GARY B. SIMMONS, MBA

P.O. Box ***

Hixson, Tennessee 37343

CELL: 301-***-****

(Relocation will be considered as required)

EMAIL: ad3q0b@r.postjobfree.com

PROFILE

A team-player, financially driven, performance-driven executive and staff-development coach. Extensive Managed Care experience with matrix-oriented business environments. Ability to bring exceptional Financial Skills for P&L improvement while enhancing Company Culture and Mission Goals.

Core Competencies:

Extensive Managed Care Experience across all Healthcare Functions

Senior Executive Leadership with Complex Matrix Managed Organizations

Extensive Experience with All Types of Networks Contracting Models, including ACO’s Risk Sharing and Shared Incentives for Commercial, Medicare and Medicaid

Exceptional Ability to Manage & Enhance Business Relationships

Proven Financial Skills for P&L Improvement, Business Expansion & Key Metrics

Exceptional Problem Solver & Team Player

Extensive Network Management Experience for Local, Regional & National Delivery Systems including exceptional relationship engagement.

WORK EXPERIENCE

AETNA 2022 – Nov 2023

Fortune 4 company offering a variety of health care plans and services for Commercial, Medicare and Medicaid recipients.

Vice President Medicaid Networks

Responsible for National Medicaid Strategy for Hospital, Physician and Ancillary Contracting, Provider Relations, and Provider Engagement Providers for Medicaid Line of Business. Responsibilities include contracting model development, Value Based Care incentive programs for targeted Network Providers.

BRIGHT HEALTH GROUP 2020 – 2022

Vice President Network Development

Responsible for National Contracting Strategies for Hospitals, Physicians and Ancillary Providers for Commercial & Medicare Lines of Business. Additional responsibilities included Vendor Management for Supplemental Benefits and Network Training Programs.

WELLCARE HEALTH PLANS / CENTENE 2018 – 2020

Vice President National Contracting

Responsible for National Contracting for Hospitals, Physicians and Ancillary Providers for Medicaid and Medicare Lines of Business including Network Strategy and Network Management Training for approximately 650,000 contracted healthcare providers and Vendor Management for Supplemental Benefit Programs.

WORK EXPERIENCE CONTINUED

UNITED HEALTHCARE 2003 - 2018

Regional Vice President, Networks

Led the Network Contracting and Provider Service for United’s Commercial, Medicare and Medicaid Products for over 1,000 Hospitals, 100,000 Physicians and 10,000 Ancillary Providers within the Northeast Region of United States. In addition, was responsible for assigned National Delivery Systems contract negotiations and relationships and lead National Network Training Programs.

Coventry Healthcare 2002 – 2003

Chief Operating Officer

Lead Provider Contracting, Customer Service, Claims Processing and General Functions for Georgia, Florida, North & South Carolina Health Plans.

Blue Cross Blue Shield of Tennessee Senior Vice President, Networks 1997-2002

Health Partners Southeast, Birmingham, AL Senior Vice President & CFO 1996-1997

Humana Health Plans, Louisville, Kentucky Director Networks 1995-1996

Healthsource Tennessee Vice President & CFO 1990-1995

Personal Care Health Management, Champaign, IL Vice President & CFO 1985-1990

Accomplishments:

Created new National Medicaid Network Organization Structure enhancing Network Performance

Implemented & Directed National Network Strategies for New Market Network Builds across multiple Product Lines

Developed & Launched National Provider Relationship Model significantly improving Provider Satisfaction

Created Network Training Program for all Levels of Network Management

Recognized Nationally for best Network Metrics across assigned Markets.

Directed New Line of Business Network Strategies for Health Plan Business Expansion

Launched National Ancillary Strategies with Financial Modeling capabilities for P&L Improvement

Graduated United Healthcare’s Network Certification Program

Assigned Dean of United Health Network University responsibilities to enhance Network Training

Awarded recognition as an Advisor of United Health Group President Leadership Program

Awarded Most Valuable Player by National Health Plan recognition process.

EDUCATION

EASTERN ILLINOIS UNIVERSITY MASTER OF BUSINESS AMINISTRATION

EASTERN ILLINOIS UNIVERSITY BACHELOR OF SCIENCE – BUSINESS

MAJOR IN ACCOUNTING

Contact this candidate