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Governance
- Enterprise ownership and accountability
- KPI/SLA cadence and escalation clarity
- Payor-facing transparency and reporting
Trust starts with disciplined governance.
Trusted by payors for 15+ years
Enterprise Healthcare Operations Leader Driving Profitable Scale
Healthcare operations executive trusted by payors for 15+ years, built through payor relationship leadership and account management that strengthens confidence, performance alignment, and long-term partnership across Medicare, Medicaid, and Commercial markets.
Network Strategy
Clinical Operations
Payor Partnerships
P&L + MLR
Compliance
Governance
Performance
Compliance
Scale
Payor trust is earned through relationship leadership + account management anchored in transparent governance and measurable delivery.
$325M
Enterprise revenue scaled
6M+
Covered lives supported
8%
MLR improvement delivered
15%+
EBITDA sustained
1,900%
Provider network scaling
Enterprise Operator. Clinical Strategist. Growth Architect.
I translate payor strategy into scalable, profitable execution across complex, multi-state healthcare environments, where financial performance, regulatory compliance, provider access, and member experience must operate in alignment.
Executive Summary
Enterprise healthcare operations executive with 15+ years of experience driving national growth, margin performance, and operational scale across Medicare, Medicaid, and Commercial lines of business. Proven record of building provider networks, optimizing clinical operations, and leading enterprise P&L with measurable results.
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Healthcare EcosystemsNational payer/provider partnerships across multi-state markets.
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Performance GovernanceKPI/SLA scorecards, executive visibility, measurable outcomes.
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Operational IntelligenceAI-enabled workflows to improve speed, accuracy, and scale.
Core Focus Areas
- Provider Network Management & Development
- Clinical Operations Oversight & Utilization Management
- Payor Relations, Client Success & Account Management
- Enterprise P&L, MLR optimization, and margin improvement
- RFP strategy, pricing architecture, and go-to-market execution
- KPI/SLA governance, regulatory compliance, and operational readiness
Payor Partnership & Account Management
My 15+ years of payor trust has been earned through relationship leadership and account management built on transparency, performance governance, and consistent delivery. I align stakeholders across clinical, financial, and operational priorities to strengthen partnership, retention, and growth.
- Executive-level stakeholder management and payer alignment
- Governance cadence that strengthens partnership and confidence
- RFP strategy, pricing architecture, and operational readiness
- Multi-state execution that protects access, quality, and margin
Why Payors Trust Me
Trust Framework
For more than 15 years, national and regional payors have trusted my leadership because I build durable, high-trust partnerships through strong relationship management, disciplined account governance, and consistent execution, where financial performance, compliance, provider access, and member experience must operate in alignment.
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Performance
- Revenue growth and margin sustainability
- MLR improvement through operational rigor
- Outcome-focused delivery at scale
Trust is earned through measurable performance.
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Compliance
- Regulatory-aligned operations
- Audit-ready workflows and controls
- Risk mitigation embedded in execution
Payors stay loyal when risk is managed proactively.
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Scale
- Multi-state readiness and expansion
- Provider network scaling systems
- Infrastructure that sustains growth
Scale matters only when it’s sustainable.
Signature Impact Areas
Where I create enterprise value, fast, measurable, and durable.
Provider Network Strategy & Development
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Network AdequacyBuild and optimize access with sustainable provider supply.
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Credentialing at ScaleStreamline onboarding while protecting compliance.
Result: Provider onboarding SLA compliance improved by 15%.
Clinical & Healthcare Operations Oversight
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UM + Clinical ControlsClinically grounded workflows that protect access and cost.
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MLR OptimizationImprove margin through disciplined operations + analytics.
Result: 8% MLR improvement across 6M+ covered lives.
Payor Relations, Client Success & Growth
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Executive Stakeholder AlignmentHigh-trust partnerships rooted in transparency and delivery.
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RFP + Pricing StrategyWin and retain business through readiness and value articulation.
Result: $10M+ new payer revenue enabled; payer engagement increased 3×.
For Recruiters, Boards, and Hiring Leaders
I am a healthcare operations executive trusted by payors for over 15 years, earned through payor relationship leadership and account management that builds confidence, aligns performance to priorities, and delivers results at enterprise scale.
Roles of Interest
- Executive Director, VP, SVP, COO
- Healthcare Operations & Clinical Operations Oversight
- Provider Network Management / Development
- Payor Relations, Client Success, Account Management
Where I Fit Best
- National or multi-state healthcare organizations
- Payers, TPAs, MSOs, provider-led platforms
- Growth, scale, integration, or operational turnaround
- Metrics-driven governance with executive accountability
Engagement Preferences
Location: Davie, FL (open to national scope)
Work model: Remote / Hybrid (limited onsite)
Travel: Up to ~20% domestic
Confidentiality: Confidential conversations welcomed
Contact
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Contact Details
Email: connect@jessicamquintana.com
Phone: 305-495-4686
LinkedIn: Profile
Confidential conversations welcomed.
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