Stephen McCandless

Email: abpefc@r.postjobfree.com

Address: *** ********** *****

City: Roanoke

State: VA

Zip: 24019

Country: USA

Phone: 540-***-****

Skill Level: Director

Salary Range: $135,000

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

Stephen B. McCandless

555 StoneLedge Drive, Roanoke Virginia 24019 540-***-****

abpefc@r.postjobfree.com

Objective

Position directing an organization's contracting, network development, and ACO services. This includes collaborative and creative approaches to address the challenges of the current healthcare delivery, quality, and cost environment.

Industry Skills

Negotiations - Institutional/Professional/Ancillary Services 28 Plus Years Health Care Experience

Consulting - Managed Care Integrated System Creative approaches and Solutions

Hospital, PHO, ACO & Payor Experience Quality and Efficiency Measures

Financial/Technical Background (BS/MBA/MHA/EMT) Provider-Payor Relations and Innovation

Professional Experience

CARILION CLINIC Roanoke, Virginia 2007 to Present

Director Revenue Management

Direct contracting for all managed care activities for this innovative 8 hospital-600 physician fully integrated network

Contract for and internally coordinate Carilion's efforts to implement Quality and Efficiency goals with bonus payments for Medicare Advantage, Medicaid MCO, Carilion Clinic-Aetna ACO product, and commercial products

Adjunct member of Carilion's Medicare and Medicaid Products' Board of Directors

Interface between Aetna and Carilion for their ACO joint commercial product

Coordinator from development to implementation of Carilion's owned Medicare and Medicaid HMO products

Developed ACO contracts for Commercial Payors for the Brooking-Dartmouth ACO demonstration project

Integrated all contracting activities under single department. Contracts' Total Net Revenues exceed $800 million

Negotiated terms resulting 45% increase in net commercial revenues over 6 years

CMS Innovations Center grant reviewer

UNITED HEALTCARE Charlotte, North Carolina 2006 to 2007

Senior Network Account Manager

Charlotte and Western NC Network Manager responsible for United's efforts to enhance its market and sales positions

Re-established relationship with providers. Expanded contracts for Medicare Risk products

Negotiated evergreen terms and language that exceeded corporate goals

CIGNA of Massachusetts Newton, Massachusetts 2002 to 2006

Assistant Director (Contracting & Network Management)

Regional contracting officer for Massachusetts and Rhode Island. Negotiated competitive agreements for the full range

of hospitals, ancillary providers, and physicians for a payor with four percent of the market

Developed and implemented contracting strategies involving new corporate mandates concerning claim processing limitations, charge neutralization, and evergreen maintenance free contract construction

Brought current a backlog of pending provider agreements. Negotiated prospective interim payments with providers that were considering leaving. Special negotiator for terminating providers

University Physician Hospital Organization/University Health Link Augusta, Georgia 2000 to 2002

Director (Contracting & Network Management)

Contracted on behalf of 500 physicians, owned tertiary and eight affiliate hospitals, and full range of ancillary facilities;

ASCs, Rehab Hospital, Home Health, DME, and Infusion

Negotiated and monitored agreements and contracts to expand network servicing the Hospital's Employee health plan and area direct agreements with 30,000 covered lives. Wrote mental health, obstetric, and transplant agreements

Reduced Days AR to 57 in 2000 and 53 in 2001through re-contracted terms and reduced denials

Hospital posted its highest ever percentage net and gross margins and corresponding excess revenues

Carolinas Healthcare System Charlotte, North Carolina 1997 to 2000

Senior Manager (Managed Care Contracting and Affiliate Relations)

Renegotiated Managed Care Payor Agreements for all affiliated providers

Reviewed, presented, and gained approval from affiliates' Boards' of Trustees for inclusion in all System Agreements

Presented monthly updates to facilities' CEOs and Hospitals' Boards of Trustees while maintaining their System relationships

Wrote, negotiated, and implemented direct agreements between individual facilities and targeted area employers

Contract reviewer for nonaffiliated PHO. Performed Due Diligence for pending Health System acquisitions

Senior Managed Care Analyst

Negotiated Managed Care Commercial Payor Agreements for this regional integrated delivery system

Provided fee based managed care consulting services to affiliated facilities through out the Carolinas

Blue Cross Blue Shield of North Carolina, Durham, North Carolina 1986 to 1997

Institutional Network Contracting Consultant

Directed and managed all activities for BCBSNC's 50 site Ambulatory Surgery Network. ASC program quality,

innovation, and safety drove the move of inpatient surgery to the use of hospital outpatient and ASC venues

Contracted 425 member Durable Medical Equipment (DME) network

Revised and renegotiated DME, Hospice, Nursing Home, Infusion, and Home Care contracts

Wrote POS and PPO Managed Care Ancillary Contracts for Sleep Medicine and niche providers

Developed computer pricing system control edits with annual savings exceeding $2 million

Special Provider Contracts Coordinator

Developed and managed all aspects of BCBSNC's Ambulatory Surgery Program with savings exceeding $65 million

Wrote Hospice Contract and designed contract benefits. Wrote special contract for Sleep Medicine Centers

Designed POS and PPO Managed Care Ancillary Contracts for Sleep Medicine and niche providers

Coordinator of Cost Containment Programs

Expanded the number of ambulatory surgery providers by 40% in the first year

Program generated 45% of BCBSNC's total institutional savings for 5 years

University Hospital Jacksonville, Florida 1984 to 1985

Administrative Resident and Assistant to the Chief Operating Officer

Prepared this 500 bed inner city teaching hospital for its JCAHO accreditation inspection

1st SPECIAL OPERATIONS WING, Captain, USAF, Hurlburt Field, Florida 1981 to 1982 Wing/Staff Chief, Self Inspection - Received 2nd Air Force Commendation Medal

Developed and implemented a Quality Control/Inspection Program for this Special Operations Wing of 4,000

personnel. Administrative chief for mobile audit team providing operational assistance. Received 2nd AF

Commendation Medal

823rd CIVIL ENGINEERING SQUADRON, Captain, USAF Hurlburt Field, Florida 1980 to 1981

Director of Administration - Directed staff of 14.

751st RADAR STATION, Lieutenant, USAF, Mt. Laguna, California 1976 to 1980

Executive Officer - Received Air Force Commendation Medal. Selected for Pilot Training

Education

Duke University, The Fuqua School of Business, Durham, North Carolina

Master of Health Administration 1984

National University, San Diego, California

Master of Business Administration (Finance) 1980

Duke University, Durham, North Carolina

Bachelor of Science (Zoology-Marine Biology) 1975

Organizations

Member Board of Directors BCBSNC PAC and Legislative Task Force, Member Durham County Board of Commissioners' EMS Advisory Council, Member-ACHE& Virginia HFMA, Member-Triangle Healthcare Executive Forum and Metrolina Healthcare Executive Forum, United Way-Division Coordinator, Member-DUHHAAA, Member CSRA-AHE. Class, Fraternity, and National Honor Society Presidents

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