Rachelle Casambre, MPH, CAPM, LSSGB
Director of Delegation and Vendor Oversight at Cook County Health- Claim this Profile
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English Native or bilingual proficiency
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Tagalog Limited working proficiency
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Spanish Elementary proficiency
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French Elementary proficiency
Topline Score
Bio
Credentials
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LSSGB Lean Six Sigma Green Belt
Six Sigma Global InstituteJul, 2017- Nov, 2024 -
HIPAA (Health Insurance Portability and Accountability Act) Online Training
University of Illinois at Chicago School of Public HealthMay, 2015- Nov, 2024 -
Certified Associate in Project Management (CAPM)
Project Management InstituteApr, 2017- Nov, 2024
Experience
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Cook County Health
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United States
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Hospitals and Health Care
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700 & Above Employee
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Director of Delegation and Vendor Oversight
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Nov 2022 - Present
Vendor (delegated and non-delegated) oversight and compliance, RFP writing and management, contract management, procurement management, and member supplement benefits program management
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Senior Manager of Delegation and Vendor Oversight
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Jun 2020 - Nov 2022
Focus on vendor (delegated and non-delegated) oversight and compliance, RFP writing and management, contract management, procurement management, and member benefit program management for both Medicaid and Medicare products.
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Medicaid Risk and Operations Manager
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Nov 2019 - Jun 2020
Focus on NCQA Accreditation (received 100% score from NCQA in administrative review), Delegated Vendor audits, Policy Management, Risk Management, and Contractual Compliance
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Centene Corporation
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United States
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Hospitals and Health Care
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700 & Above Employee
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Interim Manager, Compliance & Third Party Risk Management
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Oct 2019 - Nov 2019
- Managed and oversaw all activities and requirements of delegated vendors, to ensure compliance with all state and federal regulatory and contract requirements - Coordinated annual audits to measure the performance, including the request, receipt and closure of corrective action plans - Oversaw and reviewed all executive summaries of audit results - Ensured delegated vendor’s performance is consistent with the expectations, policies, procedures and requirements - Participated in… Show more - Managed and oversaw all activities and requirements of delegated vendors, to ensure compliance with all state and federal regulatory and contract requirements - Coordinated annual audits to measure the performance, including the request, receipt and closure of corrective action plans - Oversaw and reviewed all executive summaries of audit results - Ensured delegated vendor’s performance is consistent with the expectations, policies, procedures and requirements - Participated in quality management and improvement activities, including participating in key State stakeholder committees and meetings for all delegated functions - Conducted monthly meetings with vendors and documented discussions, issues, attendees, and action items - Ensured the timely receipt of accurate and complete reporting for all regulatory and contractually required reports required from the delegated vendor - Oversaw compliance with the contract between various business units and the delegated vendor - Acted as a liaison and resource to the delegated vendors regarding contract and regulatory requirements, as well as the communication of new or revised requirements
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Compliance Specialist
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Nov 2018 - Oct 2019
• Implemented and manages the Compliance Internal Auditing and Monitoring Program which provides oversight of regulatory compliance with all contract, State, and Federal regulations. Coordinates and conducts audits based off a risk based methodology developed by the Compliance department and produces reports based on audit results and communicates results to internal Business Partners. • Manages and executes IlliniCare’s quarterly performance auditing of Centene Corporation’s national… Show more • Implemented and manages the Compliance Internal Auditing and Monitoring Program which provides oversight of regulatory compliance with all contract, State, and Federal regulations. Coordinates and conducts audits based off a risk based methodology developed by the Compliance department and produces reports based on audit results and communicates results to internal Business Partners. • Manages and executes IlliniCare’s quarterly performance auditing of Centene Corporation’s national specialty vendors in conjunction with Centene’s Performance Management Oversight team. • Investigates potential non-compliance concerns and implements corrective action plans to mitigate noncompliance with all contract requirements and performance deficiencies through process improvements. • Manages completion of Health Services Advisory Group (HSAG) Readiness, Admin, and Compliance Review audits. • Conducts ongoing scheduled Compliance monitoring activities across the Plan including the development and maintenance of Plan and Department specific performance dashboards that are presented to the Plan and Centene Corporation Executives. • Coordinates with regulatory agencies and internal Business Partners to track new and outstanding issues and ad hoc deliverables. • Identifies, measures, monitors and reports risks and exposures across the organization in accordance with the Enterprise Risk Management Policy and framework, and related Risk Management program • Manages and implements Plan policies and procedures to ensure compliance with federal and state requirements.
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Compliance Analyst
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Nov 2017 - Nov 2018
- Provides oversight and guidance as it relates to our contractual obligations for the submission of HSAG Readiness/Admin Review and Market Conduct Exam external audits. - Performs internal audits as required by Corporate and Plan policies and procedures on IlliniCare business units. - Manages approval and quality assurance for timely, complete, and accurate contractual and regulatory reports on a monthly, bi-monthly, quarterly, and annual basis. - Analyze the impact of state… Show more - Provides oversight and guidance as it relates to our contractual obligations for the submission of HSAG Readiness/Admin Review and Market Conduct Exam external audits. - Performs internal audits as required by Corporate and Plan policies and procedures on IlliniCare business units. - Manages approval and quality assurance for timely, complete, and accurate contractual and regulatory reports on a monthly, bi-monthly, quarterly, and annual basis. - Analyze the impact of state legislative and regulatory issues and conduct periodic assessments to ensure compliance against contract requirements. - Develops and updates Plan policies and procedures to ensure compliance with federal and state requirements.
