Catherine Huber
Chicago,IL
Summary
Health care operations and compliance leader with extensive experience across Medicaid managed care, federal regulatory oversight, behavioral health systems, and hospital- and community-based care coordination. Proven ability to conduct complex psychosocial and risk assessments, lead interdisciplinary teams, ensure compliance with CMS, HRSA, FDA, and Medicaid requirements, and design systems that improve patient safety, continuity of care, and access for high-risk and underserved populations. Known for independent judgment, regulatory rigor, and the ability to translate policy into effective, trauma-informed practice across medical, behavioral health, and social care settings.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Health Facilities Surveillance Social Worker (Surveyor)
Illinois Department of Public Health – Office of Health Care Regulation
Chicago, IL
06.2024 - Current
- Conduct independent psychosocial and compliance evaluations during federal Hospice and Home Health surveys, assessing patient rights, discharge planning, interdisciplinary care coordination, social determinants of health, caregiver capacity, behavioral health needs, and service continuity in accordance with CMS Conditions of Participation, Illinois Administrative Code, NASW standards, and HIPAA.
- Investigate high-risk complaints and patient safety concerns, including abuse, neglect, exploitation, and immediate jeopardy situations, using advanced clinical judgment and regulatory criteria; lead interdisciplinary case reviews with RN surveyors, medical directors, hospice teams, and legal counsel to determine findings, corrective actions, and protection plans.
- Provide expert consultation and regulatory reporting, including guidance to social workers, administrators, and surveyors on trauma-informed psychosocial standards and Medicare/Medicaid compliance; prepare defensible Statements of Deficiency (CMS-2567), evaluate corrective action plans, and ensure appropriate linkage to community, state, and federal resources for vulnerable populations.
Product Development Consultant – Medicaid & Social Impact Strategy
Health Care Service Corporation
Chicago, IL
02.2023 - 05.2024
- Designed and led Medicaid behavioral health and social care initiatives addressing trauma recovery, maternal mental health, suicide risk reduction, serious mental illness (SMI), and high-need populations through whole-person, evidence-based care models.
- Conducted independent needs assessments and psychosocial gap analyses for vulnerable populations (foster youth, survivors of domestic violence, aging adults, individuals with disabilities, and high-utilization members), developing community resource integration strategies and referral pathways addressing housing instability, crisis response, substance use recovery, caregiver stress, and access to care.
- Provided policy, clinical, and operational leadership by partnering with community-based organizations, FQHCs, crisis teams, and Medicaid vendors; consulting with behavioral health and case management teams; authoring CMS-aligned policy and program standards (Medicaid Managed Care, parity, EPSDT, NCQA); and leading cross-functional workgroups to drive quality improvement and measurable outcomes.
Managed Care Operations Manager
Cook County Health
Chicago, IL
08.2020 - 01.2023
- Directed Medicaid care coordination operations for high-risk populations, including foster care youth, justice-involved adolescents, individuals with serious mental illness (SMI), chronic homelessness, and survivors of trauma, overseeing behavioral health case management, psychosocial supports, crisis response, care transitions, and wraparound services.
- Provided clinical and operational leadership across complex systems, delivering consultative guidance to social work and behavioral health teams; implementing interdisciplinary workflows linking primary care, specialty providers, juvenile courts, DCFS, and community partners; and expanding access to housing, mental health, and crisis stabilization resources.
- Ensured regulatory compliance and performance accountability, aligning operations with CMS Medicaid Managed Care Final Rule, NCQA and HEDIS behavioral health standards, and mental health parity requirements; monitoring documentation integrity and utilization guidelines; training staff in trauma-informed care and SDOH interventions; and using risk stratification and quality data to reduce preventable inpatient and ER utilization.
Provider Network Specialist
Centene Corporation (Aetna Better Health)
Chicago, IL
08.2019 - 07.2020
- Supported behavioral health access and continuity of care for Medicaid and dual-eligible populations by building and maintaining service networks across mental health, substance use treatment, crisis services, and community-based supports, including CMHCs, FQHCs, psychiatry groups, and inpatient providers.
- Coordinated referrals and resolved access barriers for high-risk members, including individuals with serious mental illness (SMI), trauma histories, chronic homelessness, and justice involvement, working closely with care management and utilization management teams to address care delays, provider refusals, discharge gaps, and continuity breakdowns.
- Ensured network adequacy, provider compliance, and quality alignment, educating providers on trauma-informed care, Medicaid parity and HEDIS requirements; reviewing credentialing, member rights, cultural competency, and accessibility standards; partnering with community agencies to support housing, benefits, and recovery resources; and collaborating with state regulators to meet access-to-care requirements.
Patient Access Representative
Advocate Aurora Health
Chicago, IL
01.2017 - 07.2019
- Provided patient advocacy and care navigation for diverse and high-need populations, including low-income families, older adults, trauma survivors, and individuals with chronic medical and behavioral health conditions, identifying psychosocial barriers such as insurance gaps, financial hardship, transportation, language access, and behavioral health availability.
