Management Medical

JANE ISH

705-***-**** ********@*****.***

SUMMARY

Managed Health Care Executive with extensive experience managing Provider Network

Contracting/ Development and IPA Operations. Demonstrated competencies include:

• Strategic member of Health Net management team that built a national business

from 82,000 members to 5 million members in 5 years, through mergers and

acquisitions

• Successful in medical cost management through provider network contracting,

medical management redirection strategies and benefit plan design changes.

• Proficient in turning around organizations demonstrated through multiple

consolidations and conversion planning initiatives for provider networks.

• Management of large-scale Physician/Hospital shared risk partnerships.

AETNA 2009-2010

SENIOR NETWORK MANAGER

Joined Aetna to manage the 16.5 billion Tricare HealthCare Award. Led Provider recruitment

and contracting for the Mid-America/Heartland market and the National Capital Washington DC

region for the Tricare Product. Initiated provider contracting with 100,000 providers and

completed 15% of the network prior to the Award being reversed. Managed 7 Contractors

virtually.

GERSON LEHRMAN CONSULTING

2007-PRESENT

INDEPENDENT CONSULTANT

Consult with Private Equity Firms investing in Healthcare companies. Educate, advise and offer

information related to industry trends, the impact of healthcare legislation, and discussion on the

relationship of hospital, physician and ancillary providers with Payors.

CIGNA HEALTHCARE OF FLORIDA LAKE MARY, FL 2006-2007

STATEWIDE DIRECTOR OF PHYSICIAN CONTRACTING

Implemented recruitment initiatives for a network in the Florida Keys. Led a physician

recontracting strategy to increase auto-adjudication and reduce fee schedule complexity.

Managed a Provider Network team of 12 for the State of Florida.

.

ZENITH INSURANCE COMPANY WOODLAND HILLS, CA 2004 – 2005

NATIONAL DIRECTOR, PROVIDER NETWORKS

Recruited to Zenith to lead the development of a filing with the State of California for the first

approved Workers’ Comp Medical Provider Network for a workers’ comp insurance company.

Managed multiple provider network relationships in 42 States and collaborated with medical

management to develop a custom network in surgical specialties.

HEALTHCARE PARTNERS MEDICAL GROUP TORRANCE, CA 2002 – 2004

DIRECTOR, PROVIDER NETWORKS

Managed provider network contracting for five regions covering 500,000 members in Los

Angeles County. Physician, hospital and ancillary contracting strategies included capitation/cost

modeling, employment/per diem/fee for service agreements. Led Company teams on medical

group acquisitions; electronic claims interfaces, provider performance reports and Hospital

strategy. Implemented a 7 million dollar strategy to reduce out-of-network costs.

HEALTH NET, INC. WOODLAND HILLS, CA 1989 – 2002

One of the nation’s largest publicly traded health care companies serving 5.3 million individuals

in 15 states. Managed strategic planning and consolidation efforts for provider networks,

databases and staffing through the course of five mergers.

ASSOCIATE VICE PRESIDENT DIRECT NETWORK MANAGEMENT 2000 – 2002

Assumed a National and Statewide leadership role for Provider Network Management delivering

the company’s goal to operate nationally and grow the PPO and Indemnity business.

• Developed a national PPO network integration strategy that expanded the California

national leased network agreement to six other States on the East and West Coast.

• Consolidated Provider Network/Operations management for the California Health

Plan, the Federal Services division, and the Workers’ Comp division to align and

minimize duplicate contracting.

• Non-contracted provider claims were fee negotiated to achieve $29 million in savings

on $95 million in claims for 2001 and savings of $40 million in 2002. This

successful contracting strategy was expanded nationally.

• Implemented network agreements in Mexico to support cross-border product

initiatives.

ASSOCIATE VICE PRESIDENT 1999 – 2000

PPO BUSINESS DEVELOPMENT & STATEWIDE PROVIDER CONTRACTING

Assessed, developed, and implemented Health Net’s PPO Product for growth and profitability.

Grew membership from 20,000 members to 130,000 members in 18 months.

• Led a company-wide effort to transform HMO-oriented policies, procedures,

contracts, benefit plans, and pricing to create a competitive PPO infrastructure.

• Leased a National PPO network, secured out-of-State medical management services,

and national repricing networks to ensure national account growth of 5,000 members

in 12 months.

• Created a Statewide direct contracting plan for physician, ancillary, and transplant

networks.

• Reduced California transplant costs by $2 million in annualized savings and

expanded national transplant capabilities by working closely with Medical

Management.

ASSOCIATE VICE PRESIDENT PROVIDER NETWORK MANAGEMENT 1997 – 1999

Developed and executed Network integration strategies for hospitals, physicians, and ancillary

networks, and transplant centers for the Foundation Health Systems/Health Net merger. Led

cross-functional teams typically consisting of physicians, attorneys, and other experts to

identify, evaluate and pursue strategic alliances or opportunities to produce cost-savings or

expand product growth. Consolidated provider administration functions and managed provider

database conversion for this merger through a staff of over 150 associates.

GOLDEN STATE IPA CHIEF OPERATING OFFICER 1995 – 1997

Created and implemented a Statewide IPA as a separate business with a management services

agreement with Health Net. Coordinated the healthcare for 62,000 Northern California

members through 18,000 physicians and 89 hospitals. Managed 70 staff including clinical,

contracting and claims. Collaborated closely with the Chief Medical Officer, President of the

IPA, and the Board of Directors on:

• Reviewing financials and taking actions to influence employer pricing in rural

counties

• Discussing medical community/ hospital system opportunities to improve Provider

contracting

• Reviewing individual physician performance report cards/referral patterns

• Implementing claims rules related to contracts and claims payment review

DIRECTOR, IPA ADMINISTRATION OAKLAND, CA 1989 – 1995

Directed operations for Heals IPA whose HMO services grew from 82,000 to 1.3 million

members in five years. Initially merged the provider networks of Heals IPA and the Heals

HMO. Five subsequent HMO mergers followed. (QualMed, Bridgeway, PCA, HealthNet,

FoundationHealth). Directed provider data conversions and consolidated provider network

operations for those mergers.

UNITED HEALTHCARE JACKSON, MI 1986 – 1989

PROFESSIONAL RELATIONS MANAGER

Developed a Provider Network for a start-up HMO that became the fastest growing company in

Michigan and is now one of the largest HMOs in the United States.

EDUCATION

MSW, Social Work & Program Administration Michigan State University, East Lansing

BA, Psychology/Sociology Laurentian University Sault Ste Marie, Canada

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