Courtney Rice

Program Director Contract Performance @Southwestern Health Resources

TX, US

Portfolio Management & Program Funding: Direct the operational performance of a 15-payer portfolio acrossCommercial, Medicare Advantage, Medicaid, and Exchange lines, securing $21M in dedicated funding toarchitect and scale clinical programs across a provider clinically integrated network.• Shared Savings Optimization: Orchestrated value-based initiatives that yielded over $10M in shared savingsthrough the strategic management of contract withholds and the alignment of clinical workflows with payerquality benchmarks.• Total Cost of Care (TCOC) Strategy: Co-designed network-wide population health strategies that integratedcare management engagement with medical economics, resulting in $23M in savings while simultaneouslyimproving HEDIS and Star Rating outcomes.• Actuarial & Risk Mitigation: Spearheaded financial and operational impact analyses for new contractamendments, leveraging predictive modelling to mitigate downside risk and ensure favourable benchmarkingfor cost, quality, and risk-adjustment (RAF) scoring.• Network Curation & Efficiency: Optimized the care continuum by identifying high-performance specialists andancillary providers, reducing out-of-network leakage and enhancing the efficiency of the Patient-CenteredMedical Home (PCMH) model.