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Healthplan General Management


• For CIGNA Healthplan of San Diego, as general manager of this 40,000-member managed care organization on a two-year turnaround assignment, responsible for HMO product lines, various point-of-service plans, and a PPO. Helped consolidate some functional management in regional office. Brought plan from monthly loss of $1.25 million to profitability. Directed renegotiation of key provider contracts on a more favorable basis. Negotiated settlements to several long-standing legal disputes with provider groups. Reduced local staffing from over 70 to 25. Also assisted in the integration of CIGNA and Equicor PPOs. Responsible for: $45M revenue, 70 to 25 employees.

• For Greater San Diego Health Plan, as VP administration of this 140,000-member healthplan, responsible for information systems, hospital and ancillary contracting, capitated provider arrangements, claims processing, a 50,000-member PPO, pharmacy, CoB and third party recovery. Negotiated more favorable contracts with provider hospitals. Reduced claims backlog from 90 days to two weeks. Doubled CoB / subrogation recoveries. Reorganized information systems department and completed and implemented a new managed care system. Completed Knox-Keene modifications for mental health carve-out. Implemented capitated mental health contract, reducing mental health costs and improving member satisfaction. Responsible for: $70M contracts, $5M expense, 150 employees.

• For Whittaker Health Services, as senior VP and manager, central division, reporting to the CEO of this national HMO subsidiary, responsible for the management of six HMOs located in central time zone. As regional manager, increased enrollment in central division by 250%. As senior VP, developed majority of corporate business plan for healthplan line-of-business to which board committed $100 million. Managed the on-time development of delivery systems and licensure in two California markets. Involved on staff basis in a number of the 30 markets. Performed market analysis, identified potential healthplan acquisitions, qualified these, and performed due diligence on six best candidates. Whittaker Health Services acquired one healthplan, a solid performer. Selected an information system and MIS director and implemented systems, all on-time and substantially under budget, in 30 locations in 20 states. Responsible for: $7M expense, 180 employees.

• For Whittaker Medicus, as VP consultant with above firm, codeveloped three-year service plan for management of 5 hospitals in Saudi Arabia. Whittaker Medicus received a $1.4 billion contract based on the plan.

   
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