Wendy Upthegrove
Otisville
Summary
Dynamic healthcare executive with extensive experience in provider and operations management, driving network expansion and compliance oversight. Proven track record in strategic planning and contract negotiation, achieving significant cost savings while enhancing provider relationships. Adept at problem-solving and adapting to change, ensuring operational excellence and improved patient access.
Overview
21
21
years of professional experience
Work History
Chief Operating Officer & Compliance Officer
GENESYS PHO
Burton
01.2024 - Current
- Oversee Provider Management, Operations, Contracting, HR, Risk Management
- Develop profitable growth strategies, with improved patient access while containing cost, resulting in significant cost savings for the organization
- Oversight of Corporate Compliance
Vice President, Provider Servicing
GENESYS PHO
Burton
01.2022 - 01.2024
- Provider Recruitment, Network Management and Satisfaction
- Payer Contracting and Negotiations
- Service Area Expansion & Strategy Planning Development
Director, Provider Servicing, Member Servicing & Credentialing
MCLAREN HEALTH PLAN
Flint
01.2018 - 01.2022
- Overseen (>82k) Provider Network in Michigan and Ohio, (155) Hospitals, & PO/PHOs
- Involved with a successful Michigan Medicaid rebid in all regions
- Service Area Expansion & Strategy Planning Development
- Oversight of Credentialing and Delegated agreements
Manager, Provider Network Development
MCLAREN HEALTH PLAN
Flint
01.2014 - 01.2018
- Managed Network Expansion Initiatives
- Overseen Provider & Member Satisfaction
- Overseen complex issue resolution
- Fee Schedule Management
Quality Management & Provider Educator
GENESYS PHO
Burton
01.2009 - 01.2013
- Managed Payor Quality Programs and educated providers
- Managed PCMH Program
- Developed, implemented and managed Quality initiatives and strategic plans; developed provider report cards and reporting system
Provider Network Development Educator
GENESYS PHO
Burton
01.2005 - 01.2009
- Physician Recruiting and Contracting;
- Developed and managed provider and ancillary networks;
- Overseen private and third-party payer contracts and configuration;
Education
Bachelor - Business Administration
Baker College
Flint, MI01.2002
Skills
- Provider management & network expansion
- Cross-functional team management
- Extensive payor experience
- Contract management and negotiation
- Compliance oversight
- Risk management
- Strategic planning
- Operational efficiency
- Problem solving
References
References available upon request.
Timeline
Chief Operating Officer & Compliance Officer
GENESYS PHO
01.2024 - Current
Vice President, Provider Servicing
GENESYS PHO
01.2022 - 01.2024
Director, Provider Servicing, Member Servicing & Credentialing
MCLAREN HEALTH PLAN
01.2018 - 01.2022
Manager, Provider Network Development
MCLAREN HEALTH PLAN
01.2014 - 01.2018
Quality Management & Provider Educator
GENESYS PHO
01.2009 - 01.2013
Provider Network Development Educator
GENESYS PHO
01.2005 - 01.2009
Bachelor - Business Administration
Baker College