Management Medical

FRANCINE CRIDER

**** ********** ****, ***********, **** 43081

614-***-**** C ( 614-***-**** H ( abigpe@r.postjobfree.com

SENIOR HEALTHCARE EXECUTIVE

Accomplished professional with 20+ years of progressive experience

developing and leading managed care, case and utilization management

programs for governmental and commercial healthcare plans. Diverse care

management experience encompasses medical, pediatric, behavioral health,

chemical dependency, sub-acute, and rehab services for financially at-risk

and not at-risk payers. Demonstrated success in setting and attaining

system-wide goals and objectives and improving staff accountability.

Recognized for superior interpersonal skills and an ability to quickly

develop credibility with staff, internal and external clients and community

resource representatives. Areas of expertise include:

. Strategic planning/ implementation

. Project management

. End user technology assessment

. Staff recruitment, development, and retention

. Production management

. Contract/Provider agreement compliance

. Healthcare cost management

. Quality initiatives

. Customer/Member/ Provider Relations

PROFESSIONAL EXPERIENCE

Molina Healthcare of Ohio, Columbus, Ohio 2008 to 2009

Molina Healthcare of Ohio (MHO) is a financially at-risk managed care

organization specializing in managing healthcare services and benefits for

government plans (Medicaid Temporary Assistance for Needy Families [TANF]

and Adult, Blind, or Disabled [ABD], and Medicare populations).

DIRECTOR, Utilization Management

. Selected by Executive Management to lead an interdepartmental team

developing and implementing the plan for in-sourcing of the behavioral

health services from an independent review agency. The transition plan

was so successful it was adopted as the model for use by other Molina

Healthcare, Inc (MHI) state plans.

. Oversaw development and implementation of care coordination programs

targeting reduction of inpatient readmissions and behavioral health bed

days. Based on early results, and potential annual reduction in health

care expenses of $300K+, adopted by MHI for use by other state plans.

. Oversaw the formulization and implementation of programs to reduce

inappropriate emergency department (ED) utilization resulting in a 2%

reduction in TANF utilization and stabilization of ABD utilization.

. Oversaw development and implementation of a program to enroll at-risk

pregnant women for treatment of preterm labor with the potential for

$100K in avoided healthcare expenditures. Program adopted by MHI for use

by other state plans.

. Directed a staff of 55 direct and indirect reports with a $3M+ budget

responsible for case management, care coordination and behavioral health

service management in compliance with the Provider Agreement with Ohio

Department of Jobs and Family Services (ODJFS) and National Committee for

Quality Assurance (NCQA) requirements.

DC Chartered Health Plan, Inc, Washington, D.C. 2006 to 2008

DC Chartered Health Plan, Inc. is a financially at-risk managed care

organization for the TANF and the adult uninsured Alliance plans.

DIRECTOR, Medical Management

. Responsible for the strategic planning and daily operations of the

Medical Management Department including inpatient and outpatient medical

and behavioral health, case, and disease management programs.

Responsible for $1.5 M budget and 24+ professional and ancillary

employees.

. Developed and modified programs to meet NCQA requirements for Utilization

and Disease Management resulting in a 3 year initial review

certification.

Gateway Health Management Services, a North American Benefits Network

Company (NABN),

Rocky River, Ohio 2003 to 2004

North American Benefits Network is a third party administrator for self-

funded ERISA plans.

DIRECTOR HEALTH MANAGEMENT SERVICES

. Developed the strategic plan for post merger integration of two

departments responsible for utilization and case management. The

integrated programs resulted in 20% of NABN's annual revenues.

. Instrumental in the corporate wide management of post merger transition,

including employee adaptation to differing corporate cultures, client and

member relations and development of new processes resulting from the

elimination of duplicated services.

E-V Benefits Management, Inc. (E-V), Columbus, Ohio 1991 to 2003

E-V Benefits Management is a third party administrator specializing in

custom designed benefit plans for self funded ERISA and public entity

benefit plans

DIRECTOR, Medical Administration (1996 - 2003)

. Directed the development and strategic implementation of medical risk

management through managed care, utilization review, case management, new

technology reimbursement policy, and other medical risk management.

Programs represented 25% of E-V's gross revenues and resulted in direct

and indirect medical dollar savings of 2:1 small plans and 3:1 large

plans ROI.

. Lead E-V's interdepartmental managerial team responsible for the

comprehensive planning, organizing, and implementing of new client

benefit plans and plan renewal customizations.

MANAGER, Medical Services/Operations (1991 - 1996)

. Managed the day to day operations including strategic planning to meet

corporate goals for Customer Service, Claims Administration, Incoming and

Outgoing Correspondence, Claims Registration, Member Services,

Eligibility, Quality Management, and Medical Services, and the

development and implementation of comprehensive and integrated medical

risk management programs.

EDUCATION AND PROFESSIONAL CREDENTIALS

Mount Vernon Nazarene University, Mount Vernon, Ohio

Master of Science, Management

Bachelor of Business Administration

St Francis University, Fort Wayne, Indiana

Diploma, Nursing

NLP Comprehensive, Boulder, Colorado

Masters Certification NeuroLinguistic Programming Practitioner

Certification NeuroLinguistic Programming Practitioner

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