Terri Smith
Kinsale,VA
Summary
Experienced Healthcare Leader with a demonstrated history of success in the quality and performance industry. Skilled in contract negotiations, implementation of new programs, and performance management of Accountable Care Organizations and Value Based Collaborations with both clinical and business insight including over 10 years experience with HEDIS, Stars, Provider Relations, Managed Care, NCQA, Medicaid, CMS, Commercial, UM, Care Redesign, Education, onboarding and training, project management (yellow belt), and successful implementation of healthcare startups. Collaborative leader with dedication to partnering with colleagues to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Lead Director of Provider Performance
CVS Health/ Aetna
10.2021 - Current
- Accountable for the strategic alignment and operational success of assigned VBC provider relationships
- Ensures that assigned VBC arrangements are functioning successfully and working to improve quality of care while reducing costs
- Relationship Management
- Coordinates a cross-functional team of resources to implement and maintain VBC arrangements
- VBC contract negotiations and amendments
- Responsible for establishing and maintaining a productive, professional relationships
- Sets the tone for the relationship
- Educates internal and external parties as needed to ensure compliance with contract terms and expectations
- Coordinates provider meetings and optimizes interactions (clinical meetings, JOCs, Informatics discussions, etc.)
- Assists with workflow development and strategies to integrate data and reporting
- Responsible for driving improvement in deal performance
- Leverages reporting/data to monitor contract performance against financial, clinical, cost and efficiency targets
- Identifies areas where improvements need to be made
- Provides strategy consultation on actions/tactics to make those improvements.
Senior Clinical Strategist
CVS Health/ Aetna
03.2019 - 10.2021
- Establishing trusting relationships with ACO and VBC provider partners to promote open communication
- Serving as clinical expert on actionable opportunities related to Value Based Care including: CM, gap closure, workflow discussions, and partnering with physicians, case management, and key stakeholders
- Serving as internal and external liaison and clinical resource, interpreting data and educating regarding how to utilize data for PC performance improvement
- Strategizing with SMEs and clinical teams both internally and externally to drive outcomes and improve efficiencies
- Coordinating and conducting clinically focused meetings to identify opportunities target and prioritize goals and interventions to close gaps in care and achieve optimal stars performance
- Collaboratively working across multiple functions and /or segments to obtain agreement from all impacted parties
- Collaborating with Engagement Managers, Local Market Team, Data Team, Medical Operations, and others on initiatives for overall Quality, HEDIS and Stars improvement, transformative care model SAI's to align with Aetna's strategic goals.
Director of Long-Term Services and Supports
Magellan Complete Care of Virginia
10.2018 - 03.2019
- Responsible for all provisions of Long-Term Services and Support (LTSS) home and community-based services
- Owns all contracting for F/EA vendor, state Medicaid contracts with DMAS, updates and amendments as needed
- Ensures connection of tasks, responsibilities, direction, and functional goals to Magellan Complete Care of Virginia's strategic direction
- Develops and maintains strategic partnerships with internal and external stakeholders
- Manages the financial analysis of medical cost and utilization
- Collaborates with the Medical Director to provide oversight of clinical programs, intake, care coordination/case management strategies, and operations for integrated LTSS, physical and behavioral healthcare
- Manages external F/EA vendor
- Manages and develops direct reports to include other management, supervisory personnel, exempt individual contributors, and nonexempt care coordinators for all of Virginia.
Post Acute Network Manager
Remedy Partners
11.2017 - 10.2018
- Educate Health Care Providers across the continuum on Care Redesign
- Hire, train, and lead a team of Post Acute Representatives
- Assist Providers in navigating Healthcare Quality and BPCI (Bundled Payment for Care Improvement)
- Provide software training for Episode Connect, Remedy Partner's exclusive BPCI Care Coordination/Episode Management Software
- Provide support and guidance to assist assigned Health Systems to reduce cost by implementing strategies to reduce LOS, reduce readmissions, and increase positive outcomes for patients.
Post Acute Nurse Liaison
Humana
06.2015 - 11.2017
- Provider Relations for Mid Atlantic Skilled Nursing Facilities (260 SNFs)
- Surveys all facilities to ensure quality care for Humana members
- Provides education to all stakeholders regarding HEDIS, STARS, CMS, Quality and Compliance, and Documentation Support
- Work with contracting to add or remove facilities within network
- Assists in the development of policies, procedures, and pilot programs.
Front Line Leader: Onsite Nursing Program
Humana
08.2014 - 05.2015
- Lead a team of 12 to 18 Utilization Management Onsite Nurses: Acute and Sub Acute
- Identify and Report trends
- Develop system-view recommendations
- Implement appropriate actions to control identified low value care
- Create and conducts provider outreach initiatives
- Ensure compliance with regulatory requirements.
Onsite Nurse
Humana
11.2013 - 07.2014
- Health system based embedded UM and CM RN for HCA in Richmond, VA (3 sites)
- Works onsite at assigned hospitals to provide members and their caregivers with transitional care plans
- Utilization Management for acute and post acute for all inpatient Humana members
- Assists with discharge planning, DME, and care coordination.
Nurse Manager Riverside Rehabilitation Center
Riverside Health System
06.2013 - 11.2013
- Oversee Skilled Nursing and Rehabilitation Unit: 80 bed combination Unit of Skilled, Memory Care, Long Term Care
- Lead a team of RN's, LPN's, and CNA's
- Fiscal responsibility for skilled nursing/ rehab unit
- Accountable for all patient and resident outcomes.
Hospice Case Manager Riverside Tappahannock Hospice
Riverside Health System
05.2011 - 06.2013
- Compassionately care for terminally ill patients
- Meet the physical, emotional, social, and spiritual needs of the individual patient and their family and caregivers
- Works with the Interdisciplinary team to ensure the patient and caregiver have access to all available resources.
Education
Bachelor of Science, Nursing Administration -
Western Governors University
01.2013
Associate of Science, Nursing -
Rappahannock Community College
01.2011
Skills
- Strategic Planning
- Verbal and written communication
- People Management
- Operations Management
- Project Management
- Creativity and Innovation
Certification
- Compact RN License- VA
- Hospice and Palliative Care Nurse- HPCC
- Positive Leadership Certification- Michigan Ross
Timeline
Lead Director of Provider Performance
CVS Health/ Aetna
10.2021 - Current
Senior Clinical Strategist
CVS Health/ Aetna
03.2019 - 10.2021
Director of Long-Term Services and Supports
Magellan Complete Care of Virginia
10.2018 - 03.2019
Post Acute Network Manager
Remedy Partners
11.2017 - 10.2018
Post Acute Nurse Liaison
Humana
06.2015 - 11.2017
Front Line Leader: Onsite Nursing Program
Humana
08.2014 - 05.2015
Onsite Nurse
Humana
11.2013 - 07.2014
Nurse Manager Riverside Rehabilitation Center
Riverside Health System
06.2013 - 11.2013
Hospice Case Manager Riverside Tappahannock Hospice
Riverside Health System
05.2011 - 06.2013
Bachelor of Science, Nursing Administration -
Western Governors University
Associate of Science, Nursing -
Rappahannock Community College
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