Military Service
U.S. Army Sergeant
Experience
4 years served
Future
Seeking a career in any profession
Location
Sioux Falls, SD
About Justin
I am a motivated leader with a diverse history of working in the healthcare industry. Skilled in the areas of Operational Excellence, Process Improvement, Analytics, Strategic Thinking, Account Management, Negotiation, Team and Relationship Building. I possess an MBA as well as a Bachelor's in Business Administration. My diverse experience and relationship building skills enable me to make a positive impact in any role I step into.
CV/Resume:
PROFILE
Health Care Leadership - More than 20 years of experience in the health care field. My experience has been diverse which has allowed me to grow and understand the ever changing environment of health care. I have served in a variety of leadership roles and have demonstrated success in each of these roles. Proven talent for leading complex programs, building strong teams, increasing efficiencies and developing and maximizing processes. Core competencies include:
Operational Excellence
Leadership & Teamwork
Problem Solving
Process Improvement (Six Sigma)
PROFESSIONAL EXPERIENCE
Decision Making
Strategic Planning
Reliability
Motivated
Integrity
Budget Management
Managed Care Knowledge
Communication
Sanford Health Plan, Sioux Falls, SD 12/2015 – 6/2020
An integrated health plan providing a wide variety of health care coverage’s in multiple states. Sanford Health offers health insurance options for individuals, families and businesses.
Senior Director of Operations
Responsible for the Operations of the Health Plan in the areas of Claims Processing, Customer Service, Enrollment, Quality Assurance, Benefit Configuration, Coordination of Benefits and general Office Management. Managed a budget of $7.4M. Responsible for approximately 95 team members located in offices in Sioux Falls, SD and Fargo, ND. Tasked with ensuring efficient day to day operations with an emphasis on working within the appropriated budget, improving processes and maintaining optimal performance. During my tenure at Sanford I was responsible for implementing a number of projects and process improvements saving the organization millions of dollars. Some of the projects included: Claim Editing System; Enhanced Coordination of Benefits program; High Dollar Claim Review; Overpayment Recovery Program; Duplicate payment Improvement. Also during my time at Sanford I developed and implemented Key Performance Indicators to measure and monitor operational effectiveness.
Flandreau Santee Sioux Tribal Health Clinic, Flandreau, SD 10/2012 – 12/2015
A tribally run ambulatory care facility providing services to the Native American community. Services provided at the clinic include Medical, Pharmacy, Laboratory, Dental, Optometry and Behavioral Health.
Health Care Administrator/CEO
Responsible for the overall management and operation of this tribally operated clinic. The challenges encountered in this position were numerous for many reasons. Responsibilities included preparing and managing the budget; the hiring of staff, recruitment of providers, increasing the revenue stream, setting strategic initiatives, reporting to Council on the status of the clinic, seeking out and applying for grants and leading the “new” Health Clinic building project . Accomplishments include:
Increased 3rd party revenue by over 60%
Increased clinic “User Population” by approximately 50%
Improved processes in the Purchased Referred Care program to be on budget for the first time in many years
Managed the overall budget to be in the black the past three years. First time in many years.
Updated clinic equipment including Pharmacy robotics, exam room tables, EKG machine, lab equipment and updated furnishings
Recruited and hired providers in the medical and dental departments.
Lead the New Clinic building project which included creating a project team, developing RFP’s for the evaluation and selection of architect and construction manager, evaluating and determining funding sources, coordinating the effort with Indian Health Services, working with and evaluating vendors for Furniture, Fixture and Equipment needs. End result was a new State of the Art facility.
Nominated, selected and graduated from the Native Nations Rebuilding Program.
DAKOTACARE – Sioux Falls, SD 5/08 – 10/2012
A diversified regional managed health care company, DAKOTACARE operates fully insured and self-funded health plans in South Dakota and has members in all of the lower 48 states.
Account Executive
Assisted in the setup and management of one of DAKOTACARE’s largest clients based in Boise, ID. The position required excellent analytical skills, presentation skills, industry knowledge, project management skills and working with a variety of entities to successfully implement client initiatives. Accomplishments include:
Successfully managed the implementation of a complex high performance network strategy and plan design
Develop and implement an automated reporting tool to analyze plan performance and identify trends in spending
Developed, maintained and enhanced relationships with key partners involved in the administration and management of the client’s health plan of which there were five
Prepare and present an executive summary and plan performance report to the client on a quarterly basis
Maintained an Account Management score of 4.8 or higher of a possible 5
Reviewed and negotiated contract renewals with the client
Prepared and coordinated efforts to complete Request for Proposals (RFP) for other potential business
Rapid Refill Ink – Business Owner – Sioux Falls, SD 12/2006 – 05/2010
An ink and toner retail start-up business with an emphasis on recycling and selling remanufactured ink and toner cartridges. I started the business and grew it to breakeven status and was then hit with the downturn in the economy which eventually led to its closure. Primary target market was small business sales and walk-in retail sales.
Wellmark Blue Cross and Blue Shield of SD – Sioux Falls, SD 05/1989 – 07/2006
Wellmark Blue Cross and Blue Shield is a mutual insurance company. Wellmark and its subsidiaries provide health coverage to more than two million members in Iowa and South Dakota.
Group Leader/Director, South Dakota Operations
Tenure included positions with increasing responsibility and varying focus, beginning as a management trainee in the claim processing area and concluding as Group Leader of the SD Operations. General responsibilities included overseeing the operations of claims, customer service, enrollment, BlueCard Program and the Federal Employee Program. Accomplishments include:
Operational Excellence - Under my leadership, SD Blue Cross and Blue Shield Plan was consistently one of the top performing Blue Plans in the country in overall operations. The BlueCard program and Federal Employee Program were also top performing programs.
Process Focused - Trained in process improvement ("Lean Thinking"). I have lead Rapid Process Improvement (RPI) and Value Stream Analysis (VSA) teams to analyze processes and identify improvements. Proficient in process mapping.
Project Management - Successfully lead many complex, high profile projects during my time at Wellmark including co-leading the implementation of Wellmark’s largest client at the time, Tyson Foods.
Strong Work Ethic - achieved the Presidential Award (Highest Wellmark Award) and numerous Star Awards for various projects
United States Army – Fort Belvoir, VA 01/1985 – 01/1989
Completed a four year tour in the US Army upon graduating from Augustana University. While in the Army, I achieved the rank of Sergeant in a short period of time. Serving as a Patient Administration Specialist, I was placed in charge of the Medical Records area at DeWitt Army Hospital where I re-engineered the defunct area to run with greater efficiency. I wrote a composition on how I completed this task as part of completing my Master's program. The paper ultimately was published in a military medicine journal. I also received a letter of commendation from the Hospital Commander for the improved operational performance.
EDUCATION
Master of Business Administration, Central Michigan University, Mt. Pleasant, MI
Bachelor of Arts in Business Administration, Augustana College, Sioux Falls, SD