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The Innovator in Healthcare Workforce Solutions and Staffing Services Investor Presentation March 2019

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Page 1: AMN Template - AMN Healthcareamnhealthcare.investorroom.com/download/AMN+Investor... · 2019-03-19 · AMN at a Glance. Supply ↔ Demand. Age demographic shift creates growth opportunities

The Innovator in Healthcare Workforce Solutions and Staffing Services

Investor PresentationMarch 2019

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Forward-Looking Statements

This investor presentation contains “forward-looking statements” within the meaning of Section 27A of the SecuritiesAct of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. The Companybases these forward-looking statements on its current beliefs, expectations, estimates, forecasts and projectionsabout future events and the industry in which it operates. Forward-looking statements are identified by words such as“believe,” “anticipate,” “expect,” “intend,” “plan,” “will,” “should,” “would,” “project,” “may,” variations of such words andother similar expressions. In addition, statements that refer to performance; plans, objectives and strategies for futureoperations; and other characterizations of future events or circumstances, are forward-looking statements.

The Company’s actual results could differ materially from those discussed in, or implied by, these forward-lookingstatements. Factors that could cause actual results to differ from those discussed in or implied by the forward-lookingstatements contained in this presentation are set forth in the Company’s Annual Report on Form 10-K for the yearended December 31, 2018 and its other periodic reports, its current reports and its other filings with the SEC.Developments subsequent to this presentation are likely to cause these statements to become outdated with thepassage of time.

2

Non-GAAP Measures

This presentation contains certain non-GAAP financial information, which the Company provides as additionalinformation, and not as an alternative, to the Company's condensed consolidated financial statements presented inaccordance with GAAP. These non-GAAP financial measures include (1) adjusted EBITDA and (2) adjusted EBITDAmargin on slides 10 and 27, respectively. Management believes that adjusted EBITDA and adjusted EBITDA marginserve as industry-wide financial measures. These non-GAAP measures should not be used in isolation to evaluatethe Company's performance. A reconciliation of the non-GAAP measures identified in this presentation, along withfurther detail about the use and limitations of certain of these non-GAAP measures, may be found on the Company'swebsite at http://amnhealthcare.investorroom.com/financialreports.

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Key Investment Highlights

3

Leader in Attractive MarketTrusted partner in healthcare staffing services: nurse, allied, locum tenens, physician and executive search, interim leadership, mid-revenue cycle

Innovator in Workforce Solutions MSP, VMS, RPO, workforce optimization, scheduling and credentialing solutions

Differentiated by Technology Enhances recruiting capabilities and improves efficiency

Scalable Operating ModelAbility to drive attractive cash flow and earnings growth

Strong Cash Flow and Balance SheetDisciplined management and conservative balance sheet

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AMN at a Glance

Supply ↔ DemandAge demographic shift creates growth opportunities for AMN

workforce solutions

Diverse Client Base with over 100 MSP clients, which

includes many leading healthcare systems

Recognized as largest U.S. healthcare staffing firm

2013-18Revenue Growth

16% CAGR

61%18%

21%Nurse andAlliedSolutionsLocumTenensSolutionsOtherWorkforceSolutions

$2.1B2018 Revenue

Top performer in revenue, profits, and stock returns

HRO Today’s Recruiting Excellence Award and Diversity & Inclusion

Excellence award

Innovation leaders 2018 Impact Awards -

Named largest healthcare staffing firm in the US

4

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Our Mission

5

Every day, we . . .

Deliver the best talent and insights to help healthcare organizations optimize their workforce

Give healthcare professionals opportunities to do their best work towards quality patient care

Create a values-based culture of innovation where our team members can achieve their goals

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A Recognized Leader

2011-

Peer Review Designation to AMN MSP (Managed

Services Programs) since 2011

2018

Largest Healthcare Staffing Company in

the U.S.

Re-Certified through 2020

First Corporate Certification for Staffing

Services by the Joint Commission

2018

Exemplary Compensation

Discussion & Analysis (CD&A) Award Winner

2016

Healthcare Leader

Based on Customer Satisfaction and

Quality

2018

The Top Size of DealProvider

Based on Customer Satisfaction and Quality

2018

2019

Gender Equality Index

2018

Top performer in revenue, profits, and stock returns.

