Lovelace Health Plan
Industry: Company
DescriptionFounded: 1922 Parent organization: AHS New Mexico Holdings Inc. Subsidiaries: New Mexico Heart Institute, LLC, CFO: Gary Whittington, Andrea Solin, Misty Gordon, Matt Maes COO: Nancye Cole, Dawn Tschabrun Chief nursing officer: Patti Bennett, Nancye Cole, Sharon Prudhomme, Joanne Sedei BSN
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Lovelace Health Plan Employees
Presbyterian Health Plan August 2008 - Present
Presbyterian Healthcare Services February 2006 - August 2007
Blue Cross Blue Shield of New Mexico February 2005 - March 2006
Lovelace Health Plan November 1990 - February 2005
Skills
Administrative..., Training, Customer Service, Healthcare, Insurance, Microsoft Excel, Event Planning, Microsoft Word, Employee Benefits, Marketing, Health Insurance, Outlook, PowerPoint, Office Management, Public Speaking, Teamwork, Project Management, Event Management, Access, Sales, Employee Relations, Team Building, Process Improvement
Education
University of Phoenix-Albuquerque Campus 2007 — 2011
Bachelor of Science in Business Management, Business Administration, Management and Operations, 3.49
Magellan Health Services September 2013 - Present
Lovelace Health Plan June 2009 - September 2013
Lovelace Health Plan April 2007 - June 2009
Lovelace Health Plan April 2006 - March 2007
Skills
Healthcare Management, Healthcare Information..., Process Improvement, Hospitals, Healthcare, Software Documentation, Claim, Health Policy, Medicaid, Insurance, Policy, Strategic Planning, Medicare, HIPAA, Program Management, Managed Care, Health Insurance, Provider Relations, Healthcare Industry, Management, Network Development, Employee Benefits
Education
University of San Francisco 1978 — 1983
Bachelor of Science (BS), Business Administration and Management, General
Lovelace Clinic Foundation May 2010 - Present
Lovelace Health Plan October 2008 - April 2010
ABQ Health Partners May 2005 - October 2008
Skills
Privacy Law, Policy, Healthcare, Research, HIPAA, Data Analysis, Project Management, Healthcare Management, Hospitals, Policy Analysis, Healthcare Information..., Teaching, Microsoft Office, Risk Management, Strategic Planning, Clinical Research, Governance, Risk Assessment, EHR, Security
Education
University of Louisiana at Lafayette 1994 — 1996
Master of Science, Applied Psychology
University of Washington 1987 — 1991
Bachelor of Arts (B.A.), Psychology
Blue Cross Blue Shield of New Mexico January 2014 - Present
Lovelace Health Plan December 2011 - December 2013
United Health Group January 2011 - May 2011
Passport Health Plan December 2005 - January 2011
National Health Services(SHPS) February 2000 - September 2005
Skills
Medicine, Managed Care, Medicare, Healthcare Management, Utilization Management, Healthcare, Medicaid, Disease Management, Hospitals, Healthcare Information..., Provider Relations, HIPAA, Health Policy, Health Insurance, Clinical Research, Healthcare Consulting, EMR, Healthcare Industry, Network Development, Physicians, Insurance, PPO, Credentialing
Education
University of Louisville
Doctor of Medicine (MD)
The Chase Group May 2014 - Present
Lovelace Health Plan January 2003 - December 2013
CIGNA Healthcare September 2000 - January 2003
Brokerage Services Incorporated September 1998 - September 2000
Skills
Health Insurance, Medicaid, Insurance, Managed Care, Healthcare, Medicare, Employee Benefits, Strategic Planning, Leadership, Healthcare Management, Hospitals, Brokers, Claim, Training, HMO, Process Improvement, Healthcare Industry, PPO, Healthcare Consulting
Education
University of Phoenix-Albuquerque Campus 1997 — 2000
BSBA, Business Administration and Management, General
North Star Consulting Services, LLC November 2003 - Present
Kaiser Permanente November 2014 - Present
Jawood December 2012 - October 2014
The TriZetto Group March 2012 - December 2012
APS Healthcare October 2011 - April 2012
Lovelace Health Plan June 2011 - December 2011
HealthNow New York Inc. March 2010 - May 2011
Keystone Mercy Health Plan October 2009 - January 2010
CDPHP March 2008 - June 2009
Blue Care Network July 2007 - January 2008
Skills
Test Automation, Managed Care, Test Director, Rational Rose, Robot, Quality Assurance, PVCS, ReqPro, Process Improvement, Business Analysis, Project Management, Testing, Quality Center, Healthcare Information..., HIPAA, Rational XDE, PDM, Requirements Analysis, Business Process, SDLC, Test Cases, Vendor Management, Visio, RUP, Change Management, Resource Management, EDI, Agile Methodologies, User Acceptance Testing, IT Strategy, PMO, Visual Basic, Business Process..., MS Project, Regression Testing, SQL, Program Management, Software Project..., Business Requirements, Requirements Gathering, PMP, Software Documentation, Defect Tracking, Software Development, Business Intelligence, Security, Integration, Release Management, Management Consulting, Data Warehousing
