Manager Health

PATRICIA RICHARDS

*** ***** ****** #*, ********, NY 11233

985-***-**** . ********@*****.***

SUMMARY

< Cross-functional team builder with focus in strategic operations and

project management.

< Demonstrated ability to take ownership of challenges and recognized for

strong communication skills and resourcefulness.

< MPH with concentration in Population Health Management; 8+ years of

healthcare industry and leadership experience.

PROFESSIONAL EXPERIENCE

Health Republic Insurance of New York (HRINY), New York, NY

Jan 2014-Present

Director of Strategic Planning & Development

< Manage major projects for the COO's office including provider network

strategy development, vendor contracting strategy and negotiations,

vendor engagement and integration initiatives, and the development,

implementation and optimization of vendor Service Level Agreements (SLAs)

< Primary point-of-contact at the health plan for our leased network vendor

for network expansion and strategic planning activities

< Maintain responsibility for creating Policies & Procedures for Network

Management and Provider Relations - including Contract and Recruitment,

Provider Data Management, Out-of-Network Reimbursement and Disruption

Reporting; presenting P&Ps to the Policy Committee for approval

< Manage network operational activities such as provider network adequacy

and data accuracy, vendor call center reporting, complaint/ escalation

resolutions and compliance with network regulatory requirements

< Ensure Qualified Health Plan adherence to Exchange Blueprint, State

financial and solvency standards and Centers for Medicaid and Medicare

(CMS) Loan Agreement terms

< Provide support to the COO and CFO in contracting and pricing

negotiations with key TPA vendors

< Participate in meetings with senior staff to develop operational

readiness, organizational and departmental goals

Freelancers Union/ Independent Workers Services (IWS), Brooklyn, NY

Mar 2013-Dec 2013

Account Manager for Health Republic Insurance of New York

< Served as account/ vendor manager to HRINY to facilitate communication

between the HRINY executive team and IWS project management team

< Supported the CFO and COO at Health Republic obtain Article 28 licensure

by managing documentation and acting as a key participant in the

Department of Financial Service (DFS) organizational exam

< Monitored and tracked performance of implementation activities across

work-streams

< Delivered weekly status reports, including issues and risks logs, to

HRINY

< Provided project management support to HRINY to receive licensure as a

Qualified Health Plan and participate on the NY Health Insurance

Marketplace

< Served as liaison with the Centers for Medicaid and Medicare Services

(CMS) regarding progression of milestone completion for HRINY

Interboro RHIO (Regional Health Information Organization), NY, NY

Mar 2010-Mar 2013

Project Manager

< Managed the ongoing operational activities related to the health

information exchange

< Directed the integration of over 500 community physicians, 11 hospitals

and 5 healthcare organizations

< Managed relationships between participating organizations and health IT

vendors

Student Partnerships Worldwide, Vellore, Tamil Nadu, India

Jun 2008-Dec 2008

Program Evaluator

< Evaluated impact and sustainability of an international youth development

program

< Documented best practices for dissemination at local, national and

international levels

< Performed an ethical review of informed consent practices in India;

presented to Columbia faculty and staff

The Office of William J. Clinton, New York, NY

Dec 2007 to Jun 2008

Correspondence Associate

< Liaised with multiple departments within the Clinton office as well as

the Clinton Global Initiative to develop communication material on behalf

of former President Bill Clinton

< Drafted book blurbs and memorandums

Globalemed, SA (PTY) LTD: Cape Town, South Africa

Dec 2004-Jun 2007

Quality Control Manager

< Administered quality control testing of HIV and infectious disease rapid

diagnostic products

< Maintained FDA regulatory files and internal standard operating

procedures

< Hired, trained and supervised 20 line workers

< Performed on-site trainings at local pharmacies and rural clinics

Additional Skills/ Training

< Health IT Certification in Health Information Exchange (CPHIE), 2012

< Proficient in Microsoft Word, Excel, PowerPoint, Access, SalesForce

< Intermediate level reading/ writing Spanish

< Six Sigma Black Belt candidate

EDUCATION

Columbia University, Mailman School of Public Health: New York, NY

Masters in Public Health, May 2009

Population and Family Health, Global Health Track

Loyola University: New Orleans, LA

Bachelor of Arts in English Writing, May 2004

Graduate Cum Laude, Member of Phi Alpha Theta, Honors History Fraternity

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