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Important Notification: Effective 01/01/2018 Triad HealthCare Network Utilization Management is the delegated UM authorization department for HealthTeam Advantage PPO 1 and PPO 2.
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HealthTeam Advantage, a product of Care N’ Care Insurance Company of North Carolina, Inc., is a Medicare Advantage plan with a Medicare contract. Enrollment in HealthTeam Advantage depends on contract renewal. This information is not a complete description of benefits. Call for more information: prospective members call 877-905-9216 , HTA PPO members call 888-965-1965, and HTA CSNP members call 833-324-3242 (TTY:711) from October 1–March 31, 8 a.m. to 8 p.m. ET, seven days a week, or April 1–September 30, 8 a.m. to 8 p.m. ET, Monday through Friday. Medicare beneficiaries may also enroll in HealthTeam Advantage through the CMS Medicare Online Enrollment Center located at http://medicare.gov. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Every year, Medicare evaluates plans based on a 5-star rating system.
Care N’ Care Insurance Company of North Carolina, Inc. 7800 McCloud Road, Suite 100, Greensboro, NC 27409. © Copyright 2020 – HealthTeam Advantage – All rights reserved.
© Copyright 2020 – HealthTeam Advantage – All rights reserved. H9808_20_96
As the vice president of pharmacy operations and quality programs, Deanna provides oversight to the pharmacy and quality programs. She’s an accomplished, mission and strategy-driven senior executive and licensed pharmacist with 16 years of comprehensive management experience in managed care, pharmacy benefit, clinical and retail environments, with expertise in Medicare Part D plans, Medicare quality programs, medication therapy management programs, and cost-effective formulary development.
Prior to joining HealthTeam Advantage in 2016, Deanna was the first financial clinical pharmacist at EnvisionRX Options where she helped develop and enhance pharmacy benefit management services for more than five million members across a variety of functions, including Medicare Part D, fraud, waste, and abuse, trend analysis, and cost reporting, and accreditation. Within one year, she was promoted to director operations for the national Part D plan where she oversaw all pharmacy benefit management activities, medication therapy management programs, compliance monitoring, formulary development, grievances, coverage determinations and appeals. In this newly created position, she was responsible for establishing the first pharmacy benefit management oversight department.
Deanna started her health plan career at Mercy Health Plans, Inc., a regional provider-owned insurance company in Missouri. As the clinical pharmacist and then clinical pharmacy manager, she helped effectively manage pharmacy and medical prescription medication spends for members across Missouri, Arkansas, Kansas, Oklahoma, and Texas. She also provided technical expertise for all areas of pharmacy across education, quality improvement and multi-faceted cost containment initiatives, and coordinated with sales, marketing, and finance to develop and deploy strategic pharmacy benefit designs for commercial and Medicare lines of businesses.
Deanna has pharmacy experience in hospital, retail, and long-term care settings.
When she isn’t working, Deanna spends her time walking/jogging on the Greensboro Greenway, baking, watching sports with her husband Tom, and playing with their puppy Diego.
Dave is the chief medical officer. He’s responsible for providing clinical expertise for medical management, care management, and quality improvement to make sure we provide high quality, responsive care to our members. Dave has been with the company since 2016; prior to that he was a practicing urologist for 25 years with Alliance Urology Specialists in Greensboro.
In 2018, he stopped practicing medicine and devoted his full attention to making sure HealthTeam Advantage members receive the best possible care. Dave also provides medical leadership for the Triad Healthcare Network, an accountable care organization (ACO), which includes approximately 1,400 local physicians working collaboratively to improve the health and well-being of our communities.
In 2019, Dave realized there was a patient population that was underserved in healthcare, so he led our plan in the creation of the HTA Diabetes & Heart Care HMO Chronic Special Needs Plan (CSNP).
Dave received his medical degree from The Johns Hopkins School of Medicine and completed his residency in urology at Northwestern University. He also holds a master’s degree in health care administration from the University of North Carolina and completed the Physician Leadership Academy program through the Center for Creative Leadership.
Dave loves all things outdoors and can often be seen riding his bike on local roads and trails.
As the director, human resources, Erin is responsible for all human resources and facility functions. It’s her job to ensure HealthTeam Advantage is an employer of choice with an engaged workforce that provides exceptional service to our members.
Erin has more than 15 years’ experience in management and human resources, and has a background in customer service, and employee and leadership development. She began her career in customer service with Entertainment Cruises, where she rose to become its compensation and benefits manager. She’s also worked for several global organizations, including Mitsubishi Electric Automation and International Paper.
Erin earned her Master of Business Administration in Human Resources Management from Keller Graduate School of Management and holds her Professional in Human Resources Certification from the HR Certification Institute.
