Certifications
Sandra Smith
Gilbert,AZ
Summary
Dedicated Healthcare professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
2
2
20
20
+ Years Experience
Work History
REGIONAL DIRECTOR, CLIENT MANAGEMENT
AVALON HEALTHCARE SOLUTIONS
Tampa, Fl , Remote
05.2021 - 02.2024
- Managed 5 Client contracts
- Ensure contractual adherence and alignment
- Adhere to NCQA, CMS, State, and Local requirements
- Manage all lob: Medicare, Medicaid, ACA, FEP, Commercial
- Execute timely contractual reporting, analyze performance
- JOC and QBR client meetings with C Suite and Executive Leadership
- Drive Strategy and performance
- Research escalations and root cause
- Manage multiple products and services
- Performed client & C suite communications and upsell opportunities.
- Streamlined operations for improved efficiency by evaluating existing processes and introducing innovative solutions. I have established strong partnerships with industry stakeholders, enhancing the company's reputation and creating mutually beneficial collaborations.
- Increased company sales by exploring opportunities for upsell and expansions implementing targeted marketing strategies and fostering strong relationships with key clients.
- Tracked trends and suggested enhancements to both challenge and refine company's product offerings.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
Sr. Provider Network Manager
New Century Health ~ EVOLENT
Miramar, FL Remote
10.2012 - 05.2021
- Collaboratively managed local and national aspects of network operations.
- Execute new company solutions and initiatives
- Reduce leakage and decrease financial risk
- Managed daily operations
- Developed communications and training materials
- Conducted Provider education & portal training
- Research claim issues and escalations
- Investigate grievances and/or appeals
- Conduct JOC/QBR's and annual meetings
- Collaborate with Clinical and Analytics teams to identify and present clinical and financial opportunities
- Drive high performance with clinical and financial initiatives
- Analyze and evaluate provider contracts, including Letters of Agreement (LOAs) or Single Case Agreements (SCA)
- Ensure Scope of Service compliance (regulatory, organizational, and contractual requirements)
- Comply with all audit requirements.
Health Plan & PCP Behavioral Health Referral Manager
Magellan Health Service
Phoenix, AZ
04.2009 - 10.2012
- Optimized resource allocation by conducting regular performance evaluations and providing personalized coaching for vendor development.
- Improved access to care by ensuring vendors were compliant with their contracts. .
- Streamlined workflows by identifying bottlenecks in existing systems and proactively addressing these challenges through appropriate solutions implementation.
- Defined clear targets and objectives and communicated to all vendors.
- Planned and budgeted accurately to provide business with resources needed to operate smoothly.
- Championed diversity and inclusion efforts within the workplace, resulting in an inclusive environment that fostered creativity and innovation among employees from various backgrounds.
Lead Coach Manager
Healthways INC.
Tempe, AZ
11.2007 - 01.2009
- Utilized positive communication to encourage team and promote integrity and respect.
- Researched latest industry trends and developments to keep abreast of best practices.
- Boosted team morale through regular communication, feedback, and recognition of individual achievements.
- Developed and delivered effective and engaging coaching sessions to improve performance.
- Assisted in developing marketing materials to promote coaching services.
- Monitored team practices to establish high level of performance.
Education
Bachelor of Arts - Psych & Human Services
Ottawa University
Mesa, AZSkills
- Strategy Initiatives & planning
- Analyze data/reports
- Communication
- Organization and critical thinking
- Network Management
- Relationship Building and collaboration
- Proficient in Microsoft Office, SharePoint
- Meetings and presentations
- Contract Administration
- Operations Oversight
- Client Account Management
- Training Management
Certification
- Strategic Selling - Miller Heiman Group
- Strategic Account Management- The Brooks Group
Timeline
REGIONAL DIRECTOR, CLIENT MANAGEMENT
AVALON HEALTHCARE SOLUTIONS
05.2021 - 02.2024
Sr. Provider Network Manager
New Century Health ~ EVOLENT
10.2012 - 05.2021
Health Plan & PCP Behavioral Health Referral Manager
Magellan Health Service
04.2009 - 10.2012
Lead Coach Manager
Healthways INC.
11.2007 - 01.2009
Bachelor of Arts - Psych & Human Services
Ottawa University