Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Amy Ford

Mooresville,NC

Summary

Experienced strategic utilization management leader and clinician with over 24 years of expertise in team leadership within Medicaid managed care. Skilled in utilization management, care management, provider relations and development, quality management, and direct member care. Adept at resource management to optimize patient outcomes while ensuring cost-effective healthcare delivery. Proven track record of driving operational efficiency, implementing innovative strategies, and fostering collaborative relationships with stakeholders to achieve organizational goals.

Overview

26
26
years of professional experience
1
1
Certification

Work History

Director of Utilization Management, Behavioral Health and UM Implementation

Humana
12.2023 - Current
  • UM Director for national team, providing strategic leadership for behavioral health utilization management staff across multiple states
  • Strategy, leadership and oversight of all utilization management implementation activities for all new state contracts
  • Responsibility for the successful execution of utilization management framework including, but not limited to claims processing, authorization processes, reporting requirements, prior authorization needs, contract requirements, for both physical health and behavioral health

Clinical Strategy and Practice Lead

Humana
08.2022 - 12.2023
  • Behavioral health lead for Medicaid clinical implementation team for new state contracts
  • Responsible for developing, implementing and executing clinical strategy, programs and framework for new Medicaid markets from behavioral perspective to include both care management, population health, quality and utilization management
  • Collaboration with multiple cross functional teams to drive and implement new markets contracts
  • Development of policies and procedures, workflows, manuals and training content for care management and utilization staff
  • Provide support to new market throughout implementation and post go live to ensure success
  • Behavioral health expert guiding training content for centralized new hire clinical training, content development, and facilitating
  • Additionally providing leadership to fidelity adherence for behavioral health specific trainings, to include auditing clinical staff

Senior Behavioral Health Professional

Humana
11.2021 - 08.2022
  • Behavioral health SME on Medicaid centralized utilization management team providing clinical guidance, development and implementation on policies and processes to support enterprise and markets
  • Facilitation, consultation, and coordination with enterprise and market teams around clinical best practices for behavioral health utilization management
  • Providing technical and operational guidance to drive performance from a behavioral health approach for all markets and nationally

Substance Abuse Clinical Quality Clinician

Cardinal Innovations Healthcare
01.2021 - 11.2021
  • Served as the lead clinician for all substance use related activities and monitoring for Quality Management department to ensure clinical compliance
  • Projects to include development of clinical monitoring plan for all substance use providers, development of ASAM monitoring process and tool for quality reviews
  • Completed clinical quality reviews of enhanced services to include ACTT and CST
  • Provide technical assistance to providers due to quality concerns with delivery of services, referral freezes, direction of executive leadership
  • Driver for clinical changes and improvements resulting from clinical audits and developing practice to ensure changes are made

Senior Development Coordinator

Cardinal Innovations Healthcare
01.2018 - 01.2021
  • Working with internal department, providers, and community stakeholders in the development of additional services to provider contracts, with specific emphasis on SUD services
  • Leadership of several provider collaboratives to include MST, IPS, IHTS, and SUD services
  • Lead strategic plan with Behavioral health providers on HEDIS measures related to7 day follow up, to include implementation and facilitation of value-based contracts related to7 day follow up for providers
  • Providing clinical technical assistance and guidance to internal staff and providers specific to implementation of SUD services within their programs
  • Developed and facilitated strong partnerships with network providers to support our member experience

Supervisor for Substance Use disorder and Inpatient UM team

Cardinal Innovations Healthcare
04.2016 - 01.2018
  • Oversight and management of a team of behavioral health clinicians completing clinical reviews for Medicaid and State funded adults and children receiving substance use services and inpatient behavioral health services to include supervision, hiring, and training of staff
  • Development of utilization management policies and procedures to ensure compliance with CMS and state waiver mandates
  • Facilitation or provider collaborative groups around specific service groups to ensure partnership, compliance and clear clinical expectations for delivery of services
  • Partnership with both executive leadership and state level leadership to ensure compliance with wavier and contract requirements for delivery of managed care

Um Care Manager

Cardinal Innovations Healthcare
06.2014 - 04.2016
  • Complete clinical reviews for all Adult Behavioral Health Medicaid and State funded consumers receiving Mental Health and Substance use disorder throughout the continuum of service delivery
  • Reviews included initial, concurrent, retro, as well as member specific contracts

Intensive In-home therapist

Turning Point
01.2014 - 06.2014
  • Full time therapist providing comprehensive clinical assessments, individual, and family therapy for mental health, substance abuse, and developmental disabilities through an intensive in –home model

