Amy Ford
Mooresville,US
Summary
Transformational leader in Medicaid managed care, spearheading nationwide initiatives that enhance quality standards and operational efficiency. Proven success in process optimization and compliance, with a focus on integrating physical and behavioral health solutions to improve service delivery and stakeholder engagement.
Overview
27
27
years of professional experience
Work History
Substance Use Provider Network Manager - LP
VAYA HEALTH
11.2025 - Current
- Served as SME for opioid providers, engaging state leaders for opioid funding allocations.
- Established network relations with community stakeholders and providers, enhancing development and management of provider networks.
- Collaborate with SU provider to ensure contracts are executed and provider receive necessary technical assistance
Behavioral Health Director
HUMANA
12.2023 - 04.2025
- Spearhead nationwide behavioral health utilization management initiatives, driving operational excellence and implementing innovative frameworks across multiple states
- Strategic implementation of utilization management programs and operating model for both physical health and behavioral health, enhancing operational efficiency and improving service delivery standards for new Medicaid contracts
- Led recruitment, operational leadership, and performance management for behavioral utilization teams across multiple states, overseeing a staff of 150.
- Streamlined authorization processes, quality standards, clinical documentation, and claims management systems, ensuring compliance with healthcare regulations and contract requirements.
- Fostered cross-functional partnerships to integrate physical and behavioral health management solutions, enhancing healthcare process efficiency.
Clinical Strategy and Practice Lead
HUMANA
08.2022 - 12.2023
- Developed, implemented, and executed clinical strategy, quality standards, clinical documentation, programs, and framework for new Medicaid markets from a behavioral perspective, including both care management and utilization management.
- Led cross-functional teams to implement new market contracts and initiatives for care management and utilization management
- Developed policies, procedures, workflows, manuals, and training content for care management and utilization staff
Senior Behavioral Health Professional
HUMANA
11.2021 - 08.2022
- Provided clinical guidance on the Medicaid centralized utilization management team.
- Facilitated and coordinated consultations with enterprise and market teams to establish clinical best practices for behavioral health utilization management
- Collaborated with interdisciplinary teams to coordinate comprehensive care.
Substance Abuse Clinical Quality Clinician
CARDINAL INNOVATIONS HEALTHCARE
01.2021 - 11.2021
- Led substance use activities and monitoring for Quality Management department, ensuring clinical compliance.
- Developed clinical monitoring plan for substance use providers and ASAM monitoring process and tool for quality reviews.
Senior Development Coordinator
CARDINAL INNOVATIONS HEALTHCARE
01.2018 - 01.2021
- Lead Strategic plan with Behavioral health providers on HEDIS measures related to 7 day follow up, to include implementation and facilitation of value-based contracts related to 7 day follow up for providers
- Lead Strategic plan with Behavioral health providers on HEDIS measures related to 7 day follow up, to include implementation and facilitation of value-based contracts related to 7 day follow up for providers
- Delivered clinical technical assistance and guidance to internal staff and providers for effective implementation of SUD services within their programs
UM Supervisor, SUD and Acute Inpatient
CARDINAL INNOVATIONS HEALTHCARE
04.2016 - 01.2018
- Recruited, led, and managed behavioral health clinicians conducting clinical reviews for Medicaid and state-funded adults and children receiving substance use and inpatient behavioral health services, including supervision, hiring, and training of staff.
- Developed utilization management policies and procedures ensuring compliance with CMS and state waiver mandates, enhancing service delivery and regulatory adherence.
- Facilitation or provider collaborative groups around specific service groups to ensure partnership, compliance and clear clinical expectations for delivery of services
- Collaborated with executive and state-level leadership to ensure compliance with waiver and contract requirements for managed care service delivery.
UM Care Manager
CARDINAL INNOVATIONS HEALTHCARE
06.2014 - 04.2016
- Conducted clinical reviews for Adult Behavioral Health Medicaid and state-funded consumers with mental health and substance use disorders across the continuum of service delivery, applying clinical judgment and adhering to contract standards
- Executed initial, concurrent, retro, and member-specific contract reviews to ensure compliance and quality of care
- Collaborated with healthcare teams to ensure comprehensive service delivery.
Intensive In-home therapist
TURNING POINT
01.2014 - 06.2014
- Delivered comprehensive clinical assessments and provided individual and family therapy for mental health, substance abuse, and developmental disabilities in intensive in-home settings
- Conducted assessments to identify client needs and develop tailored treatment plans.
- Provided therapeutic interventions in family settings to address mental health issues.
- Collaborated with families to enhance communication and establish coping strategies.
Outpatient therapist
EASTERSEALS UCP
07.2013 - 12.2013
- Conducted individual therapy sessions with clients to address mental health needs.