Education
University of Michigan 1983 — 1988
B.S., Computer Science
Delta Dental of NJ 2013 - Present
Coventry Health Care, an Aetna Company September 2011 - 2013
Coventry Health Care, an Aetna Company July 2011 - November 2012
Lovelace Health Plan 2007 - 2010
CIGNA Healthcare 2004 - 2007
Partners in Care, Corp. 1999 - 2004
Healthnet / Foundation Health Systems 1995 - 1999
Healthnet / Foundation Health Systems 1995 - 1999
Independence Blue Cross 1992 - 1995
Skills
Leadership, Change Management, Executive Management, Healthcare Consulting, Negotiation, Board Management, P & L Management, ..., Business Development, Commercial- Group and..., Medicare Advantage, Managed Medicaid, Delivering Results, Healthcare, Managed Care, Insurance, Employee Benefits, Provider Network..., Dental Insurance, Analysis, Board of Directors, Cross-functional Team..., Finance, HIPAA, Health Insurance, Healthcare Industry, Management, Medicaid, Medicaid Managed Care, Medicare, Mergers, Organizational..., P, Physicians, Revenue Cycle, Strategic Planning, Strategy
Education
University of Massachusetts Dartmouth
BS, Marketing
Presbyterian Healthcare Services May 2014 - Present
Presbyterian Health Plan April 2013 - May 2014
Lovelace Health Plan February 2012 - April 2013
UNM Medical Group June 2011 - February 2012
Presbyterian Health Plan September 2003 - June 2011
Express Scripts October 1997 - August 2003
Skills
Managed Care, Healthcare, Medicare, Healthcare Management, HIPAA, Hospitals, Provider Relations, Medicaid, Health Insurance, Healthcare Industry, Network Development, Contract Negotiation, Analysis, Claim, Clinical Research, Healthcare Consulting, Health Policy, Home Care, Insurance, Medical Terminology, Pharmacy Benefit..., Physician Relations, Physicians, Quality Improvement, Revenue Cycle, Strategic Planning, System Administration, Utilization Management, Healthcare Information...
Education
University of Phoenix 2004 — 2013
Business Management
Manzano High School 1991 — 1994
Optum Health May 2009 - Present
Lovelace Health Plan July 2008 - April 2009
Value Options August 2007 - July 2008
The Morton Center Louisville, KY 2001 - 2005
Skills
Behavioral Health, Counseling, Social Work, Utilization Management, Medicaid, Crisis Intervention, Healthcare Management, Utilization Review, Workshop Facilitation, Training, Public Speaking, Staff Development, HIPAA
Education
University of Louisville 2002 — 2005
Master of Social Work (MSW), Social Work
Presbyterian Healthcare Services February 2014 - Present
Lovelace Health Plan December 2010 - January 2014
UnitedHealth Group August 2003 - December 2010
Magellan Behavioral Health July 2000 - April 2003
Skills
Contract Negotiation, Negotiation, Brokers, Compliance, Healthcare, HIPAA, Appeals, Business Analysis, Legal Writing, Corporate Law, Insurance, Risk Management, Health Policy, Strategy, Process Improvement, Managed Care, Privacy Law, Program Management, Analysis, Legal Research, Medicaid, Management, Litigation, Sales, Team Building, Licensing, Health Insurance, Strategic Planning, Policy, Time Management, Medicare, Proposal Writing, Research, Executive Management, Marketing, Employee Benefits, Mergers & Acquisitions, Claim, Contract Management, Business Process, Leadership, Health Care Reform, Health Law, Healthcare Consulting, Provider Relations, Medical Compliance, ERISA, Litigation Management, Legal Compliance, Insurance Law
Education
University of Baltimore School of Law 2003 — 2007
J.D., International and Comparative Law, Public and Governmental Service
University of Maryland Baltimore County 1999 — 2003
B.A., Philosophy, Psychology
Western Maryland College 1996 — 1998
Philosophy, Psychology
BCBSAZ Advantage February 2014 - Present
Lovelace Health Plan August 2011 - February 2014
Aetna /Medicaid June 2009 - June 2011
Aetna / Medicaid January 2008 - June 2009
Schaller Anderson December 2006 - January 2008
Mercy Care Plan July 2005 - December 2006
Skills
Medicare, Compliance, Healthcare, Policy, Auditing, Managed Care, Hospitals, Healthcare Management, Health Policy, Leadership, Training, Health Insurance, Healthcare Information..., HIPAA, Process Improvement, Insurance, Healthcare Industry, Provider Relations, Healthcare Consulting, Medicaid, HMO, Physicians, Utilization Management
Education
University of Phoenix 2003 — 2005
BS, Health Care Services
Yavapai College - Prescott Arizona 1978 — 1980
Associate of Arts, 1980
University of Iowa Hospitals and Clinics May 2005 - Present