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Family Health Network
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Hospitals and Health Care
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1 - 100 Employee
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Associate Project Manager
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Nov 2016 - Nov 2017
Family Health Network and Community Care Alliance of Illinois • Works collaboratively and communicates across all departments to ensure projects are completed in timely manner with the appropriate resources • Tracks and analyzes the political environment, legislation, and regulations in regards to health care and presents these findings to the department and across the organization • Develops meeting agendas, updates project work plans, & tracks project deliverables • Identifies… Show more Family Health Network and Community Care Alliance of Illinois • Works collaboratively and communicates across all departments to ensure projects are completed in timely manner with the appropriate resources • Tracks and analyzes the political environment, legislation, and regulations in regards to health care and presents these findings to the department and across the organization • Develops meeting agendas, updates project work plans, & tracks project deliverables • Identifies areas of improvement within organization and processes • Communicates project expectations to team members and stakeholders in a timely and clear fashion • Collaborates with project stakeholders on an ongoing basis • Plans and tracks project timelines and milestones using appropriate project management tools • Performs quality assurance on project deliverables and troubleshoots problem areas • Performs various administrative duties as assigned by manager • Highlights: - Project managed NCQA accreditation for two Medicaid products which received a perfect score (100%) for both products - Assisted with request for proposal in response to HFS’ solicitation for Medicaid products for a 5/15/17 submission - Project Lead for HSAG Administrative Review Show less Family Health Network and Community Care Alliance of Illinois • Works collaboratively and communicates across all departments to ensure projects are completed in timely manner with the appropriate resources • Tracks and analyzes the political environment, legislation, and regulations in regards to health care and presents these findings to the department and across the organization • Develops meeting agendas, updates project work plans, & tracks project deliverables • Identifies… Show more Family Health Network and Community Care Alliance of Illinois • Works collaboratively and communicates across all departments to ensure projects are completed in timely manner with the appropriate resources • Tracks and analyzes the political environment, legislation, and regulations in regards to health care and presents these findings to the department and across the organization • Develops meeting agendas, updates project work plans, & tracks project deliverables • Identifies areas of improvement within organization and processes • Communicates project expectations to team members and stakeholders in a timely and clear fashion • Collaborates with project stakeholders on an ongoing basis • Plans and tracks project timelines and milestones using appropriate project management tools • Performs quality assurance on project deliverables and troubleshoots problem areas • Performs various administrative duties as assigned by manager • Highlights: - Project managed NCQA accreditation for two Medicaid products which received a perfect score (100%) for both products - Assisted with request for proposal in response to HFS’ solicitation for Medicaid products for a 5/15/17 submission - Project Lead for HSAG Administrative Review Show less
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University of Illinois Chicago
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United States
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Higher Education
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700 & Above Employee
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Graduate Assistant
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May 2015 - May 2016
• Assisted the AARCC Director and Associate Director in supervising the staff of 24-28 Peer Mentors in working with 60 first-year or transfer Asian American students at UIC • Conducted training for the Peer Mentors • Coordinated workshops and events for AAMP starting in summer for Summer College and assisted with recruiting incoming 1st year and transfer students to the program for the Fall • Redesigned the AAMP logo • Assisted the AARCC staff with programming related to Asian… Show more • Assisted the AARCC Director and Associate Director in supervising the staff of 24-28 Peer Mentors in working with 60 first-year or transfer Asian American students at UIC • Conducted training for the Peer Mentors • Coordinated workshops and events for AAMP starting in summer for Summer College and assisted with recruiting incoming 1st year and transfer students to the program for the Fall • Redesigned the AAMP logo • Assisted the AARCC staff with programming related to Asian American students • Lead coordinator of Asian American Awareness Month at UIC as well as oversaw a planning committee of about 15 representatives for a month-long series of events, talks, workshops, and movie screenings relating to issues of concern to Asian Americans and other minority populations Show less • Assisted the AARCC Director and Associate Director in supervising the staff of 24-28 Peer Mentors in working with 60 first-year or transfer Asian American students at UIC • Conducted training for the Peer Mentors • Coordinated workshops and events for AAMP starting in summer for Summer College and assisted with recruiting incoming 1st year and transfer students to the program for the Fall • Redesigned the AAMP logo • Assisted the AARCC staff with programming related to Asian… Show more • Assisted the AARCC Director and Associate Director in supervising the staff of 24-28 Peer Mentors in working with 60 first-year or transfer Asian American students at UIC • Conducted training for the Peer Mentors • Coordinated workshops and events for AAMP starting in summer for Summer College and assisted with recruiting incoming 1st year and transfer students to the program for the Fall • Redesigned the AAMP logo • Assisted the AARCC staff with programming related to Asian American students • Lead coordinator of Asian American Awareness Month at UIC as well as oversaw a planning committee of about 15 representatives for a month-long series of events, talks, workshops, and movie screenings relating to issues of concern to Asian Americans and other minority populations Show less
