Experience

Optimetra, Inc.

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Independent Consultant

  • Aug 2017 - Present

  Primary Responsibilities: Working with OptiMetra Corporation to prepare written responses to competitive RFP Proposals on behalf of regional and national HMO corporations to secure multi-year, multi-million-dollar behavioral health Medicaid contracts. Primary Responsibilities: Working with OptiMetra Corporation to prepare written responses to competitive RFP Proposals on behalf of regional and national HMO corporations to secure multi-year, multi-million-dollar behavioral health Medicaid contracts.



Beacon Health Options

• United States
• Mental Health Care
• 700 & Above Employee

• VP/Quality Management Director III

  • Jan 2015 - Jun 2017

  Primary Responsibilities: Developing and implementing the ASO Quality Management Department for a brand new, state-wide contract. Hired and trained over 25 staff to conduct behavioral health quality reviews onsite at over 200 providers around the state. Worked in conjunction with IDD sub-contractor, Delmarva Foundation, to conduct intellectual/developmentally disabled quality reviews onsite at over 250 providers around the state. The overarching goal includes offering a seamless review process for all provider types by aligning and streamlining IDD and BH review processes on behalf of the state of Georgia. Successes include: • The first Georgia Collab. ASO department to fully implement and go live across the state • Implemented the largest quality department in the company while undergoing a corp. merger • Development and implementation of an electronic BH Review Tool within first year of go-live • Produced the first ever IDD and BH Combined Annual Quality Report for the State of Georgia



Integrated Community Health Partners - A ValueOptions Colorado Contract

• Director of Performance Improvement

  • Dec 2011 - Dec 2014

  Primary Responsibilities: Implementing and overseeing the Integrated Community Health Partners (ICHP) Performance Improvement Program – begun with the inception of the Regional Care Collaborative Organizations (RCCOs) and the start of the ICHP Contract in June of 2011. The overarching goals include implementation of the triple aim by initiating activities designed to advance the idea of quality within FQHCs, PCMPs, CMHCs, and the provider network by the measurement of performance. Successes include: • Highest HSAG/EQRO Score in Colorado for any RCCO: 100% (2014) • Wrote and awarded two CMS Adult Medicaid Quality Measures Grants in both 2013 and 2014 on diabetes and depression screening • First RCCO in the state to receive performance incentives for decreasing unnecessary ER utilization • Highest performing RCCO in the state for reducing “total cost of care” metric and reducing “30-day readmission” key performance indicator



MENTAL HEALTH CARE INC.

• United States
• Hospitals and Health Care

• Performance Improvement Director/Health Information Management Director/Compliance Officer

  • Jul 2009 - Nov 2011

  Primary Responsibilities: Coordinating, implementing and monitoring the Agency’s Performance Improvement Program to ensure quality service in accordance with the Joint Commission, CARF, Florida AHCA, DCF, CMS Medicare/Medicaid and all other federal, state and local accrediting and oversight entities. As the Agency’s Chief Compliance Officer, this position was responsible for leading the Executive Team in the Joint Commission Survey and CARF Survey along with coordinating over sixty Medicare/Medicaid, HMO and Private Party Audits annually – based on all funding sources accepted for payment by the Agency. Successes include: • Best Joint Commission Survey Results (April 2010) • Streamlined all major reporting processes including: Incident Reporting, Grievance Reporting, and Outcomes Reporting • Best CARF Survey Results (August 2011) • Change Management Catalyst for: CQI, Clinical Care, Environment of Care, Credentialing, Forms, and Electronic Medical Record



R K Allen Consulting

• Healthcare Consultant

  • Aug 2007 - Jul 2009

  Primary Responsibilities: Evaluating various programs within the mental health industry to better realize: revenue generation, staffing level efficiency, outcome measurements improvement; agency-wide needs assessment and strategic planning to prepare for future industry growth and health care reform. Primary Responsibilities: Evaluating various programs within the mental health industry to better realize: revenue generation, staffing level efficiency, outcome measurements improvement; agency-wide needs assessment and strategic planning to prepare for future industry growth and health care reform.

• Director of Adult Community Services

  • May 2004 - Jul 2007

  Primary Responsibilities: Planning, organizing, directing and supervising a multi-million-dollar division dedicated to providing outpatient services to over 1,400 severely, persistently mentally ill adults with a staff of over 100. A multi-faceted team approach with a clinical focus on recovery and resiliency for those diagnosed with chronic mental illness and co-occurring disorders. Services included: medication management, case management, psychosocial rehab therapy, forensic case management, and assertive community treatment for those at significant risk for state hospitalization. Director requirements included: a thorough understanding of Federal and State mental health regulations; Medicaid, Medicare, HMO and Private Party funding compliance, including both fee-for-service and managed care reimbursement rates; Joint Commission contract compliance; and a general knowledge of additional community programs and resources, both public and private. Successes Include:• $1 million revenue realization first FY as Director• Implementation of Social Rehab Program • Bid for and awarded $1.4 million program• Highest FACT Team Evaluation in State

• Director Of Operations

  • Sep 2001 - May 2004

  Primary Responsibilities: Overseeing the day-to-day operations including the planning, organizing, and directing of the overall Agency to ensure systems are working effectively and efficiently; troubleshooting with clinical and administrative directors as well as outside entities to solve systemic issues both within the agency and within the community; identifying clinical and administrative programs with revenue deficiencies and re-tooling to maximize financial margin; working with legislative delegates on appropriations in order to create new clinical programs or strengthen already existing ones; and creating and implementing a strategic development plan to successfully carry out the mission and goals of the agency as identified by the Executive Director, Senior Management Directors and Board of Directors. Successes Include:• Committee Chair of $2 million revenue realization• Restructuring of Outpatient Clinical Divisions