Managed Care Contractor
Resume:
Harry L. Duer
La Grange, Kentucky ***** 615-***-**** ️ *******@*****.***
LinkedIn Profile
Professional Summary
Experienced managed care business developer with over 25 years of success in provider and hospital contracting, network development, and account management. Extensive expertise in Medicaid, Medicare, ACA, Dual Special Needs Plans (ISNP, CSNP), and Workers' Compensation contracting. Adept at fostering strategic partnerships, optimizing provider relations, and driving market expansion nationwide, with a strong focus on Texas, California, Georgia, North Carolina, Ohio, and Florida.
Core Competencies
Provider & Hospital Contracting
Network Development & Expansion
Contract Negotiations & Redline Review
Provider Relations & Account Management
Business Development & Market Strategy
Analytical Problem Solving
Process Optimization & Compliance
Education
Bachelor of Arts in Management & Human Relations – Trevecca Nazarene University, Nashville, TN (1994)
Professional Experience
Curana Health Ally Align Health
Provider Contracting Executive Dec 2022 – Present
Lead Medicare ISNP and CSNP contracting for hospitals, providers, and ancillary services in PA, OH, MA, and CA.
Developed an efficient Single Case Agreement process, enhancing provider relations and network growth.
Managed provider issues, assuming key account management responsibilities to drive satisfaction and retention.
Established and strengthened relationships with skilled nursing facilities, contributing to business development and operational efficiency.
Designed contracting processes, marketing materials, and internal training programs to support team development.
Bright Health Plan
National Managed Care Network Development Specialist Oct 2018 – Dec 2022
Spearheaded nationwide network development for ACA and Medicare Advantage (MA) plans.
Led contracting initiatives across NC, TX, SC, GA, and OH, securing partnerships with major health systems.
Managed provider relations, resolving network issues, and ensuring seamless integration with hospital systems.
Duers Consulting
Independent National Managed Care Consultant Feb 2008 – Oct 2018
Successfully built and expanded provider networks across Medicaid, Medicare, Dual-Eligible, ACO, CIN, and ISNP markets.
Led contracting projects in multiple states, including Florida, Texas, North Carolina, and Ohio.
Negotiated contracts for hospitals, specialty providers, ambulatory surgery centers, laboratories, and durable medical equipment providers.
Developed market intelligence reports, staffing solutions, and implementation plans for healthcare expansions.
United Healthcare
Network Account Manager May 2009 – Feb 2010
Managed provider relations for over 3,000 providers in Middle Tennessee.
Analyzed and resolved credentialing, claims, and data integrity issues to maintain network compliance.
Negotiated and renegotiated contracts for Medicare, Medicaid, and commercial providers.
Concentra Coventry Healthcare
Contract Manager Dec 2000 – Feb 2008
Led network development in TN, GA, and KY commercial markets.
Managed PTNet’s national provider network, ensuring seamless client integration.
Built statewide provider networks in response to regulatory changes in California (SB 899) and Texas (HB 7).
Trained Beech Street and Coventry personnel during network integration with Concentra.
Additional Expertise & Projects
Nationwide home health and workers’ compensation network contracting.
Developed market reports and strategic research for investment groups.
Led staffing initiatives for Medicaid expansion, VA medical recruitment, and Medicare staffing.
Interests & Hobbies
️ Collector of historical artifacts and antiques
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