Highly accomplished, results-driven Health Care Managed Care Assistant Vice President and Director with 20+ years’ experience providing cross-sectional operation and strategic solutions to enhance organizational direction, improve overall quality, drive sustained performance and maximize revenue potential in high demand medical environments. Skilled in methodologies regarding physician profiling with an understanding of quality metrics related to hospital/physician payor contracting. Adept at building upon physician relationships and collaborating on the creation of alternative payment structures. Possess strong communication skills teamed with a focus in time management, leadership, and project and departmental organization.
Vice President- Strategic Pricing and Analytics @ From 2013 to Present (2 years) Greater Nashville AreaAssistant Vice President @ Responsible for the performance of assigned payors in the $2.5B managed care portfolio. With a personal portfolio designation exceeding $1.5B, ensures appropriate planning and execution of negotiation process. Handled the management of the design, development, implementation and maintenance of a revenue cycle resource for use by CHS Total Enterprise.
• Received one-out-of-one performance-based promotion.
• Lead and conduct ongoing negotiation with payers, third-party entities and direct employer groups on behalf of CHS Total Enterprise which consists of 34 hospitals and 2000+ employed physicians, outpatient surgery and diagnostic centers; effectively arrange contract increases with managed care companies to meet annual budgetary requirements.
• Serve as the leader for staff assigned to departmental function and oversee the consultants responsible for developing contract and managed care solutions.
• Achieve agreements through negotiation processes for Patient Centered Medical Homes; actively assist in the development of strategy used in market implementation for PCMH.
• Key member of the Patient Centered Medical Home Development Advisory Committee, Contracting Division and Group/Division/Market Operations Management Team; deliver expertise, support and advocacy in education, legislation, budget alignment and communication strategy.
• Participates in the creation and development of a strategic course used in CHS markets(s) for implementation in delivery system redesign, healthcare reform and strategic pricing approaches.
• Partner with the quality and clinical leadership of CHS in efforts to align Managed Care Organizations with short- and long-term financial goals; devise quality and performance metrics that align corporate objectives with payor focus areas.
• Oversee the Joint Operating Committee for Strategic Payors; conduct ongoing due diligence to ensure proper compliance and function of hospital, physician practice and ancillary facility acquisition. From 2011 to 2013 (2 years) Charlotte, North Carolina AreaDirector, Strategic Pricing & Analytics- Capital and TriStar Divisons @ Responsible for the development and implementation of the annual operating plan and managed care strategic plan for the nation’s leading provider of healthcare services which is comprised of 164 hospitals and 106 freestanding surgery centers across 20 states and Great Britain, and employs 183,000 individuals.
• Championed the negotiation of rates and language for all Tier 1 and Tier 2 contract portfolios located within Tennessee, Kentucky and New Hampshire; led and managed three employees.
• Oversaw managed care compliance efforts including the analysis and estimation of financial impact of contracting efforts.
• Spearheaded the administration of implementation protocols.
• Effectively prepared monthly reports to summarize contracting analysis and compliance activities per division; reviewed and disseminated performance measures and provided evaluation on existing contracts.
• Created and implemented corporate guidelines for payor contracting and compliance; responsible for all due diligence measures taken on new payer relationships.
• Exercised strategic pricing component used in potential acquisition processes; managed audit program per division.
• Maintain and improve on knowledge of state and federal legislative measures, regulations and laws regarding managed care industry.
• Effectively oversaw payor class action litigation for employed physicians and performed outside consulting for key independent physician practices.
• Recipient of Committee/Work Group Appointments related to:
o Alternative Payment Methodology Steering Committee
o Alternative Payment Methodology Evaluation Committee
o Network Development and Maintenance Committee
o Delegated Relationships
o Credentialing
o Oncology Committee
o Asian Market From 2001 to 2011 (10 years) Greater Nashville AreaAdjunct Faculty, Massey School of Business @ From 2006 to 2010 (4 years) Greater Nashville AreaDirector, Contracts and Development, Health Advantage Plans, Inc. @ From 1997 to 2001 (4 years) Birmingham, Alabama AreaAdministrative Director – Transplant Center @ From 1995 to 1997 (2 years) Mobile, Alabama Area
Master of Science, Health Administration @ University of Alabama at BirminghamBachelor of Arts, Psychology @ University of Alabama at Tuscaloosa Jay Scannelly is skilled in: Managed Care, Policy, Process Improvement, Healthcare, Leadership, Team Building, Contract Management, Health Insurance, Hospitals, Revenue Cycle, PPO, Data Analysis, Healthcare Management, Analytics, Cross-functional Team Leadership
Websites:
http://carolinashealthcare.org