Jose M. Samuel Jr.

917-***-****

ad4lx9@r.postjobfree.com

Professional Profile:

Multi-lingual managed care professional with extensive experience in contracting, issue resolution and network management.

Experience:

Fidelis Care New York

Supervisor, Provider Relations 12/13-10/23

Managed Provider Relations representatives to facilitate appropriate provider on-site education, problem resolution, partnership development and ensure optimum provider satisfaction, compliance with regulatory requirements and achievement of Fidelis goals and objectives. Developed relationships with key providers and coordinated projects related to marketing and quality initiatives. Directed the daily activities of the Provider Relations staff and network contracting including incentive programs. Involved in identifying, communicating and holding staff accountable for performance expectations; monitored the job results/performance and promoted a positive, team-oriented work environment.

● Supervised division departmental staff to ensure the achievement of the company's network development goals. Planned performance expectations, monitor, and appraised the Provider Relations representative job results and performance in order to develop, counsel, or discipline staff members.

● Coordinated partnership meetings to foster strong, positive, collaborative relationships with key providers, and facilitated and strengthened marketing opportunities.

● Involved in identifying and remediating operational short-falls and researching and remediating claims.

● In conjunction with the Director, Provider Relations, established incentive programs and monitor projects to support QAAR, HEDIS and Access and Availability projects to assure compliance with regulatory requirements, and achieve optimum results

● Identified staff training needs and provide ongoing training, as well as initial orientation, to ensure the effectiveness of Provider service staff. Document, evaluate, and counsel poor performing employees in order to maintain staff job results.

UnitedHealthcare 12/10-11/13

Sr. Physician Advocate

Responsible for a full range of provider relations and service interactions within UnitedHealthCare Group, including working on end to end provider claims, training and development of external provider education, design and implement incentive programs.

● Designed and implemented programs to build and nurture positive relationships between the health plan, providers and practice managers.

● Implemented strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs.

● Involved in identifying and remediating operational short-falls and researching and remediating claims.

● Worked collaboratively with Clinical Team and develop plans for network growth.

● Developed value added personal relationships with assigned physicians and medical groups through face to face tracked and documented meetings.

Neighborhood Health Providers – New York, NY 08/09-12/10 Manager, Marketing and Provider Retention

Directed the daily activities, Acquisition & Marketing and responsible for the strategy and implementation of companies retention, activation, stimulation and winback programs for existing customers across its core businesses. Develop and manage campaigns and highly analytical projects aimed at mitigating and reducing customer churn, increasing customer loyalty, and stimulating response, including offer analysis, customer segmentation and campaign analysis.

● Developed retention, in stimulation and winback marketing strategies.

● Worked closely with the product management team, channel marketing, and forecasting groups to execute and evaluate product and channel forecasts.

● Managed and drove all analytical initiatives and strategies behind existing customer marketing initiatives . Education: Received a Bachelor’s Degree in Mining Survey from the Krivoy Rog Mining Institute. Computer Skills: Fluent in Microsoft Word, Excel, Access and PowerPoint. MHS, Pegasys. Uniflow, Meditrac, Maxsys systems, Macess and Facets.

Languages: Fluent in English, Spanish; Russian, French and Portuguese

Contact this candidate