Teams at USA Managed Care Organization

Leads hospital network expansion and managed care contracting strategy across multiple regions. Builds executive relationships with hospital systems, negotiates high-value agreements, oversees contract governance and provider performance, and manages engagement and relationship teams. Provides market intelligence and reporting to executive leadership while coordinating provider integration with claims, billing, eligibility, credentialing, and performance systems.

Design, develop, and maintain healthcare applications, APIs, integrations, and data pipelines supporting members, providers, and claims operations. Modernize legacy IBM i systems into cloud-native platforms using Creatio and Databricks. Champion secure architecture, code reviews, automated testing, CI/CD, infrastructure as code, observability, and documentation. Mentor developers, contribute to engineering standards, and help deliver legacy modernization and reliable healthcare data integrations.

Builds and expands healthcare provider networks by conducting outreach, presentations, reimbursement negotiations, and contract finalization. Reviews provider enrollment and credentialing applications, maintains contract tracking, responds to provider inquiries, and collaborates with network development and contracting teams to improve network adequacy. The role also requires familiarity with reimbursement methodologies, medical coding concepts, healthcare terminology, information security, and HIPAA compliance.