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Lynn Childs


PHONE 860-663-1396 * FAX 860-663-8082


* Over eighteen years managed care experience including Commercial, Medicaid and
Medicare lines of business.
* Current - nine years experience in a not-for-profit Medicaid Managed Care Orga
nization founded by nine federally qualified health centers with 300,000 covered
* Excellent provider relations experience including recruitment, contracting, re
tention, and claims issue resolution.
* Executive leadership skills in Network Management, Medical Management includin
g both Case Management and Utilization Management, Pharmaceutical Benefits Manag
ement, Quality Improvement, Vendor Relations, and Health Services Operations.
* Extensive experience in benefit design and management, reimbursement methodolo
gy and policy formulation.

COMMUNITY HEALTH NETWORK OF CT Wallingford, CT 2001 - 2010
Community Health Network of Connecticut is a not for profit Medicaid Managed Car
e Plan contracted with the Department of Social Services in Connecticut. It was
originally founded by 9 Federally Qualified Health Centers (FQHCs) and is curre
ntly owned by 7 of these founder FQHCs.
Vice President of Health Services Department (2003-2010)
* Directed all Health Services Operations, which included Network Management (Pr
ovider Relations and Contracting), Care Management, Utilization Management, Gove
rnment Relations, Quality Improvement and Vendor Programs.
* Developed strategic plans and goals for four departments and ninety-five staff
members as organization grew from less than 50,000 members to a membership of o
ver 300,000.
* Set performance standards for four senior directors and managed a budget for f
our departments. Developed organization's first "work-at-home" program for clin
ical staff.
* Managed all Health Services vendor relationships, including the CHNCT Pharmacy
Benefits Management Company, the CHNCT Behavioral Health Vendor, Dental Vendor
and Vision Care Vendor. Management of vendors included RFP review and audit res
* Contracted with providers and hospitals. Developed network retention activitie
s and the first pay for performance incentives ever for the organization.
* Directed all practitioner credentialing activities and implemented a new crede
ntialing system to streamline the process - CACTUS software.
* Participated as key executive team member on Reimbursement Policy Committee wh
ich was responsible for formulation of claims methodology and payment recommenda
tions as well as benefit design and modifications.
* Obtained UR licensure for organization.
* Brought organization through URAC accreditation and ongoing reaccreditation ac
tivities. The very first accreditation granted was full three year accreditation
as were the subsequent reaccreditations.
* Acted as key health services executive liaison with the Department of Social S
ervices, the State of Connecticut Behavioral Health Partnership, and Dental Heal
th Partnership.
* Developed and directed all quality improvement initiatives which included HEDI
S reporting, case management and utilization management training, provider contr
acting strategies, audit of vendor contract compliance, tracking and analysis of
utilization trends, and all provider profiling reporting. Set HEDIS benchmarks
at 90th percentile - NCQA Quality Compass results for Medicaid plans.
* Ensured compliance with the CHNCT contract with the Department of Social Servi
ces and directed all Health Services Department required reporting. Key executi
ve member of team involved in DSS contract negotiations and final contract langu
age development.
* Developed both direct and cross-departmental policies and procedures.


Director of Utilization Management and Quality Improvement (2001 - 2003)
* Directed the utilization and case management functions for CHNCT and all clini
cal quality improvement activities.
* Implemented an asthma disease management program and working registry of acute
asthma patients
* Developed new processes for identification of children with special health car
e needs.
* Facilitated the organization's first HEDIS measures submission.
* Standardized utilization management reporting.
* Implemented an extensive emergency room coding audit.
* Improved processes and reporting around clinical rounds and improved overall c
ase management documentation.
CONNECTICUT VNA, Wallingford, CT 2000 - 2001
Connecticut Visiting Nurse Association is a 10 agency statewide Medicare certifi
ed homecare organization providing home visits, care management, and hospice ser
vices to patients throughout the State of Connecticut.
Director of Statewide Intake
* Developed three regional intake offices for a statewide home care agency consi
sting of ten branches. Consolidated intake functions for each separate branch i
nto three large regional centers.
* Worked with the provider community to provide nursing visits for 100 % of the
referrals received.
* Streamlined processes and improved access to availability of staffing informa
tion for the entire organization.
Health Care Consultant
* Assigned, as a consultant, to Aetna as Project Manager responsible for impleme
ntation of an on-line utilization review system for use by Aetna's network of ph
* Supervised the technical specifications development team and all end-user test
PROHEALTH PHYSICIANS, Farmington, CT 1998 - 2000
Vice President Health Services
WELLCARE MANAGEMENT GROUP, North Haven, CT & Kingston, NY 1996 - 1998
Director of Medical Management
MD HEALTH PLAN, North Haven, CT 1992 - 1996
Manager of Utilization, Management Department


Masters Degree in Health Care Administration
State of CT R.N. License #E51735
UNIVERSITY OF THE STATE OF NEW YORK, Regents Program Albany, NY (now "Excelsior
Bachelors Degree In Nursing