- Coordinated interdisciplinary care and service linkage, assisting patients and families with treatment understanding, discharge planning, benefit verification, and pre-authorization; facilitating referrals to social work, behavioral health, primary and specialty care; and connecting patients to community resources including Medicaid, SNAP, charity care, disability services, and transportation supports.
- Delivered trauma-informed, compliant clinical support, collaborating with nursing, care management, and physicians to prioritize high-risk patients; documenting care coordination in EPIC in accordance with HIPAA and hospital policy; and ensuring patient rights, dignity, cultural responsiveness, and continuity of care to reduce treatment delays and readmissions.
Transitional Care Liaison
Health Resource Solutions
Chicago, IL
07.2015 - 01.2017
- Conducted comprehensive biopsychosocial assessments and home safety evaluations for patients transitioning from hospitals and skilled nursing facilities to home or community settings, assessing discharge readiness, caregiver capacity, functional needs, and risk of avoidable readmission.
- Developed and implemented individualized transition-of-care plans, addressing medical, psychosocial, and social determinants of health (food insecurity, transportation, housing instability, financial hardship), coordinating referrals to home health, behavioral health, DME, palliative care, hospice, and community support services.
- Ensured continuity, safety, and regulatory compliance, collaborating with interdisciplinary teams; providing post-discharge follow-up, medication reconciliation support, and early risk identification; completing mandated reports to Adult Protective Services when indicated; and maintaining compliant documentation aligned with HIPAA, CMS care transition standards, and agency policy.
340B Program Coordinator
Walgreens Boots Alliance
Chicago, IL
01.2010 - 06.2015
- Managed compliance for the federally regulated 340B Drug Pricing Program, overseeing contract pharmacy partnerships and ensuring access to affordable medications for low-income and uninsured patient populations across outpatient and chronic care settings.
- Led internal audits and compliance investigations, validating 340B transactions to identify and resolve eligibility errors, duplicate discounts, diversion, and billing discrepancies; applying root-cause analysis and corrective action planning to prevent audit findings and maintain program integrity.
- Coordinated cross-functional and regulatory readiness efforts, collaborating with hospitals, FQHCs, pharmacists, physicians, finance, and compliance teams; delivering staff training on HRSA/OPA requirements, inventory controls, and documentation standards; and preparing defensible records for HRSA audits while safeguarding patient data.
Education
Bachelor of Science - Biology
Loyola University of Chicago
Chicago, IL12.2019
Master of - Social Work
Loyola University of Chicago
Chicago, IL05.2020
Skills
Operations, Compliance & Quality:
Regulatory Compliance (CMS, HRSA, FDA), Audit Readiness & Corrective Action, Policy & Program Standards, HIPAA & Data Privacy, Risk Management, Quality Improvement, Incident & Root-Cause Analysis
Program & Process Leadership:
Program Design & Implementation, Workflow & Process Improvement, Cross-Functional Coordination, Performance Monitoring, Change Management
Stakeholder & Systems Collaboration:
Provider & Partner Relations, Network Coordination, External Stakeholder Engagement, Interdisciplinary Team Leadership
Data, Systems & Tools:
Data Validation & Reporting, Outcomes Measurement, Operational Metrics, Electronic Health Records (EPIC), Compliance & Care Management Systems, Microsoft Office – Advanced
Languages:
English – Native/Bilingual Tamil – Native/Bilingual Spanish – Professional Working
Certification
- Licensed Social Worker (LSW), State of Illinois, Illinois Department of Financial & Professional Regulation (IDFPR), Status: Active
- Basic Life Support (BLS) – American Heart Association, Status: Active
- SBIRT Certified – Screening, Brief Intervention, and Referral to Treatment Substance Use Intervention Training
- CADC Training – Alcohol & Drug Counselor Coursework Completed, Illinois Certification Board
- HRSA Workforce Training – Behavioral Health Integration
- CABISAM & OWETP Federal Grant Training Recipient
- Co-Author – Circulation Research Journal (Feinberg School of Medicine, 2008), Peer-reviewed cardiovascular research publication.
Timeline
Health Facilities Surveillance Social Worker (Surveyor)
Illinois Department of Public Health – Office of Health Care Regulation
06.2024 - Current
Product Development Consultant – Medicaid & Social Impact Strategy
Health Care Service Corporation
02.2023 - 05.2024
Managed Care Operations Manager
Cook County Health
08.2020 - 01.2023
Provider Network Specialist
Centene Corporation (Aetna Better Health)
08.2019 - 07.2020
Patient Access Representative
Advocate Aurora Health
01.2017 - 07.2019
Transitional Care Liaison
Health Resource Solutions
07.2015 - 01.2017
340B Program Coordinator
Walgreens Boots Alliance
01.2010 - 06.2015
Bachelor of Science - Biology
Loyola University of Chicago
Master of - Social Work
Loyola University of Chicago