Annette Ramirez

Background

About Annette Ramirez

Director of Member Retention/Network Management: I work closely with Network Management's Senior Vice President and Vice President as well as managing a team, Project Manager, and Transition Experts. The Network Management team works with our contracted providers, Primary care physicians and Specialists to ensure contracts, referral/authorizations and encounters for all lines of business are maintained for continuity and are current with proper DMHC guidelines. Managing all Retention for the North Network region; which encompasses San Gabriel, Whittier, West Covina, all of Los Angeles area, San Fernando Valley (including Burbank/Glendale)and Ventura network. I work closely on a daily basis with 22 Network Managers and Coordinators in addition to the various Network Directors. Member Retention efforts pertain to Consolidations, Exclusivities and Semi-Exclusivity physicians. Responsible for strategizing, development and implementing processes to retain and grow contracted providers. Continued on-going monitoring for each project, managing, and reporting the overall performance of all projects on a daily basis. On average Member Retention will manage 20 projects per month encompassing approximately two hundred thousand members. I have an extensive background of working in the health care industry of 21 years. Proven ability to multi-task yet pay sharp attention to detail; strong analytical skills, communication, customer Satisfaction. In addition in adherence with the U.S. Health Insurance Portability and Accountability Act (HIPAA) to ensure Network maintains compliance with Federal, State and regulatory guidelines in terms of provider related issues, while promoting interdepartmental communications. Over seeing multiple projects with strict deadlines, strong professional managerial skills and communicate data trends to all levels of the organization.