Mark W. Renna, MHA, BSN, RN

adybk0@r.postjobfree.com 636-***-**** Florissant, MO 63031 linkedin.com/in/mark-renna0424/

Healthcare Executive

Expertise in operations, contract negotiation, marketing, nursing, and staff management within managed care, disease management, hospice, and home health care sectors. Spearhead operational improvements that drive productivity and reduce costs while leveraging highly developed interpersonal skills to lead diverse projects and teams. Consistently demonstrate that quality, productivity, and employee engagement can co-exist. Key competencies include:

Health Plan Management Utilization Review Call Center Operations Contract Negotiation Case Management Medicare/Medicaid/Marketplace Managed Care Home Health Disease Management Ambulatory Services

Professional Experience

Manager Outpatient Services / Care Management Shriners Children’s Hospital St. Louis, MO Oct 2022 - Present

Responsible for oversight and throughput of orthopedic outpatient clinic of 18 exam rooms for initial and established patients with special skeletal and neuromuscular conditions. Oversee 8 FTE base staff in clinic, 1.5 FTE in social work services, 1 FTE in transport navigation, and 4 FTE in care management, with 8 supporting PRN staff. Provide leadership to case managers in coordination of care for each medical-surgical specialty clinic for outpatient & inpatient services along a child’s journey at Shriners Children’s.

Attained a wait time of less than 10 minutes from point of entry to clinic.

Achieved rooming of patient at assigned appointment time > 95% daily.

Manager, Utilization Management Lumeris/Essence Health Care St. Louis, MO Oct 2019 - Sep 2022

Led daily Prior Authorization and Concurrent Review Management services for a Medicare Advantage Plan.

Monitored CMS timeliness, contractual requirements, and quality on requests for eligible members with 99% on time turnaround times resulting in meeting contractual CMS requirements.

Coached and developed Utilization Management staff on performance to successfully meet CMS turnaround times and quality measures.

Executive Director Mederi Caretenders/LHC Group St. Louis, MO Dec 2018 - Oct 2019

Directed services of 3 home health agencies in Greater St. Louis. Managed CMS compliance for billing, provision of skilled nursing and therapy services for Medicare/Medicaid and Managed Medicare enrollees. Managed retention, recruitment, training, and corrective disciplinary action for 65 clinical staff. Supervised 2 branch clinical directors and office staff manager of provider location. Fiscal budget responsibility for the provider.

Reduced outstanding billing for services provided in FY 2018 by 65%.

Hired a clinical director, 3 account executives, and 2 office staff in first 90 days; terminated one.

Re-established working relationships of top 10 providers across 3 agency locations.

Team Director Seasons Hospice and Palliative Care St. Louis, MO Sep 2017 - Oct 2018

Directed multidisciplinary team of 15-20 registered nurses, LPNs, social workers, chaplains, and hospice aides providing services to terminal residents in nursing homes, assisted living facilities, and private homes. Hired, coached, and terminated clinical/non-clinical staff. Directed patient caseload assignments, billing of equipment/services, care planning, intake and prognostic evaluations of patients. Provided office/vendor support to field clinicians/non-clinicians.

Facilitated interdisciplinary meetings with Hospice Medical Director for patient census for Medicare compliance.

Reviewed and approved clinical documentation, 485 Plan of Care creation, hospice data sets of admission and discharge submissions to Medicare, and ongoing physician order processing.

Director Healthcare Services Molina Healthcare of New Mexico Albuquerque, NM Dec 2013 - Aug 2017

Led startup and ongoing operations in support of new Centennial Care Program as dictated by Human Services Division (HSD) of State of New Mexico.

Provided oversight and project management of transitional care authorization and claims payment within mandated turnaround time of 15 days.

Implemented care coordination model in Centennial Care (Medicaid) program in 2014.

Led daily operations of Utilization Management processes and communication to HSD and statewide providers.

Led Health Plan Accreditation audits such as NCQA, Health Insight, and HSD state. Achieved outstanding results in all audits over 2-year period including (2) 98% scores with Health Insight (2014 & 2015).

Achieved 3-year accreditation as NCQA Managed Care Organization in 2015.

Built and maintained relationships with all hospital providers across state to provide effective payment and authorizations for contracted and non-contracted services.

Implemented remote electronic medical record access and onsite concurrent review in largest hospitals and hospital systems across state.

