Registered Nurse Manager
Resume:
KENLEY FREEMAN
*************@*******.***
**D Lane Ave. C 978-***-****
Clinton, MA 01510 H 978-***-****
______________________________________________________________________
SUMMARY: Extensive professional and managerial experience in health care
delivery systems and managed care with specialized skill in:
Contract Negotiations Payer Relations
Operations Management Physician Relations
Credentialing Contract Maintenance
EXPERIENCE:
2007-PRESENT INDEPENDENT CONSULTANT/MANAGED CARE
Supported renegotiation of major managed care contract for community
hospital and physician group in Southern Maine representing $20 Million in
revenue
Reviewed claims payment history for contract compliance
2008-2010 AMERICAN RED CROSS OF MASSACHUSETTS BAY, Cambridge, MA
Director, State Testing
Leader responsible for the development, administration, scoring and
registering of competency examinations to CNA and Medication Administration
candidates in MA and NH
Managed three state government contracts exceeding $2 Million in gross
revenue
Served as key content and process expert in the development of a new
certification and registry renewal database
1999-2007 YORK HEALTH CARE (PHO), York, ME
Executive Director
YORK HOSPITAL, York ME
Leader, Medical Staff Care
Executive leader for all managed care operations and contracting for 120+
physician/single hospital PHO in Northeast
Performed predictive analysis of various reimbursement methodologies
Served as primary resource responsible for resolution of business and
claims issues associated with 12 managed care contracts
Negotiated and maintained full delegated credentialing with 100% NCQA
compliance for all managed care contracts
1995-1999 UMASS MEMORIAL HEALTH CARE, Worcester, MA
Director of Managed Care Contracting
Negotiated all capitated and fee-for-service managed care contracts
covering over 150,000 commercial and Medicare Risk covered lives for major
integrated delivery system
Developed interim reimbursement and risk-sharing strategies to support full-
risk commercial and Medicare managed care contracts
Supported the Contract Management Department in the analysis of anticipated
versus actual reimbursement and was the primary resource for resolution of
claims issues
1994-1995 PRIVATE HEALTHCARE SYSTEMS, Waltham, MA
Director of Network Operations
Oversaw consistent contract development, credentialing, provider data input
and market reporting for national preferred provider organization
Helped to support the coordination of claims, provider relations and
network development functions
1992-1994 BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS, Boston, MA
Regional Network Manager/Operations Manager
Managed regional provider relations and member service operations for
dominant statewide managed care organization
1990-1991 THE TRAVELERS HEALTH NETWORK, Boston, MA
Health Plan Manager
Led a team of contracting, provider relations and member service
professionals through the recontracting of managed care network in the
Boston area
1987-1990 HEALTH ALLIANCE PLAN, Detroit, MI
Director of Contracting and New Ventures
Responsible for all provider contracting for one of the oldest health
maintenance organizations in the country, representing over 400,000 members
Successfully completed contract negotiations with dominant Detroit medical
center and associated physicians to support acquisition of 150,000 new
members
1988 HEALTH ALLIANCE PLAN, Lakeland, FL
Chief Operating Officer
On temporary assignment, successfully managed the closure and transfer of
membership of a failing HMO in Florida
During six-month assignment, renegotiated provider contracts to move plan
from $3 Million loss to break-even
1986-1987 FIREMAN'S FUND, Indianapolis, IN
Professional Relations Director
Developed network for small HMO in Indiana serving small group market of 50
employees or less
1983-1985 KREINDLER MEDCENTER, Cincinnati, OH
Director of Planning
Oversaw completion of 52,000 sf facility for a large multi-specialty
physician group
1978-1983 THE CHRIST HOSPITAL, Cincinnati, OH
Registered Nurse-IV Therapy
1975-1977 THE LOGAN DAILY NEWS, Logan, OH
City Editor
EDUCATION:
University of Cincinnati, Cincinnati, OH.
Health Planning/Administration, (48 hours completed toward M.S., 1981-83)
Northern Kentucky University, Highland Heights, KY
A.D., Nursing, 1981
Hocking Technical College, Nelsonville, OH
Certificate, Practical Nursing, 1978
Wilmington College, Wilmington, OH
B.A., History and Government, 1975
COMMUNITY ACTIVITIES:
Town Meeting Representative, Precinct 7, Chelmsford
Past Chairman, Board of Directors, Innovation Academy Charter School,
Tyngsboro, MA
Member, 2008 Stipends Review Committee, Town of Chelmsford
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