Experience

UnitedAg

• United States
• Non-profit Organizations
• 1 - 100 Employee

• Director Care Management

  • Oct 2023 - Present

  United States



Clearlink Partners

• United States
• Business Consulting and Services
• 1 - 100 Employee

• Director of Clinical Management Services

  • May 2022 - Jun 2023

  Dallas, Texas, United States • Provided Healthcare-management consulting services delivering contractual and organizational key results to multiple managed care companies across the United States - specializing in Population Health, Case Management, Service Coordination, LTSS, and stratification for complex membership groups in the MMP and D-SNP programs. • Provided leadership and guidance for design and launch of a new Transition of Care (TOC) Program integrating into an already existing D-SNP program, requiring… Show more • Provided Healthcare-management consulting services delivering contractual and organizational key results to multiple managed care companies across the United States - specializing in Population Health, Case Management, Service Coordination, LTSS, and stratification for complex membership groups in the MMP and D-SNP programs. • Provided leadership and guidance for design and launch of a new Transition of Care (TOC) Program integrating into an already existing D-SNP program, requiring operational restructuring of HRA teams, training, and development of new reporting, driven by cross-functional relationships and collaboration among multiple teams within that MCO and the consulting firm. • Captured the MCO’s current state processes for Case Management and LTSS for over fourteen states using an agile project-management methodology, for a total development of over 150 workflows and processes, moving them from market-specific processes to enterprise current state process maps, then developed future state processes, and captured business and functional requirements at an Epic/Feature level. This allowed the client to enhance their medical-management system implementation and scalability across the organization to meet individual product-line needs as well as state and federal requirements. • Reviewed multiple state and federal three-way contracts for D-SNP and MMP programs, creating business review documents (BRDs) to develop training materials for contractual requirements for various healthcare organizations, along with developing operational policies, procedures, workflows, new reporting development and implementation and quality review. • Analyzed, reviewed and developed new reporting and reportable metrics to assist with operation and contractual needs required to improve processes, providing solutions for streamlining and corrective action plans. Show less



Superior Health Plans

• Insurance
• 100 - 200 Employee

• Director- Service Coordination, Nursing Facilities/Assisted Living Facilities-Texas

  • Jan 2018 - Feb 2022

  Dallas, Texas, United States • Successful leadership, culture development and case management of 75 RN case managers for overseeing 900 nursing and assisted living facilities, and ten thousand Medicaid and dual eligible members for Texas. Consistently meets and exceeds contractual monthly metrics by sharing, supporting, and implementing remediation plans within the case management processes. • Successful implementation of carve out of assisted living membership, requiring restructuring, training, and development of new… Show more • Successful leadership, culture development and case management of 75 RN case managers for overseeing 900 nursing and assisted living facilities, and ten thousand Medicaid and dual eligible members for Texas. Consistently meets and exceeds contractual monthly metrics by sharing, supporting, and implementing remediation plans within the case management processes. • Successful implementation of carve out of assisted living membership, requiring restructuring, training, and development of new reporting. Driven by cross-functional relationships and collaboration among multiple teams. • Successful carve out of the Specialty Dental Team, requiring restructure and retraining of staff, review and process improvement to meet required contractual metrics. • Success in driving employee engagement across teams with a strong and active focus in culture development.

• Director Service Coordination MMP and MAPD Programs

  • Jan 2016 - Jan 2018

  Dallas County, Texas, United States • Successful startup of pilot Medicare Medicaid Plan (MMP) Service Coordination line of business in meeting all metrics and initiatives leading the state of Texas in performance. • Implemented multiple successful initiatives through good understanding of state, federal, and contractual complex care-management regulations and requirements that translated into achieved operations metrics, quality metrics, and compliance. • Successful launch and development of all policies and procedures… Show more • Successful startup of pilot Medicare Medicaid Plan (MMP) Service Coordination line of business in meeting all metrics and initiatives leading the state of Texas in performance. • Implemented multiple successful initiatives through good understanding of state, federal, and contractual complex care-management regulations and requirements that translated into achieved operations metrics, quality metrics, and compliance. • Successful launch and development of all policies and procedures to maintain alignment of contractual obligations for the Medicare Advantage program in 2016. • Successful launch of Contact Center in 2016 with hiring, training, and leading of new team. Maintained compliance of all required metrics. • Maintained the lowest turnover rate of all service delivery areas and tied for first position for achieved KPIs for all SDAs.