- Developed treatment plans tailored to each client's specific challenges and goals.
- Conducted comprehensive clinical assessments and provided individual and family therapy for clients with mental health, substance abuse, and developmental disabilities
- Collaborated with interdisciplinary teams to ensure comprehensive client care.
Outpatient therapist
DONLIN COUNSELING
02.2011 - 07.2013
- Delivered individual, family, and group therapy to diverse specialty populations, enhancing client coping strategies and emotional resilience.
- Provided individual therapy sessions to clients with diverse mental health needs.
- Developed and implemented treatment plans based on client assessments and goals.
- Collaborated with multidisciplinary teams to ensure comprehensive client care.
- Partnered with court system and social services to coordinate comprehensive support for clients, facilitating access to essential resources and promoting successful rehabilitation.
Outreach Liaison Manager
PIEDMONT BEHAVIORAL HEALTHCARE
06.2007 - 05.2010
- Coordinated programs for Community Jail Diversion for SPMI adults, substance abuse residential community liaison, state hospital liaison for SPMI adults transitioning from inpatient to community settings, primary care collaborative, and state developmental centers
- Managed performance, supervised, recruited, and trained 5 community care management staff in Access/Care Coordination Outreach Department
- Coordinated communication between clients and healthcare providers.
Primary Care Liaison
PIEDMONT BEHAVIORAL HEALTHCARE
04.2006 - 06.2007
- Coordinated with pediatric clinics within PBH catchment area to enhance service delivery for consumers and families.
- Facilitated communication between departments to enhance patient care and support services.
- Coordinated training sessions for staff on behavioral health best practices and protocols.
- Developed informational materials for patients and families regarding available services.
Local Unit Manager
PIEDMONT BEHAVIORAL HEALTHCARE
07.2004 - 02.2006
- Led clinical operations and supervised recruitment and performance of 10 clinical care management staff for Jail Diversion and Community Integration grant programs serving SPMI adults
- Supervised daily operations of behavioral health units to ensure quality care.
- Managed scheduling and staffing to maintain optimal unit coverage and support.
- Facilitated community collaboration and managed stakeholders to ensure integrated care and effective coordination of best practices
- Collaborated with staff to develop and implement treatment plans for patients.
Care Coordinator
PIEDMONT BEHAVIORAL HEALTHCARE
10.2003 - 07.2004
- Conducted 5-8 assessments weekly for adults and children in Mental Health, Substance Abuse, and Developmental Disability populations, ensuring tailored care plans
- Completed care management assessments for members, aligning services with their values, goals, and preferences
- Coordinated patient care plans with multidisciplinary teams and family members.
- Facilitated communication between clients, providers, and community resources.
- Managed scheduling and follow-up appointments for clients and providers.
Child and Youth Case Manager
Piedmont Behavioral Healthcare
05.1999 - 10.2003
- Collaborated with children and families to deliver intensive case management services, ensuring effective monitoring and coordination of essential resources
- Oversaw caseload of 12-15 consumers from at-risk populations, facilitating access to support services and promoting individual well-being
- Developed individualized care plans for youth based on assessments and needs.
- Coordinated with families to provide support and resources for youth development.
- Facilitated group therapy sessions to promote communication and social skills.
Education
MA - Professional Counseling
LIBERTY UNIVERSITY
LYNCHBURG, VA09-2010
Skills
- Substance Use Treatment
- Program Oversight
- Policy Development
- Care Coordination
- Network development
- Strategic Planning
- Process improvement
- Decision-making
- Team management
- Effective communication
- Relationship Building
Professional Licenses
- Licensed Clinical Mental Health Counselor, #8583
- Licensed Clinical Addiction Specialist, #2463
Timeline
Substance Use Provider Network Manager - LP
VAYA HEALTH
11.2025 - Current
Behavioral Health Director
HUMANA
12.2023 - 04.2025
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
UM Supervisor, SUD and Acute Inpatient
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
EASTERSEALS UCP
07.2013 - 12.2013
Outpatient therapist
DONLIN COUNSELING
02.2011 - 07.2013
Outreach Liaison Manager
PIEDMONT BEHAVIORAL HEALTHCARE
06.2007 - 05.2010
Primary Care Liaison
PIEDMONT BEHAVIORAL HEALTHCARE
04.2006 - 06.2007
Local Unit Manager
PIEDMONT BEHAVIORAL HEALTHCARE
07.2004 - 02.2006
Care Coordinator
PIEDMONT BEHAVIORAL HEALTHCARE
10.2003 - 07.2004
Child and Youth Case Manager
Piedmont Behavioral Healthcare
05.1999 - 10.2003
MA - Professional Counseling
LIBERTY UNIVERSITY