Health Science Education, Worksite Wellness @
University of Florida
A highly effective, health professional with over 15 years of experience, exceptional leadership, program management, and interpersonal skills. Extensive knowledge and experience in managed care health contracting, the development and implementation of health and wellness programs, provider and partner relations, and delivering quality-driven outcomes. Successful at working in a fast-paced, multi-level environment targeting both large system-wide organizations
A highly effective, health professional with over 15 years of experience, exceptional leadership, program management, and interpersonal skills. Extensive knowledge and experience in managed care health contracting, the development and implementation of health and wellness programs, provider and partner relations, and delivering quality-driven outcomes. Successful at working in a fast-paced, multi-level environment targeting both large system-wide organizations and individual/clients one-on-one. Excellent track record of negotiating agreements, managing, collaborating, and training high performing teams and delivering results.
Network Development Executive @ - Responsible for identifying and evaluating opportunities, negotiating optimal reimbursement rates, and drafting contracts for an assigned provider network to ensure patient access to the highest quality, cost-effective providers of healthcare services.
- Manages Washington DC, Virginia, Maryland, and Delaware markets for all provider types including high volume provider Groups, Facilities, Hospitals, and PHOs. Provides assistance to other Southeastern states and markets like Florida and Georgia.
- Negotiate provider contracts (multi-million dollar targets) to support penetration and discount objectives relative to competitive market trends and client expectations through comprehensive, aggressive execution of region specific contracting goals.
- Currently the top Network Development Executive employee in the East Region (over 40 staff) and have already met individual annual performance goals since April.
- Build relationships with internal and external customers, effectively negotiate rate structures and contract language, and provide knowledge and understanding of provider finance components including budget, charge structure, reimbursement formulas and healthcare finance. From May 2013 to Present (2 years 8 months) Independent Contractor @ • Provide evidence-based, quality research, and support around program development/implementation/evaluation efforts
• Training opportunities: strategic planning, focus-group implementation, collaboration
• Business contracts include: Constella Group and Cloudburst Consulting Group
• Client samples include Worksite Initiatives for CDC and Health & Human Services (HHS) Health Guidelines From September 2007 to Present (8 years 4 months) Field Network Coordinator @ • Support all activities related to developing and maintaining physician, practitioner, group, facility, and/or organizational services amongst the delivery system of behavioral health management for Georgia
• Assess network needs, analyzes network composition, uses organizational databases to apply regulatory requirements, accreditation entities, recruits various providers to meet adequacy standards and assure a quality network
• Conducts and oversees provider contracts, amendment initiatives, maintenance of current credentialing status, and evaluation of appropriate action of quality of care issues
• Conducts administrative provider site visits, coordinates report development, ongoing audits, and conducts necessary provider education and activities to maintain contractual obligations
• Assist with internal committees (ex. Regional Network and Credentialing Committee) to determine provider acceptance into Magellan network and ongoing Quality Improvement for Georgia Wellcare contracts From September 2011 to May 2013 (1 year 9 months) Clinical Education Advisor @ GMCF is currently a Quality Improvement Organization (QIO) on a federal contract from Centers for Medicare Services (CMS) via Health and Human Services.
• Provide support to 181 providers amongst 12 counties in Georgia by way of continuous quality improvement efforts, and effective uses of data through on-site visits, meetings, conference calls and ad hoc requests for additional involvement.
• Distribute resources and evidence-based materials to assist providers with quality improvement efforts- targeting diabetic beneficiaries
• Participate and collaborate around events (health fairs, trade shows, community collaborative meetings, etc) that promote health and wellness
• Collaborate with other QIO related programs (Patient Safety, Care Transitions, Prevention, and Chronic Kidney Disease) with performance outcomes and quality metrics From February 2010 to July 2011 (1 year 6 months) Marketing/Outreach @ • Assist Georgia providers/physicians to introduce and train staff regarding APS Healthcare disease management services and program resources
• Distribute tools and evidence-based materials to providers/physicians to improve quality improvement efforts and internal systems
• Participate and collaborate around events (health fairs, trade shows, community collaborative meetings, etc) that promote health and wellness for program eligible ABD Medicaid members
• Performs coordination of services and resource utilization across all internal departments for effective quality management pertaining to both the Georgia Enhanced Care (GEC) as well as Georgia Managed Medicaid Program (GAMMP).
• Oversees functions with URAC and other accreditation sources as it relates to Disease Management, Case Management and Utilization Management.
• Developed APS Healthcare’s internal Health and Wellness committee and chaired all activities
• Initiates and oversees Quality Improvement Projects (QIP’s) for effective outcome measurement From May 2007 to February 2010 (2 years 10 months) Greater Atlanta AreaGuest Relations @ • Provides suite hospitality to clients and guests for over 65 corporate suites.
• Provides excellent communication, knowledgeable skills, and customer service.
• Collaborates with clients and guests for promotions and marketing of services. From April 2000 to September 2007 (7 years 6 months) Greater Atlanta AreaPrevention Unit Director @ • Through Population Based Services approach, developed and implemented statewide health promotion and risk reduction programs related to chronic disease prevention target areas: Educational Awareness, Behavior Modification, Policy and Environmental Change.
• Managed Unit in the health areas of Worksite Health Promotion, Physical Activity, Health Education, Tobacco Cessation, and Nurse Program Consultant.
• State liaison that provided technical assistance and training to over 30 Health Promotion Coordinators within each of the 18 Public Health Districts in Georgia.
• Directed internal worksite health promotion initiative, Health Matters, and overall primary prevention programming for all staff within the Department of Human Resources located at 2 Peachtree Street state office- targeted 2000+ employees
• Chaired worksite work-group of CDC funded (1 of 28 states) statewide physical activity and nutrition initiative, Take Charge of Your Health Georgia.
• Coordinate programs and services with other federal, state, and community organizations to promote specific alignment of visions, goals, and objectives.
• Initiated several contracts and oversee direct services of contractors with both internal and external deliverables pertaining to the area of Worksite Health Promotion and Risk Reduction. From April 2002 to May 2007 (5 years 2 months) Greater Atlanta Area
Masters in Public Health, Health Promotion @ Georgia State University From 2009 to 2012 Health Science Education, Worksite Wellness @ University of Florida From 1995 to 1999 Jon Ducote, MPH is skilled in: Program Management, Health Promotion, Training, Strategic Planning, Health Education, Healthcare, Public Health, Leadership, Management, Quality Improvement, Project Planning, Customer Service, Case Management, Provider Relations, Policy
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