2019

Corporate Equality Index

2018

Best Proxy Statement

6

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History of AMN Healthcare

7

Strategic Transformation in Workforce Solutions

1980s 2000–08 2014-15 2018-19

1990s 2010-13 2016

Travel NurseAmerican Mobile Nurses: A founding company

Nurse and Allied ExpansionPreferred Healthcare, Medical Express, NursesRx

Workforce Solutions: MSP, RPO and VMSMedFinders,ShiftWise

Nurse, Physician, VMS, Interim Leadership, Workforce SchedulingOnward Healthcare, Locum Leaders, Medefis, The First String,MillicanSolutions, Avantas

Physician, Allied, Nurse and Search ExpansionMerritt Hawkins,Staff Care,MedTravelers, O’Grady Peyton

Interim Leadership and Executive Search, Labor Disruption, Medical CodingBE Smith, Peak Health,HealthSource Global

Mid-Revenue Cycle, C-Suite and Interim Leadership, andCredentialing SolutionsMedPartners, Phillips DiPisa, Leaders For Today,Silversheet

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Evolution of AMN: Driving Towards Workforce Solutions

8

AMN has evolved from traditional healthcare staffing to providing comprehensive workforce solutions

4%

2008

WorkforceSolutionsStaffing 63%

Staffing and Recruitment

Workforce Solutions

Leadership

Workforce Technologies

2018

Workforce Solutions Now Dominate Revenue Mix

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Revenue Growth with Operating Leverage

9

($ Millions)

$1,012 $1,036

$1,463

$1,902 $1,988

$2,136

2013 2014 2015 2016 2017 2018

$85 $91

$165

$237 $256

$270

2013 2014 2015 2016 2017 2018

Revenue Adjusted EBITDA

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2019 – A Year of Focus and Investment

Tailwinds• Recent MSP wins and

implementations

• Strong MSP pipeline

• Healthy demand across staffing service lines

• Added Silversheet credentialing solution

• Deleveraging and share repurchases

10

Headwinds• Locum Tenens

turnaround

• Lower staffing volume with large client

• Tough Q2 comp due to $25M strike revenue

• Margin impact from Silversheet and investments

Investments• Locum Tenens

enhancements and headcount

• Candidate and client engagement

• Digital and mobile

• Analytics, data management and reporting

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Industry Overview

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Healthcare Staffing: Large, Fragmented Market

Sources: US Healthcare Staffing Forecast, Staffing Industry Analysts, September 2018; AMN internal estimates of other markets

U.S. Temporary Healthcare Staffing

12

• Growing economy

• Shortage of clinicians & physicians

• Aging population & medical advances

• Adoption of outsourced solutions

• New emerging clinical roles

Demand Drivers($ Billions)

$13.2$15.2

$16.2 $16.7 $17.4

$0

$5

$10

$15

$20

Other Addressable Markets: Greater Than $5 Billion(Interim Leadership, Perm/Search, RPO, Mid-Revenue

Cycle, Workforce Consulting, VMS, Credentialing)

Page 13: AMN Template - AMN Healthcareamnhealthcare.investorroom.com/download/AMN+Investor... · 2019-03-19 · AMN at a Glance. Supply ↔ Demand. Age demographic shift creates growth opportunities

Why JOLTS Matters

13

Job Openings

Hires

Quits

1%

2%

3%

4%

5%

6%

7%

2013 2014 2015 2016 2017 2018

% o

f Em

ploy

men

t

3%

14%

5%

Hires Openings Quits

Five-Year CAGRs

JOLTS = Job Openings and Labor Turnover Survey

• Healthcare sector has record-high % of open jobs

• Voluntary quits = 66% of hires in Q4 2018

• Hires reached 3% of jobs for first time since 2008

Healthcare Hires, Openings and Quits

Data source: Job Openings and Labor Turnover Surveys, US Bureau of Labor Statistics