Outpatient therapist

Easter Seals UCP
07.2013 - 12.2013
  • Full time therapist providing comprehensive clinical assessments, individual, and family therapy for mental health, substance abuse, and developmental disabilities

Outpatient Therapist

DonLin Counseling Services
02.2011 - 07.2013
  • Full time therapist providing individual, family and group therapy as well as care management to specialty populations
  • Populations include sexual abuse, substance abuse, sexual offender, and domestic violence for both children and adults
  • Collaboration with court system, department of social services, and other community stakeholders to holistically serve members

Outreach Liaison Supervisor

Piedmont Behavioral Healthcare
06.2007 - 05.2010
  • Provided direct supervision, hiring and training for5 community care management staff within the Access/Care Coordination Outreach Department
  • Programs included: Community Jail Diversion for SPMI adults, Substance abuse residential community liaison, State Hospital Liaison for SPMI adults transitioning to community from inpatient settings, Primary Care Collaborative with area PCP offices, and State Developmental Centers transitioning Olmstead consumers back into the community to live
  • Managed data and reporting to be sent to state, as well as daily operational and clinical supervision of direct care staff within each program

Child and Youth Liaison for Primary Care Collaborative

Piedmont Behavioral Healthcare
04.2006 - 06.2007
  • Responsible for working and forming collaborative relationships with the pediatric clinics within the PBH catchment area to assist in providing quality services to the consumers and families served

Local Unit Coordinator for Transition services

Piedmont Behavioral Healthcare
07.2004 - 02.2006
  • Oversee operations, hiring, training, and clinical supervision for10 clinical care management staff , including Jail Diversion and Community Integration grant programs for SPMI adults
  • Provide leadership and ensuring team focus of patient-centered care, integration of all needs, focusing on an early proactive approach to ensure needs were met
  • Community collaboration and meetings with stakeholders to ensure integrated care and coordination of best practices
  • Driving process improvement and training for all staff

Care Coordinator- Transition Services

Piedmont Behavioral Healthcare
10.2003 - 07.2004
  • Completed care management assessments for members, prioritizing member’s values, goal, and preferences
  • Focus on patient -centered care and a holistic approach to provide individualistic care
  • Conducted approximately5-8 assessments per week for consumers, both adults and children within the Mental Health, Substance Abuse and Developmental Disability populations

Case Manager II- Child and Youth Services

Piedmont Behavioral Healthcare
05.1999 - 10.2003
  • Worked with children and their families providing intensive case management services including monitoring, linking and arranging these services
  • Managed caseload of approximately12-15 consumers within the At-Risk populations

Education

MA - Professional Counseling

Liberty University
Lynchburg, VA
09.2010

BS - Criminal Justice

Appalachian State University
Boone, NC
09.1999

Skills

  • Relationship building
  • Strategic planning
  • Verbal and written communication
  • Decision-making

Certification

  • Licensed Clinical Mental Health Counselor #8583
  • Licensed Clinical Addiction Specialist #2463
  • ASAM Training Facilitator
  • Certified BOUNCE Facilitator
  • Certified QPR Facilitator

Timeline

Director of Utilization Management, Behavioral Health and UM Implementation

Humana
12.2023 - Current

Clinical Strategy and Practice Lead

Humana
08.2022 - 12.2023

Senior Behavioral Health Professional

Humana
11.2021 - 08.2022

Substance Abuse Clinical Quality Clinician

Cardinal Innovations Healthcare
01.2021 - 11.2021

Senior Development Coordinator

Cardinal Innovations Healthcare
01.2018 - 01.2021

Supervisor for Substance Use disorder and Inpatient UM team

Cardinal Innovations Healthcare
04.2016 - 01.2018

Um Care Manager

Cardinal Innovations Healthcare
06.2014 - 04.2016

Intensive In-home therapist

Turning Point
01.2014 - 06.2014

Outpatient therapist

Easter Seals UCP
07.2013 - 12.2013

Outpatient Therapist

DonLin Counseling Services
02.2011 - 07.2013

Outreach Liaison Supervisor

Piedmont Behavioral Healthcare
06.2007 - 05.2010

Child and Youth Liaison for Primary Care Collaborative

Piedmont Behavioral Healthcare
04.2006 - 06.2007

Local Unit Coordinator for Transition services

Piedmont Behavioral Healthcare
07.2004 - 02.2006

Care Coordinator- Transition Services

Piedmont Behavioral Healthcare
10.2003 - 07.2004

Case Manager II- Child and Youth Services

Piedmont Behavioral Healthcare
05.1999 - 10.2003

MA - Professional Counseling

Liberty University

BS - Criminal Justice

Appalachian State University
Amy Ford