LoveLace Health Plan Albuquerque, NM Apr 2013 - Dec 2013

Interim Director, Utilization Management Oct 2013 - Dec 2013

Promoted to interim role directing health plan’s daily utilization processes. Maintained and managed fiscal budget. Directed all concurrent review, retrospective review, and prior authorization processes.

Collaborated with staff and community providers to provide the right service at the right time.

Communicated and coordinated changes in plan processes to improve provider and member satisfaction.

Ensured NCQA and CMS requirements were fulfilled.

Supervisor PA, Health Services-Prior Authorization Apr 2013 - Oct 2013

Provided oversight coordination and prior authorization of services for health plan’s membership. Supervised prior authorization staff including inbound call management, facilitation of authorization of health care services to contracted/non-contracted providers, and communication to members.

Ensured 24-hour/7 days a week coverage provided by on-call nursing team.

Collaborated in Health Services Department’s oversight of member appeals and grievance process.

Charge Nurse Centerpointe Hospital Weldon Springs, MO Aug 2012 - Apr 2013

Supervised 21-bed acute psychiatric unit. Managed direct patient care, staff assignment, patient complaints, medication compliance, and coordination of services.

Healthways Incorporated St. Louis, MO Jan 2000 - Sep 2011

Executive Director Dec 2006-Sep 2011

Director Care Management Mar 2005-Dec 2006

Clinical Operations Director Mar 2003-Mar 2005

Led daily operations and strategic direction for a telephonic disease/population management contact center of 250 employees while developing and implementing quality standards, operational performance, and analysis for up to 18 health plan contracts. Led directors of Clinical/Account Management, Sales, Business Technology, Dialer Management, and Human Resources. Managed, hiring, termination, and performance reviews for 5-10 direct leader staff.

Served as Lead Manager of Standard Operating Guide Core Committee and developed Standard Operating Guideline Committee for the entire enterprise.

Recognized by the Central Business Unit Executive Team as Executive Director of most productive, profitable call center of entire corporation.

Established operational strategic vision, policies, and procedures for the telephonic contactcenter.

Member of CIGNA Business Unit Leadership team.

Managed metric and quality performance monitoring; analyzed/formulated reports summarizing operational and financial performance of team to ensure consistency in service delivery to drive contract outcomes.

Served as overall leader of client relationships and coordinated relationships between the clients and the corporate office. Provided Account Management integration with employer groups of the health plan.

Directed and planned onsite presentations and tours in order to retain existing clients as well as add new ones.

Health Services Manager Jan 2002 - Mar 2003

Well Aware Manager Jan 2000 - Jan 2002

Managed daily operations of Health Services and Utilization Management authorization, concurrent review, and case management activities.

Identified program participants and managed resources in 4 disease management programs to improve clinical outcomes, provide quality care, and decrease medical costs.

Integrated case management and disease management saving $3.50/member monthly.

Saved $150K in 1st year by consolidating St. Louis/Kansas City prior and pre-certification phone queues.

Home Care Consultant and Patient Care Supervisor BJC Home Care Services St. Louis, MO Feb 1996 - Jan 2000

Marketed durable medical equipment and varied health care services to physicians and healthcare professionals. Provided sales of Home Infusion, Durable Medical Equipment, Intermittent Home Health, and Supportive Care & Hospice business lines. Supervised 50-75 employees, including registered nurses, social workers, home health aides, chaplains, and volunteers. Negotiated per diem contracts.

Increased durable medical equipment sales 33%, supportive care 22.5%, hospice patient days 41%, home infusion 5%, and consistently met budget on home health sales.

Processed accounts payable/receivable and wrote appeals to insurance companies with 85% return.

Created 24-hour tracking system of clinical documentation for billing.

Director of Development and Outreach Beacon of Hope Hospice St. Louis, MO Jan 1995 - Feb 1996

Directed daily census of 100-130 hospice patients and managed $5M budget. Opened Columbia, MO location and negotiated 15 new nursing home contracts.

Registered Nurse Saint John’s Mercy Medical Center St. Louis, MO May 1990 - Jan 1995

Served in the capacity of registered nurse in varied hospital settings.

Education

Master of Healthcare Administration (MHA) Saint Louis University St. Louis, MO

Bachelor’s Degree in Nursing (BSN) University of Missouri Saint Louis St. Louis, MO

Diploma in Nursing (RN) Missouri Baptist School of Nursing St. Louis, MO

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