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Projected Healthcare Labor Shortage in 2030Aging Healthcare Professionals

~ 50% of RNs and physicians are age 50+

Annual Growth in Healthcare Spend Aging Population and Healthcare Utilization

Drivers of Healthcare Employment Growth

Sources: National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers – 2013 data and Association of American Medical Colleges April 5, 2016; AMN Healthcare survey, November 2017; AMA Physician Master File and 2012 Physicians Foundation Survey conducted by Merritt Hawkins – 2012 data; National Health Expenditure Projections – CMS, February 2019; AMN Healthcare 2013 Clinical Workforce Survey of Hospital Leaders; “The Complexities of Physician Supply and Demand,” Association of American Medical Colleges, March 2018; Future of the Nursing Workforce, Health Resources and Services Administration, December 2014.

• Over 65 - 3x more hospital days

• Over 75 - 4x more healthcare days

2010 2015 2020 2025 2030Source: U.S. Department of Health and Human Services

5.5%

4.4%3.9% 40

72

U.S. population aged 65+in millions

55% of RNs who plan to retire will do so by 2020~38% of active physicians are age 56 & older Up to 104,900

physician shortageRegional & specialty

nurse shortages

2018–272017 2018

15

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Business Overview

Page 16: AMN Template - AMN Healthcareamnhealthcare.investorroom.com/download/AMN+Investor... · 2019-03-19 · AMN at a Glance. Supply ↔ Demand. Age demographic shift creates growth opportunities

Staffing and Recruitment

• Travel nursing• Allied staffing• Locum tenens• Local staffing• Physician placement• Rapid response• EMR implementation• Labor disruption

Workforce Solutions

• Managed services programs (MSP)

• Vendor management systems (VMS)

• Recruitment process outsourcing (RPO)

• Mid-revenue cycle workforce solutions

• Scheduling and labor management

• Credentialing solutions

AMN Portfolio of Solutions

ExecutiveLeadership

• Interim leadership• Executive search• Physician leadership search• Nurse leadership search• Leadership training and

development• Workforce analysis and

optimization• Predictive modeling and analytics• Education services

17

Value through leadership, innovation and strategic insight

Staffing and Recruitment Workforce Solutions Leadership and

Consulting

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Leader in Managed Services Programs (MSP)

18

Outsourced partner to manage all supplemental workforce needs

AMN manages staffing vendors, credentialing, clinical support, reporting, consolidated invoicing

500+ affiliates

Client Benefits AMN Benefits• Higher fill rates

• Improved fulfillment time

• Staffing optimization

• Controlled spend

• Accountability

• Credentialing compliance

• Cross-selling opportunities

• Recruitment advantages

• Less cyclicality

• Improved demand visibility

• Strong client relationships

• High client retention

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2010 2011 2012 2013 2014 2015 2016 2017 2018

$134 $185 $265 $296 $350$454

$649$786

$892

$85$106

$115 $110$154

$308

$369

$379$346MSP Direct Fill Revenue

Filled by Affiliate Network

MSP: Growth Engine

19

Adoption of MSP has gained momentum

(1) Staffing revenue consists of Nurse, Allied, and Locum Tenens revenue; on a consolidated basis, MSP was 42% of 2018 revenue

MSP direct fill revenue grew from 1% of AMN staffing revenue in 2008 to 51% today (1)

MSP

Gro

ss B

illin

gs U

nder

Man

agem

ent (

$M)

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Nurse and Allied Solutions

20

Short- and Long-term Travel and Local Staffing• AMN is the largest travel nurse

and allied staffing company• Travel nurse assignments are

typically 13 weeks• Over 60% of segment

revenue comes through exclusive MSP relationships

61%of 2018

AMNRevenue

Robust Demand: Key Drivers

Shortage of nurses

Shift to MSP relationshipsShift to flexible staffing models

Aging U.S. and clinical population

Favorable economy

Skill Specialties

All nursing specialties

Physical, occupational, speech therapists

Respiratory, imaging, lab

Pharmacists, technicians

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Locum Tenens Solutions

21

Shortage of physicians

Growing demand for healthcare services

Specialty-specific demand

Aging physician population

19%

Robust Demand: Key Drivers

We place physicians, advanced practice clinicians and dentists on temporary assignments throughout the United States

