Health Care
Resume:
VANESSA M. OWENS
Columbia, SC 29223
803-***-**** (Cell)
803-***-**** (Home)
************@***.***
PROFILE
Healthcare executive with 10+ years of progressive management experience in healthcare delivery and financing. Successful
background in managed care and hospital operations with vast experience in contract negotiations, network development,
provider relations, compliance, marketing, Medicaid, Medicare, Tricare and commercial (HMO, PPO, POS, EPO) lines of
business.
EDUCATION
M.A., Health Care Administration- 1995
Hofstra University, Hempstead, New York
B.S., Business Administration/Management-1991
South Carolina State University, Orangeburg, South Carolina
Cum Laude
RECENT PROFESSIONAL EXPERIENCE
Aetna - Hartford, Connecticut 2010-present
Contract Consultant/Independent Contractor
• Negotiate agreements with medical providers for Aetna’s Medicaid line of business throughout the United States as assigned.
Coventry Health Care- Columbia, South Carolina 2007-2009
Director, Network Management (Provider Relations & Network Development)
• Negotiated, executed and implemented agreements with hospitals, centers of excellence transplant facilities, FQHC’s, RHC’s,
IPA's, PHO's, MSO’s independent physicians and ancillary providers on behalf of Coventry Health Care.
• Acted in an advisory capacity to Coventry Health Care's corporate legal department with regard to the financial and legal impact
of proposed contract language revisions.
•Managed state regulatory compliance activities, regulatory filings and contract and agreement review functions.
•Developed and implemented network management strategies and methodologies for specific initiatives and geographic areas in
support of Coventry Health Care’s strategic goals and objectives.
• Observed network management activities to ensure efficiency and maintain compliance with Coventry Health Care’s policies
and standards, government laws and regulations.
• Created network management policies and procedures.
• Prepared network management budget.
• Compiled, maintained and analyzed fee schedules for the purpose of identifying cost saving opportunities.
• Evaluated and monitored providers’ performance standards and financial performance of negotiated contracts.
• Recruited, directed, developed and motivated network management staff.
• Worked closely with Coventry Health Care’s sales/marketing, health services, customer services, provider services and finance
departments located throughout the United States.
Coventry Health Care- Charleston, South Carolina 2006-2007
Independent Contracting Consultant/National Network Development
• Negotiated, executed, and implemented contracts with hospitals, centers of excellence transplant facilities, IPA's, PHO's,
independent physicians, and ancillary providers for Coventry Health Care throughout South Carolina.
Wellcare Health Plan of Georgia- Marietta, Georgia 2005-2005
Independent Contracting Consultant
• Negotiated agreements with primary care physicians, specialty physicians and ancillary providers for Wellcare Health Plan
throughout the state of Georgia.
CIGNA Healthcare- Charleston, South Carolina 2000-2001
Manager, Contracting
• Negotiated, managed, coordinated and implemented contracts with centers of excellence transplant facilities, large physician
groups, hospitals, network systems, nursing homes and ancillary vendors throughout the state of South Carolina on behalf of
CIGNA Healthcare.
• Utilized facility and physician pricing models to analyze and determine financial impact of contracts being negotiated in order
to decrease medical loss ratios. Actively participated in provider compensation/reimbursement and pricing development
activities.
• Worked closely with sales/marketing, provider relations, medical management and medical economics departments.
Loris Healthcare System- Loris, South Carolina 1999-2000
Director, Managed Care & Industrial Relations
• Negotiated and directed all managed care organization, physician-hospital organization, health center, network systems,
ancillary vendors, nursing home and local business contracting on behalf of Loris Healthcare System.
• Established relationships with local industries in South Carolina and North Carolina in order to promote Loris Healthcare
System.
• Performed financial analyses to identify medical cost improvement opportunities of current and future managed care
organization contracts.
• Created departmental policies and procedures.
• Prepared departmental budget.
Fidelis Care New York- Rego Park, New York 1996-1998
Director, Network Development/Contracting
• Negotiated and/or renegotiated agreements with hospitals, IPA’s, D&TC/FQHC’s, pharmacies, SNF’s/nursing homes/hospices
centers of excellence transplant facilities and other numerous ancillary vendors in New York City, Westchester, and Long Island.
• Negotiated capitated arrangements for dental, vision, mental health and free-standing laboratory services in order to provide in-
network coverage for Fidelis Care New York’s 81,000 statewide membership utilizing requests for proposals (RFP’s).
• Contracted and coordinated special project contracting for Child Health Plus, special needs populations (HIV/AIDS) and school
based health centers.
•Managed state regulatory compliance activities, regulatory filings and contract and agreement review functions.
• Created departmental policies and procedures.
• Prepared departmental budget.
OTHER HEALTHCARE EXPERIENCE
New York City Department of Health/Division of Health Care Access- New York, New York
Assistant Director of Compliance and Performance
Empire BlueCross BlueShield- New York, New York
Manager, Ancillary Contracting
Oxford Health Plan- New York, New York
Provider Relations Administrator
HONORS & AFFILIATIONS
• South Carolina State University Presidential Honors
• South Carolina Health Alliance-Society of Managed Care Professionals
• Healthcare Financial Management Association
EXCELLENT PROFESSIONAL REFERENCES PROVIDED UPON REQUEST
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