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
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
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
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.
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
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