Lovelace Health Plan 2000 - 2005
Mayo Clinic February 1999 - October 2000
Lovelace Sandia Health System 1995 - 1999
Skills
Healthcare, Analytical Skills, Business Intelligence, Decision Support, Performance Dashboards, Performance Measurement, KPI Dashboards, Tableau, Microsoft SQL Server, Microsoft Excel, Monarch Pro, SSAS 2008, Hospitals, EMR, Business Analysis, Analysis, Access, Data Analysis, Management, Healthcare Management
Education
University of Arizona, Eller College of Management 1991 — 1993
MBA, Healthcare Management
Washington University in St. Louis 1985 — 1989
BA, Economics
St. Louis University High
St. Louis University High
ValueOptions New Mexico CFOValueOptions2007 - 2009
Lovelace Health Plan 2004 - 2007
HealthNet of AZ 2000 - 2004
Health Net 2000 - 2004
Education
University of California, Irvine 1977 — 1980
MS, Administration
Amerigroup April 2013 - Present
Amerigroup Corporation July 2009 - March 2013
Amerigroup Corporation August 2009 - February 2011
Prescriptoin Solutions June 2009 - June 2009
Thornburg Mortgage April 2005 - June 2009
State of New Mexico June 2005 - June 2008
Lovelace Health Plan April 2004 - April 2005
American Red Cross Grand Canyon Chapter 1999 - 2004
UnitedHealthcare 1999 - 2004
UnitedHealth Group 1995 - 2004
Education
University of Phoenix 2002 — 2004
Healthcare Administration
Presbyterian Health Plan December 2013 - Present
Lovelace Health Plan October 2011 - November 2013
Tricore Reference Laboratories June 2010 - October 2011
Robert Half Technology February 2010 - September 2010
UniRac, Inc. September 2009 - February 2010
The Insource Group for Thornburg Mortgage May 2008 - April 2009
Peyote Bird Designs April 2004 - April 2008
Accenture Technology Solutions July 1999 - June 2003
Skills
Software Documentation, SharePoint, User Acceptance Testing, Program Management, Analysis, Outlook, Access, Vendor Management, Team Building, Requirements Analysis, ERP, Quality Assurance, SQL, Visio, Project Management, Microsoft Office, Leadership, Healthcare Information..., JavaScript, SDLC, IT Management, Cross-functional Team..., Databases, Technical Support, Management, Business Requirements, Business Intelligence, Business Process, ITIL, Risk Management, Strategy, Software Development, Microsoft SQL Server, HTML, Requirements Gathering, Integration, HIPAA, Process Improvement, Change Management, Business Analysis, Budgets, ASP, Data Analysis, Business Process..., VSS
Education
University of Florida 1998 — 1999
MBA, Finance
University of Florida 1996 — 1999
MS in DIS, Computers and Business
Lovelace Health Plan June 2012 - Present
WellCare May 2006 - May 2012
WellCare 2004 - 2011
Hilton Hotels Worldwide 1996 - 1998
Skills
Medicaid, Medicare, Provider Relations, Network Development, Managed Care, Insurance, Claim, HMO, Health Insurance, HIPAA, Medicare Part D, Health Policy
Education
University of Missouri-Columbia
NurseAdvice New Mexico March 2006 - Present
Lovelace Health Plan October 2003 - March 2006
Lovelace Health Plan March 1997 - October 2003
Skills
Project Management, PMO, Change Management, PMP, Project Portfolio..., Project Delivery, Stakeholder Management, Grant Writing, Strategic Planning, SDLC, Vendor Management, Business Process...
Education
National Association for Healthcare Quality 1996 — 1997
Certified Professional in Healthcare Quality (CPHQ), Quality Management and Improvement, Certified
Yale University School of Nursing 1983 — 1985
Master of Science (in Nursing, MSN), Community Health Nursing
University of Bridgeport 1976 — 1980
Bachelor of Science (in Nursing, BSN), Registered Nursing/Registered Nurse
Molina Healthcare 2013 - Present
UnitedHealth Group November 2009 - March 2013
Lovelace Health Plan October 2007 - November 2009
Skills
Managed Care, Clinical Trials, Healthcare Management, Medicaid, Healthcare, Utilization Management, Disease Management, Healthcare Information..., Hospitals, Medicare, Healthcare Consulting, Provider Relations, HIPAA, Medicine, Informatics, Physicians
Education
University of California, San Francisco 1970 — 1974
Doctor of Medicine (MD)
Universtiy of New Mexicl 1965 — 1969
Chemistry
Lovelace Health Plan 2012 - Present
Albuquerque Clinical Trials June 2007 - February 2012
Rio Grande Family Medicine June 2007 - February 2012
Skills
Hospitals, Healthcare Management, HIPAA, Medicaid, Healthcare, Disease Management, Team Building, Healthcare Information..., Medicare, Provider Relations, EMR, Managed Care, Healthcare Consulting, EHR, Utilization Management, Health Policy, Healthcare Industry, Process Improvement, Health Insurance
Education
University of North Carolina at Chapel Hill School of Medicine
MD