Typical assignments range from days to multiple months

Areas of Practice

18%

• Hospitalists• Anesthesia/CRNA• Emergency Medicine• Internal Medicine• Psychiatry

• Surgery• Advanced Practices• Radiology• Primary Care• Dentistry

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Locum Tenens Turnaround in Progress

22

Before: Multiple, unintegrated, inflexible, aging technologies

Today: Integrated, scalable, agile technology platform

Our focus for growth:• Enhance system adoption and usability• Improve data quality and integration• Sales hires and productivity ramp• MSP and new client sales

Inconsistent operating model across brands Single, cohesive operating model

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Other Workforce Solutions

Workforce and leadership shortages

Rising healthcare costs

Increased administrative complexityRevenue integrity/capture, quality reporting

Increased need for data-driven insights

Interim and permanent executive leadership and permanent physician placement

Recruitment process outsourcing

Mid-revenue cycle solutions

Vendor management systems

Workforce optimization solutions

Credentialing solutions

Informed decision-making

Reduced complexity

Flexible access to scarce talent

Drive optimal workforce mix

Key Demand Drivers

Business Lines

Key Advantages

21%

23

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Terms of AcquisitionSolution Set

Silversheet Acquisition

Subscription-based credentialing and privileging software platform

Credential Verification Organization services

$30 million cashUp to $25 million earn-out,

based on revenue and earnings targets for 2019-20

24

Credentialing Solutions

Provides sophisticated, cloud-based software solutions to reduce the complexities and challenges of the credentialing

process for clinicians and healthcare organizations

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Diverse Client Base

25

As the market leader, AMN delivers a broad suite of workforce solutions to many leading health systems

AMN knows the national landscape. They know what’s out there and what the trends are. They bring that valuable information to us so that we can better plan as partners.

Chief Nursing Officer,Large Integrated Health System

& AMN MSP Client

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Financial Overview

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Five-Year Financial Summary

27 ($ in Millions)

$1,036

$1,463

$1,902 $1,988 $2,136

$-

$500

$1,000

$1,500

$2,000

$2,500

2014 2015 2016 2017 2018

$316

$469

$620 $644 $696

30.5%32.1% 32.6% 32.4% 32.6%

25%

30%

35%

40%

$0

$200

$400

$600

2014 2015 2016 2017 2018

$91

$165

$237 $256 $270

8.8%

11.3%12.5% 12.9% 12.7%

5%

10%

15%

$0

$50

$100

$150

$200

$250

2014 2015 2016 2017 2018

9%

16%14%

16%14%

0%

5%

10%

15%

2014 2015 2016 2017 2018

Gross ProfitTotal Revenue

Adjusted EBITDA Return on Invested Capital

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Allocation of Strong Free Cash Flows

28($ Millions)

$476

$-

$100

$200

$300

$400

$500

2014 2015 2016 2017 2018

$ M

illio

ns

Cumulative Free Cash Flow

$476 Million Free Cash Flow Generated in Last Five Years

$(551)

$(100)

$285

$(600)

$(400)

$(200)

$-

$200

$400

Acquisitions Stock Repurchases Net Borrowing

$ M

illio

ns

Selected Other Uses and Sources of CashFiscal Years 2014-18

$651 Million Spent on Acquisitions, Stock Buybacks

Strong Balance Sheet, 1.7x Leverage Ratio

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Key Investment Highlights

29

Market leader and trusted partner in healthcare staffing services - nurse, allied, locums, physician and executive search, interim leadership

Innovator in healthcare workforce solutions: MSP, VMS, RPO, medical coding, workforce optimization; expanding solutions to support clients

Positive secular trends supported by aging population and clinical labor shortages

Investment in technology differentiates AMN services, enhances recruiting capabilities, and reduces costs

Scalable operating model with leverage

Strong cash flow and balance sheet