SHARON BROWN SAIKALI

1509 San Ponte Road

Corona, California 92882
ss6ab366@westpost.net
Cellular: (949) 378-9811
A healthcare director with more than 20 years' experience in operations, provide
r relations, business development, contract negotiation and administration for d
iverse environments, including health plans, physician groups and hospital chain
s. Possesses strong skills in strategic planning, project management, and implem
entation of new programs as well as integration of operations.
A personable professional, who is well respected by physicians, mentors staff, h
andles sensitive issues with diplomacy and wins respect by creating an inclusive
work culture.
PROFESSIONAL EXPERIENCE
NORTH AMERICA MEDICAL MANAGEMENT/PRIMECARE, Ontario, California-2005-2010
Executive Director:
Responsible for managing operations for two multi-specialty physician organizati
ons. Responsibilities included: contract negotiations and development for local
markets; implementing marketing and business development plans and programs to
expand membership; managing the Medical Executive Committees; oversight of local
office clinical and business staff; maintaining relationships with physicians a
nd partner hospitals and overseeing the joint operating committee meetings withi
n local market.
INSIGHT HEALTH CORP, Lake Forest, California-2003-2005
Director of Managed Care Contracting:
Responsible for contract operations for InSight's imaging centers in California
and negotiating national agreements for all imaging centers.
Contracts Operations:
-Established regular meetings between contracting and key departments: legal, bi
lling, facility operations and MIS to increase efficiencies.
-Re-engineered credentialing process (member of the national credentialing commi
ttee). Standardized the process, worked with quality management, legal to revis
ed policy and procedures)-implemented at facility level.
-Establish audit process to ensure all contracts were accurately loaded and trac
ked in the system Accountable for the strategy and tactical implementation to in
crease revenue/scan volume within region (California-36 imaging centers).
-Led the contract integration team for new center acquisitions and de novas
-Develop policy and procedures addressing contracts due diligence and implementa
tion
-Oversaw the development of training materials for sales and marketing and facil
ity operations to query contracts database
-Developed contract strategy to address changes in workers compensation
Contracts Database:
-Re-engineered system: worked with MIS to add functionality: security tracking,
history, reporting. Redesign user interface for business applications that prov
ided ease of use by representing the flow of business process.
-Oversaw the development of training manuals for internal contracting staff) and
field teams (imaging centers and sales and marketing) for staff to query web-ba
sed system
St Joseph Health System, Orange, California -2002
Consultant, Corporate Office-Finance
Served as a project leader for senior management of a major not-for-profit healt
hcare system. Developed contract strategy and financial analysis that assessed f
inancial performance of hospital risk agreements in the desert region. Provided
supportive documentation and recommendations for negotiations and long-term stra
tegies.
St. Joseph Heritage Health Care, Orange, California-1997-2002
St. Joseph Hospital Affiliated Physicians
Director, Business Development & Marketing (2001-2002)
Led the start-up of a customer service department with responsibility for member
ship growth and outreach activities for an IPA with 86,000 commercial and senior
lives and more than 600 physicians. Created project plan which identified staf
fing, equipment and system needs in support of processing more than 350 calls pe
r day. Directed the design and implementation of a marketing strategy that built
a brand image, targeted health plan enrollment and increased communications wit
h physicians. Supervised five staff.
-Created and implemented assessment tools for membership services evaluation, in
cluding patient and physician satisfaction surveys.
-Developed design/image and text for the new web site. Worked with the hospital
team to rollout new web portal to the organization and established physician pra
ctice criteria and cost benefits.
-Oversaw the publication of the organization's inaugural physician and member ne
wsletters and the development and distribution of the physician surveys. Produce
d and distributed at nominal costs to the organization.
-Designed and planned the organization's first comprehensive marketing plan. Col
laborated with a hospital partner to rollout business development and marketing
strategies, increasing exposure to health plans, employers, community and broker
s. Plan included detailed competitor analysis and identified resources, costs e
stimates, and timeline for implementing the various marketing programs.
Director, Business Operations (2000-2001)
Oversaw business operations for a multi-specialty physician organization with 25
staff supporting 100,000 members. Managed a $550,000 budget. Reported to the Ch
ief Operating Officer.
-Spearheaded the redesign of the physician referral process through multidiscipl
inary teams and reduced turnaround time from three weeks to five days, improving
patient satisfaction and compliance to health plan requirements. Created busin
ess plan detailing project scope, costs, and resources. Also, developed algorit
hm for new process, staff and physician communication plan, and developed traini
ng program.
