Sarah Hooks
Garner,NC
Summary
Experienced healthcare leader with over 10 years in managed care, provider network management, and strategic program oversight. Proven success in driving performance improvement, managing complex cross-functional projects, and optimizing healthcare operations for Medicaid and Medicare programs. Strong experience in the North Carolina healthcare market and deep knowledge of systems such as PowerBI, Salesforce, Xcelys, and ServiceNow. Skilled in leading internal and external training initiatives, including extensive education around Value Added Benefits (VABs). Known for building high-performing teams and delivering results through data-driven strategies.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Manager, Provider Relations
WellCare Health Plans
Raleigh, NC
02.2022 - Current
- Lead strategic initiatives to optimize provider network performance across Medicare and Medicaid contracts in NC.
- Manage daily operations and performance across Provider Relations, Credentialing, and Network Management teams (6 direct reports).
- Oversee relationships with four of the state’s largest health systems (UNC, Duke, WakeMed, ECU Health), ensuring contract compliance and value-based strategy alignment.
- Conduct extensive internal and external training on Value Added Benefits (VABs), enhancing provider understanding and engagement.
- Drive improvement initiatives through collaboration with state agencies, joint operations committees, and internal stakeholders.
- Develop and deliver strategic performance reports using PowerBI and internal systems to inform executive leadership.
- Represent WellCare at managed care conferences and maintain key relationships with statewide healthcare boards.
Provider Network Administrator
WellCare Health Plans
07.2019 - 02.2022
- Served as liaison between WellCare and all contracted hospital facilities statewide, supporting Medicaid Go-Live.
- Led planning and execution of joint operations meetings, focusing on provider performance, claims resolution, and compliance.
- Partnered with internal teams to coordinate authorizations, high-dollar claim resolution, and provider education.
- Provided training to new hires and external providers, including orientation sessions and portal usage guidance.
Senior Provider Relations Specialist
WellCare Health Plans
08.2016 - 07.2019
- Managed relationships with contracted providers across specialties, ensuring satisfaction and compliance with WellCare policies.
- Delivered provider training on systems, claims resolution, HEDIS, and other quality metrics.
- Supported ongoing performance monitoring and reporting through utilization reviews and analytics tools.
Provider Relations Specialist / Referral Team Manager
The Austin Diagnostic Clinic
Austin, TX
09.2015 - 07.2016
- Liaised between physicians and health plans to resolve insurance and billing issues.
- Managed referral team of 3 and implemented cross-training and performance review processes.
- Created process improvements that significantly reduced internal errors and financial write-offs.
Education
Broadcast Journalism -
University of North Texas
Denton, TX01.2008
Marketing -
Georgia Southern University
Statesboro, GA01.2005
Skills
- Program & Project Management
- Medicaid Managed Care (NC Market)
- Cross-Functional Leadership
- Performance Monitoring & Optimization
- Value Added Benefits (VAB) Training
- Process Improvement
- Strategic Planning
- Data Tools: PowerBI
- Data Tools: Salesforce
- Data Tools: ServiceNow
- Provider Network Management
- Claims Resolution & Regulatory Compliance
Accomplishments
- Selected to participate in the launch of the Frontline Leader Development Program, in partnership with Harvard Business Publishing Corporate Learning
Certification
- Completed a six-month Industry Immersion Program, Essentials of Managed Health Care
Timeline
Manager, Provider Relations
WellCare Health Plans
02.2022 - Current
Provider Network Administrator
WellCare Health Plans
07.2019 - 02.2022
Senior Provider Relations Specialist
WellCare Health Plans
08.2016 - 07.2019
Provider Relations Specialist / Referral Team Manager
The Austin Diagnostic Clinic
09.2015 - 07.2016
Broadcast Journalism -
University of North Texas
Marketing -
Georgia Southern University
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