Attorney and Healthcare Executive


Last Updated: 2nd October 2017 (over 4 years ago)

Address
United States

E-mail
Locked

Phone Number
Locked

Gender
Male

Age Range
45 to 54

Qualification Level
Other Post Graduate

Languages
English, Spanish

Summary

Attorney and management executive w/25+ years of strategic, organizational, and leadership experience in private and public sectors. Expertise in public health, managed care, health insurance exchanges, insurance, Medicaid, and Medicare providing account management, legal counsel, and C-suite leadership for government relations, public relations, regulatory affairs, compliance, contract management, policy development, financial oversight, and board management for Fortune 500 companies and state agencies. Leading and directing client and stakeholder-focused relationships with matrix-based teams (operational, clinical, marketing, sales, product, IT, regulatory, and finance) on a local, national, and international scale.

Education

Mississippi College School of Law
Juris Doctorate

   Aug 1985
— May 1988

Louisiana State University
Bachelor of Science, Finance

   Aug 1981
— Dec 1984

Experience

Avalere Health, LLC
Vice President, Health Plans and Managed Care

   Feb 2017
— Current

• Lead and coordinate business development, sales, and brand awareness efforts to advance Avalere in the health plan sector; ensure strong and growing sales pipeline
• Support the development, implementation, and execution of the Health Plan Practice’s business development strategy, including outreach, communications, thought leadership, and content
• Serve as subject matter expert in health plan operations, leading teams within the Health Plan Practice and across the firm while solving complex client issues and present clients with novel solutions and ideas, with an emphasis on health plans in the Medicaid and Medicare Advantage space
• Manage client portfolio to identify and deliver on business opportunities with Avalere’s expertise and offerings
• Counsel and advise clients to achieve optimal operational results, while designing and executing a broad range of client projects involving diverse, cross-functional, and cross-practice teams
• Effectively mentor, manage, and train individuals, teams, and junior staff members (through its Associate Immersion Program) within the Health Plans Practice and across the firm
• Directing and overseeing direct reports’ workload and professional development

NTT DATA, Inc. (formerly Dell Services, Perot Systems)
Business Development Senior Consultant

   Jun 2013
— Feb 2017

• Served as Global Solutions Lead and subject matter expert for solutions for health plan for health insurance exchanges, payment integrity (FWA; COB; subro), provider management (credentialing, contracting, data management), and utilization management
• Promoted solutions for Medicaid managed care and Medicare Advantage organizations; connecting policy and regulatory requirements with NTT solutions and thought leadership
• Facilitated discussions between clients and internal staff around subject matter areas, strategies, policies, and programs, including impacts of federal/state health care policies (focused on Medicare, Medicaid, FEP, and VA/Tricare)
• Analyzed market data to identify trends & opportunities for business development for acquisition of new customers as well as organic growth within existing customer base, including frequent presentations and speaking engagements
• Lead multidisciplinary teams (operations, BPO, development, marketing, IT, legal, finance, executive) for oversight and implementation of client solutions
• Educated health plans on the merits and advantages of NTT DATA Service’s range of services and skills, including supporting sales and account management staff with SME expertise

CSG Government Solutions, Inc.
Senior Consultant

   Sep 2012
— Jun 2013

• Served as subject matter expert, consultant, policy leader, and business analyst focused on CSG’s Healthcare and Human Services consulting & project management practices to state and federal healthcare (Medicaid, Medicare) & state departments of insurance
• Served as Lead Business Analyst for ACA-mandated exchange implementations
• Facilitated corporate communications and served as liaison to state agencies (i.e., DOI, Medicaid) and other key federal agencies (CMS, CCIIO), associations (NAIC), and commercial (health plans/payers) and advocacy stakeholders
• Assisted state insurance, Medicaid, public health, and mental health agencies with strategic planning around healthcare reform, marketing, and implementation

Centene Corporation (Magnolia Health Plan, Inc., subsidiary)
Vice President, Compliance and Regulatory Affairs

   May 2010
— Sep 2012

• Led launch of Medicaid MCO in MS (full-time employee #2); conducted staff interviews, assisted network development, established and nurtured key regulatory, advocacy, legislative, and marketing relationships
• Served as lead health plan contact for all state Medicaid agency interaction and communication
• Managed compliance and regulatory activities with state (Medicaid, public health, mental health, insurance) and federal (CMS) agencies, including communications, policy guidance and interpretation, and ongoing interaction and responses
• Developed and managed strategic senior relationships with state and federal government agencies, elected officials, consultants, project management staff, and executives with community and external stakeholders
• Developed policies, procedures, and processes for corporate parent/subsidiary compliance with state and federal laws, contract requirements, and other industry-based standards (i.e., NAIC requirements)
• Led and interacted with all areas (operational, clinical, marketing, IT, regulatory, and finance) to ensure requirements and mandates were addressed, issues were resolved, and appropriate corporate/subsidiary departments were engaged
• Developed and advocated for legislative and regulatory public policy issues, focusing on Medicaid and managed care; maintained an extensive knowledge base of state and federal laws and regulations on Medicaid, managed care, and accountable care
• Served in key advisory and operational liaison to corporate parent/subsidiary leadership
• Implemented and administered, compliance programs, including payment integrity; HIPAA and HITECH, new employee and continuing education staff training; led vendor management and oversight activities
• As a corporation, managed all Board of Directors activities, including serving as secretary to the Board, writing Board minutes, recommendation and oversight of new member selection, development and provision of new member training and orientation, communications, and logistics

