Director, Provider Solutions; Network Management

• May 2021 - Present

Director Network Management

• Jan 2020 - May 2021

Sr. Manager Value-Based Contracting

• Jul 2017 - Jan 2020

Working in payment innovation and quality compliance within value based contracting market. Currently manage contracts representing 50% of government healthcare lives to include PPO, HMO, Medicaid, Medicare and ACA products valued at over $250 million dollars. I oversee the contracting and performance for a large, award winning health system and also the largest physician practice in the region. I also manage the qualified health plan program for value based contracting and continuously strive to create innovative ways to disrupt the market and be a true partner to providers and health systems with the goal of improving health outcomes and keeping healthcare affordable for our members.

Clinical Compliance Supervisor- Auditor

• Aug 2016 - Jan 2017

Create and implement independent audit tools to gather, track, and evaluate data as it pertains to the various clinical and operational standards of production for Medical Management staff-clinical and non-clinical. Analyze audit findings. Identify opportunities for process improvement and quality initiatives,Meets work standards by tracking production, productivity, quality and customer-service (discharge planning) standards; assist in resolutions for identified operational deficits and assist with development of work process improvement initiatives. Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure Serves as liaison to the Compliance Department as it pertains to Medical Management/UM functions and serves as clinical compliance contact for Health Plan related audit/reporting requests as they relate to UM. Serve as Subject Matter Expert to Training Department for UM related training, specifically training of clinical staff. Serve as principle trainer for new hire training, on-boarding, and chair side training.Participate in departmental and staff specific training as it relates to audit findings, health plan corrective action plans, identified process improvements and quality initiatives. Ensure compliance and integration regarding new policies, job aids and new procedures established and how these changes impact other areas. Collect, analyze and organize all data as required by the individual Health Plans for monthly and quarterly reporting.Process, analyze and coordinate Annual Health Plan Audits as they relate to UM functions and responsibilities. Track and monitor all regulatory changes and update all necessary Policies and Procedures pertaining to the UM Department. Track, analyze, and perform, if necessary, Inter-Rater Reliability Audits on Medical Management Staff.

Clinical Supervisor Inpatient UM

• Aug 2015 - Jul 2016

Daily oversight of clinical case management team. I assist in managing work loads, addressing complex cases and patient needs, work with an interdisciplinary team to provide the highest quality of care while maintain the highest level or resource management and allocation. Act as a leader in managing departmental compliance to policy and regulations, maintain fiscal responsibility to the company objective, clinical trainer for new hire nurses. program and process development.

Student

• Oct 2015 - Jul 2016

Masters in Public Adminstration- Healthcare Administration- with DistinctionBA Business Healthcare Administration- Magna Cum Laude Masters in Public Adminstration- Healthcare Administration- with DistinctionBA Business Healthcare Administration- Magna Cum Laude

Executive Director/Healtcare Services Director

• Aug 2009 - Jun 2015

While I was director, we saw census growth to 100% and maintained census above 90% under my leadership. I also introduced creative pricing, strong marketing strategies, and cost cutting measures that saw the first positive NOI for the building and I maintained positive earnings while in my position. I constructed and faciliatated a successful compliance plan in cooperation with state licensing to improve care standards within the community. I managed all day to day operations within the facility. Managed staff of 70+ with a resident capacity of 80. Maintain fiscal compliance, regulatory compliance with Title 22. Oversee an interdisciplinary team of department mangers ranging from dietary to physical plant management. Also, acting Director of Nursing while in the role of executive director. Marketing and census development. Community outreach and third party relationships with outside agencies such as physicians, hospice, home health, and hospitals.

Director of Healthcare Services

• Jun 2012 - Sep 2013

Under my leadership, the care department celebrated a deficiency free compliance audit from state licensing. We were able to succeasfully rebuild our staffing deficits through creative and inclusive hiring strategies that embraced team empowerment. I also built a community of trust and reliability within the staff and outside community members that was reflected in our continuous growth in census during my time as Director. I had Direct oversight of the healthcare of 80+ residents as well as the direct supervision of 40+ care staff. Fiscal compliance within care department, networking, marketing, and relationship building.

Healthcare Administration

• Jun 1999 - Dec 2012

Combat nurse that served in OIF. Worked the combat support hospital and forward surgical team as well as Medi-vac coordination and medical records. Worked on OPSEC detail. Managed the medical records at Fort Hood housing over 50,000 active participants. Worked as a PACU nurse in William Beaumont Army Medical Center Combat nurse that served in OIF. Worked the combat support hospital and forward surgical team as well as Medi-vac coordination and medical records. Worked on OPSEC detail. Managed the medical records at Fort Hood housing over 50,000 active participants. Worked as a PACU nurse in William Beaumont Army Medical Center