Erin enjoys running and she and her family participate in several local runs, like the Triad GO FAR 5K & Fun Run. Usually you can find her training with her husband in their High Point neighborhood.
Francisco, or as he likes to be called Cisco, is one of the medical directors for Health Team Advantage. He, in addition to the other physicians, is responsible for the many medical duties involving leadership, review, and oversight.
He currently practices family medicine at the office he and his wife started 21 years ago in Asheboro, N.C. and serves as medical director at two skilled nursing facilities overseeing patient care and medical extender responsibilities. He is board certified in family medicine and has served as president of the Randolph County Medical Society. He also served as the chief-of-staff at Randolph Hospital, re-writing and modernizing its by-laws and organization structure. Cisco was an associate professor at both Duke University and University of North Carolina.
Cisco grew up splitting time between San Diego and Dayton, Ohio. He graduated the University of California at San Diego, with a degree in physiology; he also played tennis there at the intercollegiate Division 3 level. Cisco did his master’s research work at Wright State University in kidney physiology and went on to medical school at the Wright State University School of Medicine. He then completed a three-year family practice residency at Riverside Regional hospital in Newport News, Virginia.
In his spare time, Cisco coaches soccer for two travel soccer club teams in addition to serving as vice-president of the Asheboro City Futbol Club. He enjoys vintage comic book collecting (and really anything superhero related) and travelling to the beach with his wife and three kids.
As one of HealthTeam Advantage’s medical directors, Beth is responsible for reviewing member and provider appeals and educating providers about the rules governing Medicare Advantage insurance plans.
She also practices medicine in the same office she opened with her husband in 1999, a family practice office in Asheboro.
Beth grew up in a small town in Ohio and wanted to settle in a similar community (but with warmer weather), which led her to Asheboro.
She received her medical degree from Wright State University in Dayton, Ohio and did her family medicine residency at Riverside Regional Medical Center in Virginia. Beth received an additional specialty accreditation in hospice and palliative care in 2010.
When she isn’t serving as a medical director or taking care of her patients, you’ll find her on the sidelines of her kids’ soccer games or doing house calls for her hospice patients. Beth and Cisco have three teenagers, three dogs, one cat, and 21 goldfish.
Thomas is the vice president and chief compliance and privacy officer. He’s responsible for all aspects of the company’s compliance and privacy activities, including the compliance program, required education and training of staff and members of the board of directors, regulatory requirements issued by state and federal agencies, and contracting and vendor oversight.
Prior to joining HTA, Thomas served as the Medicare compliance officer at CareSource, where he oversaw all compliance aspects for the Medicare Advantage, dual eligible, and the Affordable Care Act products. Previously, Thomas served in several progressively responsible roles for Blue Cross and Blue Shield of Florida primarily focused on regulatory oversight for Medicare Advantage products.
Thomas has an extensive compliance and regulatory background that spans nearly 20 years in the Medicare Advantage industry. He also served as the director of marketing for an assisted living and skilled nursing facility, and area coordinator for the American Cancer Society.
Thomas holds degrees in history and Spanish from Flagler College, a master’s in public administration from Florida International University, a master’s in health administration from the University of Florida, and a Doctor of Philosophy in public policy and administration from Mississippi State University.
Thomas enjoys spending his free time traveling with his wife Vicki, watching football, jogging, and playing with their four-legged daughter, Gracie. Gracie likes playing at Le Bauer Park with her buddies.
Nancy is the vice president of utilization management; she’s responsible for the overall compliance of the delegated utilization management (UM) programs for the health plan, to include referral management, telephonic utilization review, prior authorization functions and care management. She ensures the delegated UM programs emphasize the appropriate admissions and concurrent and retrospective reviews of care based upon the health plan benefit guidelines and medical necessity while ensuring high quality and cost-efficient medical outcomes for our members. She’s also responsible for ensuring Part C health plan regulatory compliance requirements are met, including the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Program and the National Committee for Quality Assurance (NCQA).
Nancy brings more than 30 years’ experience working in the healthcare industry both in provider and health plan leadership roles. She spent 10 years with GE Healthcare Financial Services traveling the United States assisting healthcare organizations achieve improvements in patient care, cost and workflow efficiencies, and regulatory compliance and financial stability. She also spent five years in the Dallas market where she led a team of 72 primary care clinics and 250 specialists in achieving NCQA Medical Home accreditation and implemented one of the first Medicare Advantage health plans in the market.
Nancy obtained a Bachelor of Science in Nursing and a master’s degree at the State University of New York at Buffalo. She’s a licensed registered nurse in South Carolina and New York. Nancy has been published in Senior Living Business, Long-Term Care Management and Long-Term Living. She has presented at national conferences including American Medical Group Association (AMGA) Fall Symposium, National Investment Council Skilled Nursing Forum and Catholic Health East.
