy of PCPs, specialists, and ancillary providers through ongoing monitoring and timely corrections.
- Conducted monthly reviews of neighborhood performance by analyzing MLR RAF cost and utilization trends.
- Cultivated and sustained IPA and medical group relationships through regular monthly and quarterly meetings and Joint Operating Committees (JOCs).
- Led the organization and execution of quarterly JOC meetings with IPA partners, focusing on reviewing and improving operational and financial results.
- Investigated provider claim billing TIN/W9 utilization management and credentialing discrepancies, facilitating accurate resolution and enhancing service delivery.
- Facilitated quarterly hospital Joint Operating Committee meetings to enhance collaboration and decision-making.
- Delivered comprehensive monthly reports on HEDIS performance, enabling providers to enhance their service delivery. Recognized and addressed performance gaps among providers through targeted outreach initiatives for HEDIS completion.
- Performed detailed chart audits and facilitated medical records collection to align with company standards for HEDIS and STAR performance evaluations.
- Facilitated collaboration among diverse teams to implement strategic initiatives aimed at enhancing operational efficiency.
- Analyzed data to refine processes, resulting in accelerated service delivery timelines.
- Implemented systematic performance evaluations to pinpoint areas for staff improvement and professional growth.
- Identified and assessed market trends to guide strategic initiatives and enhance overall market positioning.
- Engaged with stakeholders to ensure alignment of organizational goals with health plan initiatives.
- Managed budget oversight to optimize resource allocation and support financial goals.
- Cultivated a motivated workforce to drive productivity and foster engagement in daily operations.
HICAP Program Manager
Inland Agency HICAP
Riverside, CA
02.2003 - 12.2010
- Oversaw comprehensive management of all HICAP-related activities across four California counties.
- Facilitated hiring, training, and performance enhancement for team members while managing scheduling conflicts and fostering a positive team dynamic.
- Designed and implemented comprehensive annual plan and budget for HICAP, focusing on resource allocation and operational efficiency.
- Coordinated meetings with auditors to supply necessary information and documentation, supporting accurate assessment of program performance and ongoing reporting requirements.
- Developed and executed strategic public information and education initiatives to enhance community awareness.
- Achieved accurate and timely reporting of all program data, enhancing stakeholder communication. Strengthened relationships with CMS, Social Security, and the California Department of Aging to improve program outcomes.
- Directed oversight of bi-annual grant proposal submissions and ensured compliance with state and county regulatory requirements.
- Monitored and evaluated performance metrics to consistently meet or exceed federal and state benchmarks.
- Executed performance measurement initiatives throughout fiscal year to ensure alignment with performance targets.
- Developed comprehensive plans for program enhancement to support county and state government agencies.
- Managed documentation verification and submission to comply with state registration requirements.
- Reviewed and prepared site contracts while assessing annual program contracts for adherence to compliance requirements.
- Developed and implemented training programs to meet state requirements and enhance staff competencies.
- Conducted thorough assessments and implemented quality assurance strategies across all program components.
- Led cross-functional teams to develop and implement strategic program initiatives.
Education
MBA - Business Administration And Management
Fayetteville State University
Fayetteville, NC05-2019
Bachelor of Arts - Economics, Business Administration
California State University, San Bernardino
San Bernardino, CASkills
- Effective leadership
- Excellent communication and problem-solving skills
- Cultivating strong partnerships
- Strategic planning
- Analytical decision-making
- Clear communication skills
- Staff development
- Project management
- Staff skill enhancement
- Skilled in contract negotiation
Accomplishments
- Collaborated with team of five in the development of enterprise facility, ancillary and value-based contract templates.
- Achieved operation efficiency through effectively helping with development of Contract Review Committee for Medicare.
- Resolved Ancillary non-PAR leakage which led to $600k annual savings.
- Supervised team of seven staff members.
Affiliations
- Project Management Institute
- Omicron Delta Epsilon, International Honor Society in Economics
- Phi Kappa Phi, Academic Honor Society
Interests
Work Preference
Work Type
Full TimeLocation Preference
RemoteTimeline
Director, Contracting (Key Provider Contracts)
Health Care Service Corporation (Cigna MA Acquisition)
03.2025 - Current
AVP, West Region MA Contract Enablement
Cigna Medicare Advantage
07.2024 - 03.2025
Director MA Contracting
Cigna Medicare Advantage
06.2021 - 07.2024
Provider Contracting Executive
Humana Inc.
02.2019 - 05.2021
Provider Network Manager II
Elevance Health, CareMore Health Plan
06.2015 - 01.2019
Manager Network Relations
Elevance Health (CareMore Health Plan)
04.2011 - 06.2015
HICAP Program Manager
Inland Agency HICAP
02.2003 - 12.2010
MBA - Business Administration And Management
Fayetteville State University
Bachelor of Arts - Economics, Business Administration
California State University, San Bernardino