McKesson Corporation (McKesson Health Solutions, LLC, subsidiary)
Government Programs Manager

   May 2005
— May 2010

• Senior executive and account manager for relationships and contracts with:
o California Department of Health Care Services’ Medi-Cal (Medicaid) Disease Management (DM) Pilot Program, providing DM, care management (CM), and triage services for select state populations with chronic illnesses and multiple morbidities
o Los Angeles County Department of Health Services’ Community Health Plan, with DM, CM, and triage services for all covered lives; and Healthy Way Los Angeles, providing triage services for its uninsured populations
o Montana Department of Health and Human Services’ Medicaid program, with DM, CM, and triage services for all covered lives
o Tricare Eurasia-Africa with triage and clinical appointing services for all US military and dependents in Europe and northern Africa
o Tennessee Department of Health’s TennCare program, with triage services for select Medicaid populations
o CMS’ Medicare Health Support pilot in Mississippi, with DM, CM, and triage services for select Medicare populations
• Developed and managed strategic senior relationships with state and federal government agencies, elected officials, consultants, project management staff, and executives with community and external stakeholders
• Developed policies, procedures, and processes for corporate program compliance with state and federal laws, contract requirements, and other industry-based standards (i.e., NAIC requirements)
• Led and interacted with all areas (operational, clinical, marketing, IT, regulatory, and finance) to ensure requirements and mandates were addressed, issues were resolved, and appropriate corporate departments were engaged
• Developed and advocated for legislative and regulatory public policy issues, focusing on Medicaid and managed care; maintained an extensive knowledge base of state and federal laws and regulations on Medicaid and managed care
• Account management responsibilities specifically included:
o Served as primary contact for account management, contract management, and administration with government entities; extensive knowledge of state and federal laws, regulations, and policies
o Developed and managed strategic relationships with government agency leadership, elected officials (state & federal Medicaid and Medicare leadership, Governor’s staff, legislators), consultants, other stakeholders, insurers, & providers

Mississippi Health Care Association
Director of Member Services

   Mar 2003
— May 2005

• Responsible for government relations, education and training services, membership outreach, public relations, strategic planning, and other member-related services
• Managed and trained membership on regulatory activities with state (Medicaid, public health, mental health, insurance) and federal (CMS) agencies, including communications, policy guidance and interpretation, and ongoing interaction and responses
• Developed and managed strategic senior relationships with state and federal government agencies, elected officials, consultants, project management staff, and executives with community and external stakeholders as related to nursing homes and assisted living
• Developed policies, procedures, and processes for membership around compliance with state and federal laws
• Provided internal legal counsel and support to Association’s outside legal counsel
• Managed all Board of Directors activities, wrote Board minutes, supported new member selection, development and provision of new member training and orientation, communications, and logistics

Mississippi State Department of Health
Director, Office of Licensure

   Mar 2001
— Mar 2003

• Served as primary contact with senior agency leadership, Board of Health, external governmental entities, advocacy organizations, and trade organizations for licensure of allied health professions, child care, and healthcare facilities
• Maintained extensive knowledge of existing and developing state and federal laws and regulations on facility and professional licensure areas
• Assessed and advised agency leadership and departments on legislative trends and action resulting in needs for policy and regulatory changes and updates
• Developed and advocated for legislative and/or regulatory public policy issues
• Provided key support, information, and recommendations to State Health Officer, Deputy State Health Officer, agency leadership, and members of the State Board of Health on all licensure area‐related issues
• Served as agency spokesperson for licensure‐related issues; provided support and counsel to agency’s public relations for licensure‐related issues
• Oversaw divisional leadership and management functions, personnel, and organizational budgets (ranging from 8
• to 200+ staff in the respective departments); specific departments/divisions overseen by position included:
o Health Facilities Licensure and Certification – licenses and inspects state’s healthcare facilities (i.e., skilled nursing facilities; personal care/assisted living facilities) and managed care entities
o Emergency Medical Services – licenses and inspects state’s pre‐hospital, hospital, and trauma systems, along with EMS/EMT/paramedics professions
o Child Care Licensure – licenses and inspects over 1,700 child care and related facilities in state
o Professional Licensure – licenses and oversees policies and regulations of 13 allied health professions

Mississippi State Department of Health
Director, Office of Policy and Policy

   Nov 1995
— Mar 2001

• Served as lead liaison/lobbyist for agency and State Board of Health in drafting legislation and interaction with state legislature (and their committees and staff), and state’s congressional delegation
• Directed agency’s policy development and analysis, strategic planning, comprehensive internal programmatic and operational evaluations, and financial/management analysis, including grant applications and interaction with Federal and state entities at senior levels
• Served as liaison to other state agencies (insurance, Medicaid, mental health, corrections, finance, medical, nursing, allied health commissions), outside organizations, advocacy groups, and health-focused coalitions
• Provided key support, information, and recommendations to State Health Officer, Deputy State Health Officer, agency leadership, and members of the State Board of Health on all policy and legislative‐related issues
• Directed agency’s anti‐tobacco policies, contracts, and programs for Division of Tobacco Policy and Prevention
• Explored opportunities and initiatives for public‐private partnerships between governmental bodies and trade and/or advocacy organizations; developed relationships and drafted documentation to establish legal partnerships
• Managed community health center grants and contracts through Mississippi Qualified Health Centers Grants Program used for expansion and capacity building within state’s 21 Federally Qualified Health Centers
• Served as agency spokesperson for licensure‐related issues; provided support and counsel to agency’s public relations for policy and legislative‐related issues

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