Nancy and her husband are avid outdoorsmen enjoying hiking, fishing, equestrian trail rides, and golf.
Joleen serves as the vice president of operations; she’s responsible for member services, enrollment, provider relations, claims, appeals, and grievances.
She’s considered a subject matter expert on Medicare operations with more than 20 years’ experience in Medicare managed care, Medicare regulations, benefits, and the Centers for Medicare and Medicaid Services (CMS).
Prior to joining HealthTeam Advantage, Joleen served as the director of operations at Evolent Health, for all health plans managed within the payer services and operations department, the director of government programs at AIM Specialty Health, a WellPoint Company, as well as the corporate director of operations for Fidelis Senior Care, a Medicare Special Needs Institutional Plan. Joleen has also held management positions at PwC, HealthSpring, United Healthcare, and Humana.
Outside the office, you can find Joleen reading historical fiction, crocheting, or traveling though the United States. One of Joleen’s goals is to visit every state in America! At last count, she only has eight more states to visit.
Though born and raised in Chicago, Joleen enjoys the Triad area and everything the state has to offer, like being close to the beach and the mountains—a big change from the Midwest!
Trish is the vice president of accounting and finance. In addition to being responsible for all aspects of the company’s financial operations, budgeting and strategies, Trish also oversees the information technology, data analytics, and revenue program management functions. She joined the organization in 2017 as the controller before moving into her current role.
Trish began her career in public accounting at Ernst & Young, LLP, specializing in the healthcare sector in New York, where she was responsible for managing audits for large hospital systems such as New York Presbyterian. After seven years at Ernst & Young, LLP, Trish moved into private industry in the role of controller at June Media, Inc. rising to chief financial officer and vice president of operations over a 10-year tenure.
Outside of the office, Trish is an active volunteer with several animal rescue organizations. She serves as treasurer to two charities, including the Declan Donoghue Foundation (run by her family), which is dedicated to building playgrounds in communities here in the Triad.
As president, Brendan is responsible for the health plan’s overall performance. Before joining HealthTeam Advantage in September 2015, Brendan worked at a Blue Cross Blue Shield plan for more than 24 years in various leadership roles; he has extensive experience in compliance, and internal audit and claims.
In addition to his more than 28 years of healthcare leadership experience, Brendan holds a Bachelor of Business Administration from the University of North Florida and a Master of Business Administration from the University of Phoenix. Brendan also holds the Certified Internal Auditor® designation.
Brendan and his wife Lori are active in the community volunteering at Ronald McDonald House and St. Benedict Catholic Church, where Brendan serves on the finance council. Brendan and Lori also enjoy the outdoors and traveling and have a desire to visit all the national parks!
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We value our certified agents & brokers and look forward to assisting you with any questions. Contact your Agent Concierge Team at 855-547-0344 or use the form below to send us an e-mail.
Visit our office Monday through Friday, 8 a.m.-4 p.m. (ET) at 7800 McCloud Road, Suite 100, Greensboro, NC 27409.
Because HealthTeam Advantage denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.
Expedited appeal requests can be made by phone at 1-844-846-8003.
Who May Make a Request: Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact us to learn how to name a representative.
We’re committed to providing excellent customer services to our members and their designees. Questions? Call a HealthTeam Advantage Healthcare Concierge at 1-888-965-1965 (TTY 711), seven days a week, between 8 a.m. to 8 p.m. Or, send us an email using the form below.
In an effort to reduce paper and deliver timely and accurate confidential communication to our members, we are making our materials available to you electronically. If you choose, we will securely send our plan materials to your email address instead of your mailbox. It’s easy and will help us reduce our carbon footprint by limiting the materials we print.
Simply complete the form below, click “submit,” and we will make the switch for you.
This option does not apply to all mailings sent to you from HealthTeam Advantage. To protect your personal health information, we will continue to send this material to you via the U.S. Postal Service.
As always, your Healthcare Concierge is ready to assist you. To make the switch to electronic communications, complete the form below or call your Healthcare Concierge at 1-888-965-1965 (TTY 711).
Lost or damaged HealthTeam Advantage member identification card? Complete the online form below to request a replacement card.
To make a change to your primary care physician on your ID card, please contact your Healthcare Concierge at 1-888-965-1965 or email conciergehta@healthteamadvantage.com
Interested in getting certified to sell HealthTeam Advantage health plans? Just complete and submit the form below:
Need sales material for your next appointment? Let us know what materials you require by completing this online form. We will get back to you to confirm your order!