Your Name
Summary
Dedicated and compassionate healthcare leader with a track record for aligning strategy to achieve business goals and building a culture of accountability with people who are results driven, innovative and committed to excellence.
Overview
41
41
years of professional experience
Work History
Vice President, Health Care Management
Bayada Home Health Care
Newton, NC
04.2012 - Current
Development, implementation and oversight of integrated Medical
Management in the Health Plan. Initiatives include the establishment of
indicators for monitoring and evaluating quality care, appropriateness,
continuous improvement, member satisfaction, utilization and case management
services across the continuum of care to members.
- Directs and provides leadership for designing, developing and implementing Health Plan integrated medical management program to meet the demographic and epidemiological needs of the population served.
- Collaborates with key health care professionals towards identification of opportunities for improvement, trend analysis, education, and development of actions plans to meet organizational goals.
- Establish and execute objectives and annual goals to meet Health Plan initiatives.
- Foster teamwork and collaboration to ensure the sharing of information and best practices across the corporate structure.
- Manage successfully in a matrix model business environment which includes collaboration with HR, IT, Finance, Underwriting, Legal, Compliance/Risk Management, and Shared Services such as the National Call Center.
- Executed successfully NCQA Health Plan accreditation.
Director, Workers' Compensation and Medicaid Division
Qualis Health
City, STATE
06.2005 - 04.2012
Expertly planned, coordinated, organized and directed all operations for care
management services for the State of WA Medicaid and Labor and Industries Departments.
- Fiscal responsibility for the department including contract deliverables to the State of WA (review timeliness, ROI, etc.).
- Strategic planning/Contract negotiations with providers.
- Ensured department fully met with all required legal, contractual, and accreditation standards.
- Primary point person for collaboration and communication between providers, Qualis Health, and State of WA.
- Ensured the integrity and high quality of care management delivery utilizing LEAN methodology. Case in Point Platinum Awards Finalist. According to Dorland Health, these awards aim to recognize the most successful and innovative UM programs working to improve healthcare across the care continuum.
Director of Utilization Management - East Region
Group Health Cooperative
City, STATE
08.1988 - 11.1992
Created, directed, and managed the utilization management program for
Eastside Hospital, six outpatient clinics, and contracted hospitals in
Everett and Bellingham, WA.
- Created and organized departmental resources that supported the corporate strategic plan.
- Assisted in corporate selective contracting for services provided outside of HMO.
- Monitored contract administration of external services.
- Responsible for the achievement of clinical, utilization, and quality outcomes with established performance measures.
- Collaborated with HMO physicians, hospital leaders, and external providers to establish and implement clinical programs that supported the objectives and growth initiatives of the organization.
- Assured effective and efficient utilization of facilities and services through ongoing monitoring and educational programs.
Associate Administrator of Clinical Services
Greenery Rehabilitation Center
City, STATE
08.1986 - 08.1988
Directed all clinical services for this facility within the framework
of the established philosophy and objectives of the national corporation.
- Negotiated contracts for funding sources from private insurers, Medicare, and Medicaid.
- Responsible for the design, coordination, and implementation of rehabilitation programs.
- Formal liaison with the corporate office, medical staff, funding sources and management staff for strategic planning.
- Analyzed and evaluated services rendered to improve quality of care and utilization of staff and services.
- Participated in community educational health programs for head-injured patients.
Nurse Manager - Pediatrics
Swedish Hospital
City, STATE
05.1985 - 08.1986
Responsible for the direct and indirect nursing care of patients on a
newly opened 30 bed pediatric unit.
- Developed and managed unit capital and operating budgets.
- Managed day-to-day operations.
Executive Director Nursing Services
Lynn Hospital
City, STATE
07.1983 - 05.1985
Operational responsibility for the management of all nursing service
functions in a 240 bed hospital.
- Established goals and objectives for the department to complement and support the organization.
- Developed and managed department capital and operating budgets.
- Decentralized accountability for patient care and budget management to the unit level.
- Implemented nursing practice standards and quality assurance programs.
- Planned and implemented DRG phase-in program.
- Administrative liaison for union contract negotiations.
Education
Master of Science - Health Services Administration
University of Detroit
1985
BSN - Nursing
Mercy College of Detroit
1980
Skills
- Leadership
- Quality management
- Customer-oriented
- Strategic planning
- Process improvement
- Nursing Practice
- Financial management
- Operational management
- Human resource management
- Compliance/Risk management
Accomplishments
Health Services and Quality:
- Oversight and participation in medical management, including staffing, quality scores, monthly accrual analysis, and Population Health programs.
Strategic Planning:
- Adept at the development of organization's business plan, quarterly reviews and course corrections. Oversee budgeting, financials, and capital budgets. Strong strategic thinking with problem solving skills.
Human Resources:
- Highest ranking department within Health Plan for associate satisfaction, willingness to refer new associates, and intent to stay with the company.
Operations Management:
- Launched the WA Amerigroup Health Plan in 2012.
- Established operating processes for health care team, remedied service issues, implemented new programs and supported all areas of the Health Plan to accomplish established business goals.
- Built broad based support among key decision-makers and influencers to promote activities to achieve favorable organizational impact.
Promote Mission and Culture:
- Demonstrated success in building teams with a culture committed to execution, collaboration, communication, and a positive learning environment for associates and the members served.
Timeline
Vice President, Health Care Management
Bayada Home Health Care
04.2012 - Current
Director, Workers' Compensation and Medicaid Division
Qualis Health
06.2005 - 04.2012
Director of Utilization Management - East Region
Group Health Cooperative
08.1988 - 11.1992
Associate Administrator of Clinical Services
Greenery Rehabilitation Center
08.1986 - 08.1988
Nurse Manager - Pediatrics
Swedish Hospital
05.1985 - 08.1986
Executive Director Nursing Services
Lynn Hospital
07.1983 - 05.1985
Master of Science - Health Services Administration
University of Detroit
BSN - Nursing
Mercy College of Detroit