-Led a comprehensive restructuring of internal systems that resulted in aligning
utilization, quality and case management policies and procedures with governmen
t and health plan regulations.
-Successfully developed and maintained staffing plans and space planning for mul
tiple relocations of the organization. Relocations were made with no downtime on
computers or telephone systems and physician offices did not experience any ser
vice delays.
Director, Special Projects-Project Management (1998-2000)
Played a key role in the strategic and transition planning following the acquisi
tion of assets of a competing IPA. Led the integration of operations of the two
IPAs. Developed detailed business plan outlining process of integration, budget
s, resources and timeframes.
-Established and led a team to develop and implement a new web-based system that
supported claims status, referrals and eligibility information, forecasting $45
0,000 in savings and eliminating redundancy for medical offices and the organiza
tion. Developed detailed business plan outlining project scope, budgets, resour
ces and timeframes.
-Implemented a new immunization purchasing plan to physician offices in collabor
ation with a hospital partner, achieving a 30% cost reduction. Developed detail
ed business plan to roll out new immunization plan. Plan included communication
plan to internal departments, vendor and network physicians and timeframe for i
mplementation.
-Developed and implemented new provider networks, including Mission Hospital Aff
iliated Network, with responsibility for identifying budgetary needs, systems, o
perational and network requirements. Worked with health plans to recognize the n
ew IPA and established the physician advisory council.
-Oversaw quarterly audit of a third-party administrator in the adjudication of p
rovider claims. Led the team in creating validation policies/procedures for a co
ntract/claims system involving 450,000 individuals. Created document to track o
pen items, resolutions and savings.
St. Joseph Heritage Health Care-Director Special Projects, Continued
Bristol Park Medical Group
Director of Business Support Services (1997-1998)
Recruited to develop a managed care strategy for a medical group with 15 clinics
. Created an alternative for physicians that maintained private practices while
preserving hospital referrals.
-Successfully developed five year financial forecasting, budgets and strategic p
lanning for a new physician venture and oversaw an executive steering committee.
Created executive summary and presentation to senior team outlining venture sc
ope, budgets and return on investments under various financial scenarios.
Foundation Health, Pasadena, California-1995-1996
Manager, Provider Services
Responsible for the introduction/negotiation of Medicaid managed care contracts.
Identified and targeted traditional Medicaid providers for HMO capitated contra
cts. Responsible for education and monitoring physician group performance. Deve
loped criteria/tool to measure potential physician group's ability to manage con
tract.
-Successfully managed and negotiated hospital and physician agreements (capitati
on and fee-for-service) for all product lines, within cost goals. Conducted IPA
and medical audits using criteria/tool to evaluate operations, systems and finan
cials to assess if provider could meet contractual requirements. Supervised sta
ff of 5.
Health Systems International (Health Net), Woodland Hills, California-1993-1995
Regional Manager, Provider Services
Accountable for provider services for the Los Angeles and San Gabriel markets fo
r a growing health plan with responsibility for network development, medical gro
up relationships and hospital capitation agreement negotiations. Supervised sta
ff of 5.
National Medical Enterprises, Incorporated, Santa Monica, California-1989-1993
(now Tenet HealthSystem)
Provider Contracts Administrator
Established a nationwide network for the acute-care hospitals with responsibilit
y for negotiating more than 400 contracts with physicians and hospitals for the
second largest healthcare chain. Analyzed utilization and claims data and identi
fied cost saving opportunities. Hired and managed consultants and four staff to
support local area needs for contract negotiations and program development. Ove
rsaw development of contracts database and nationwide provider directories.
Maxicare Health Plans, Incorporated, Los Angeles, California-1986-1989
Development Specialist (1988-1989)
Targeted physician groups for expansion of service area in Southern California a
nd negotiated full and shared risk agreements for the fastest growing HMO. Secur
ed contracts with more than 50 groups, increasing health plan membership while r
educing costs.
Supervisor, Consumer Affairs (1986-1987)
Consumer Affairs Representative (1986)
EDUCATION
University of Southern California, Los Angeles, California
Masters Degree, Business Administration (1996)
Guest lecturer/speaker, USC Health Administration/Management of Managed Care Sem
inar (1998)
University of California, Los Angeles, Los Angeles, California
Bachelors Degree, Sociology (1986)
SKILLS
Microsoft Project, Access, Excel, PowerPoint, Word