HEALTH PLAN OPERATIONS
When your health plan needs experienced operational leadership, I help connect the people, priorities and work.
Fractional leadership. Interim support. Focused projects.
One experienced operator, working directly with you.
Over 30 years of experience
WHEN TO BRING ME IN
You may have capable people and a clear goal. What’s missing is the time, leadership or coordination to bring the work together.
A leadership gap that needs experienced operational support.
A vendor issue that keeps returning, without a clear path to resolution.
An implementation that crosses departments, systems and partners.
A transition with moving deadlines and too many dependencies to leave to chance.
HOW I HELP
A defined project or an ongoing leadership role.
We start with what your organization needs.
Executive support when you need additional leadership capacity, continuity or help setting priorities.
A practical look at how the work gets done, where responsibilities meet and what needs attention.
Leadership to bring operational teams, technology partners and vendors together around a workable plan.
EXPERIENCE BEHIND THE WORK
I understand how decisions in one part of a health plan affect the people, systems and processes around it.
As Vice President, Operations, my responsibilities have included project management, enterprise reporting, provider credentialing, benefit services, customer service, appeals and grievances, utilization management, and oversight of outsourced TPA functions.
As Executive Director, Provider Contracting and Network Management, I led three directors and approximately 50 indirect reports, with financial and operational oversight of contracting and network management.
My experience includes national claims initiatives, a claims forecasting and staffing model, Epic–DIAMOND benefit accumulation integration, and claims and configuration leadership at University of Maryland Medical System Health Plans.
Selected employment experience. Earlier roles include CareFirst BlueCross BlueShield and Capital Blue Cross.
WORKING TOGETHER
The scope should fit the situation. Here’s how I approach the conversation.
Talk through the challenge, who is involved and where work is getting stuck.
Define priorities, responsibilities, scope and what a useful outcome looks like.
Bring the right people together, review progress and address issues as they arise.
A LITTLE ABOUT ME
I bring over 30 years of experience across Medicare Advantage, Medicaid, commercial insurance and integrated delivery systems.
My career has taken me through claims, configuration, provider contracting, network management and executive operations leadership. That breadth shapes how I approach a problem: understand the details, see how the pieces connect and help people move the work forward.
When you work with Jay Brain Consulting, you work directly with me.
More about my background on LinkedInLET’S TALK
Tell me what your organization is working through.
We can discuss where my experience may help.