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Policy and Advocacy Intern
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Mar 2015 - Mar 2016
• Compiled and analyzed quantitative and qualitative data and incorporated findings into reports • Researched policy best practices and implications in other state and local governments • Attended internal meetings • Represented the department through official communications and meetings with external entities • Identified, tracked, analyzed, and summarized policy and legislation • Created documents and fact sheets to educate senior community about changes that would occur… Show more • Compiled and analyzed quantitative and qualitative data and incorporated findings into reports • Researched policy best practices and implications in other state and local governments • Attended internal meetings • Represented the department through official communications and meetings with external entities • Identified, tracked, analyzed, and summarized policy and legislation • Created documents and fact sheets to educate senior community about changes that would occur following cuts of state funding for the Community Care Program titled Proposed New Restrictions on Access to the Community Care Program Will Impact Chicago Seniors • Created document highlighting the importance of integrating social and health services titled Integration of Primary Care and Social Care: A Review of U.S. Frameworks Show less • Compiled and analyzed quantitative and qualitative data and incorporated findings into reports • Researched policy best practices and implications in other state and local governments • Attended internal meetings • Represented the department through official communications and meetings with external entities • Identified, tracked, analyzed, and summarized policy and legislation • Created documents and fact sheets to educate senior community about changes that would occur… Show more • Compiled and analyzed quantitative and qualitative data and incorporated findings into reports • Researched policy best practices and implications in other state and local governments • Attended internal meetings • Represented the department through official communications and meetings with external entities • Identified, tracked, analyzed, and summarized policy and legislation • Created documents and fact sheets to educate senior community about changes that would occur following cuts of state funding for the Community Care Program titled Proposed New Restrictions on Access to the Community Care Program Will Impact Chicago Seniors • Created document highlighting the importance of integrating social and health services titled Integration of Primary Care and Social Care: A Review of U.S. Frameworks Show less
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MidAmerica Center for Public Health Practice
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Wellness and Fitness Services
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Graduate Research Assistant
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Jul 2014 - Jun 2015
Developed and maintained website for the Great Lakes Public Health Training Collaborative to aid in education and training services for the current and future public health workforce Developed and maintained website for the Great Lakes Public Health Training Collaborative to aid in education and training services for the current and future public health workforce
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Asians with Disabilities Outreach Project Think-Tank (ADOPT)
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University of Illinois at Chicago
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Undergraduate Research Assistant, Graduate Research Assistant
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Oct 2012 - Jun 2015
This project is housed within the Department of Disability and Human Development (DHD) with UIC’s Center of Capacity Building on Minorities with Disabilities Research (CCBMDR) and Asian American Studies Program. Developed ADOPT’s website (adoptil.org), which will be an important resource for the Illinois Division of Rehabilitation Services (IDRS) and many local immigrant, refugee and minority serving agencies. Created research presentation posters, flyers, PowerPoints, fact… Show more This project is housed within the Department of Disability and Human Development (DHD) with UIC’s Center of Capacity Building on Minorities with Disabilities Research (CCBMDR) and Asian American Studies Program. Developed ADOPT’s website (adoptil.org), which will be an important resource for the Illinois Division of Rehabilitation Services (IDRS) and many local immigrant, refugee and minority serving agencies. Created research presentation posters, flyers, PowerPoints, fact sheets, and other media tools that highlight best practices and project outcomes for various local and national meetings and conferences. Show less This project is housed within the Department of Disability and Human Development (DHD) with UIC’s Center of Capacity Building on Minorities with Disabilities Research (CCBMDR) and Asian American Studies Program. Developed ADOPT’s website (adoptil.org), which will be an important resource for the Illinois Division of Rehabilitation Services (IDRS) and many local immigrant, refugee and minority serving agencies. Created research presentation posters, flyers, PowerPoints, fact… Show more This project is housed within the Department of Disability and Human Development (DHD) with UIC’s Center of Capacity Building on Minorities with Disabilities Research (CCBMDR) and Asian American Studies Program. Developed ADOPT’s website (adoptil.org), which will be an important resource for the Illinois Division of Rehabilitation Services (IDRS) and many local immigrant, refugee and minority serving agencies. Created research presentation posters, flyers, PowerPoints, fact sheets, and other media tools that highlight best practices and project outcomes for various local and national meetings and conferences. Show less
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Education
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2014 - 2016
University of Illinois at Chicago
Master’s Degree, Public Health, Health Policy and Administration -
2010 - 2014
University of Illinois at Chicago
Bachelor’s Degree, Kinesiology and Exercise Science -
2006 - 2010
Northside College Preparatory High School
High School -
2017 - 2017
Udemy
Certification, Certified Associate in Project Management -
2017 - 2017
6sigmastudy
Certification, Six Sigma Yellow Belt -
2017 -
Six Sigma Global Institute
Certification, Lean Six Sigma Green Belt
Community
