Staffing Solutions – NYS DOH – Division of Data Services and Analytics
04.2024 - Current
As a Medicaid Program Manager for DDSA I have three main goals: 1: Development and implementation of a division wide internship program to include: a) Design of program structure and processes; b) Production of supporting documentation; c) Research and understanding of NYS and DOH policies related to internships; d) Outreach to universities to establish relationships; e) Communication within division and DOH
2: Development and implementation of a division wide training program to include: a) Create and maintain catalog of required and requested training domains and resources for division staff; b) Research and coordinate connection with available training resources; c) Develop standardized format and processes for division training; d) Maintain training calendar and oversee staff outreach and communication 3: Standardization and oversight of division wide standard operating procedures to include: a) Support creation and documentation of division operations procedures; b) Review draft documentation and provide direction and insight; c) Establish standards for format and communication of division operations procedures.
Medicaid Program manager
Staffing Solutions – NYS DOH – Division of Finance and Rate Setting
04.2023 - 04.2024
Revitalized the student assistant program for Office of Health Insurance Programs (OHIP); provided supervision and leadership to team; revised and developed policies and procedures; research; collaboration with outside stakeholder to promote program; scheduled and attended meetings; Manage and oversee projects and program development; researched and developed process to streamline the employment process for student interns through the development of online application process
Presented proposal to Executive Leadership team on Student Experiential Learning Program (SELP); attended career fairs, scheduled, and conducted interviews; completed nomination packages; collected data and submitted reports to leadership on the progress of the SELP program; recruitment; training; presentation development; and other duties as assigned.
Medicaid Program Manager
Staffing Solutions -NYS DOH – Division Program Development Management
03.2022 - 04.2023
Assist the Director and staff in the Office of Health Insurance Programs (OHIP), Division of Program Development and Management, in a broad range of planning, implementation, evaluation, and reporting activities; Manage and oversee projects and program development while ensuring timely completion, fact-based, and addressing a need within the Children’s Services design; Become knowledgeable and understand the Children’s Health Home program and Home and Community-Based Services (HCBS) Children’s Waiver to determine changes and enhancements to the services and programs; Synthesize information and feedback to determine the need for new services or changes to current services
Evaluate and research implementation strategies for the services—present solution-focus information and program design to the director and leadership; Develop policies and procedures for various subjects relevant to developing, implementing, and managing the children's services, including power points and training webinars; Manage and supervise staff and contractors regarding different project and program aspects of Children Services of the Health Homes, HCBS program, and State Plan Services
Program services development and research to determine implementation strategies, including working with other divisions and State agencies, assisting with system development by providing program knowledge and understanding for the CANS-NY, Capacity Management, Service Tracker, and MAPP
Other activities may be deemed necessary in response to the changing needs of OHIP.
Director of Behavioral Health
Alliance Healthcare
09.2019 - 07.2020
Provided leadership to LTS supervisors and Innovations waiver (HCBS); provided clinical supervision to MH/SUD supervisors
Provided innovative leadership in dual diagnosis (IDD/MH) to staff; participated in clinical case staffing; team meetings; clinical case reviews specifically for members with IDD/MH; Review; ensured compliance with DHHS policies, procedures, and guidelines; provided quality and completeness; identified policy and programming issues and developed solutions utilizing standards for measuring the performance and improvement of population health, providers of services, and other clinicians in the delivery of SDOH services; implemented critical business practice around documentation; implemented essential staff training in mental health and intellectual developmental disabilities
Developed organizational communications skills around documentation for member files
Improved care coordination between mental health and IDD departments to ensure optimal member services
Identified high scrutiny cases for review: Duke Med link administrator; SOC clinical reviews
State IDD Clinical Director Liaison.
Clinical Care Manager
Alliance Health
08.2016 - 09.2019
Used DHHS policies, procedures, and guidelines to ensure and evaluate medical necessity, clinical appropriateness, and effectiveness of authorizations; ensured quality and completeness of authorizations and supporting documentation; authorized MH/SA state-funded services
Provided strategic insight into the development of the ABA training program
Assisted with preparation of State Review; Leadership: Trained all providers and staff on ABA requirements; reviewed and authorized assessments and treatment requests for child ASD and Child/Adult IDD populations
Monitors the outpatient level of care services related to mental health treatment to ensure medical necessity and effectiveness; Performed concurrent reviews for outpatient care to measure the performance and improvement of the population by reviewing person-centered mental health plans by providers of services and other clinicians to determine the effectiveness of the delivery of mental health care services and different levels of care as allowed by scope of practice and experience; Performed quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment; Provided information to members and providers regarding mental health managed care programs and company policies and procedures, and criteria; Interacts with Medical doctors to discuss clinical and authorization questions and concerns regarding specific cases; Participated in quality improvement activities; Maintained an active workload by Managed Care performance standards; Works with community agencies as appropriate
Proposed alternative treatment plans when service requests do not meet medical necessity criteria; Advocates for the patient to ensure treatment needs are met
Interacts with providers in a professional, respectful manner that facilitates the treatment process
Used medical necessity to reduce hospital readmissions by providing members with outpatient care within seven days of discharge.
Regional Coordinator
Parent to Parent of NYS
03.2015 - 06.2016
Recruited, trained, and maintained a network of trained and supervised volunteer support parents; facilitated parent matches, assisted families with locating resources; conducted workshops, and training in person, via webinars, community outreach, and vendor tables.
Social Worker - LCSW
United Health Group
06.2013 - 07.2014
Functioned as a social worker and member of an interdisciplinary team (care coordinators; social workers; nurses) educating Geriatric patients on SDOH needs; provided team members with benefits, community resources, and referrals for counseling; used Healthcare Effectiveness Data and Information Set (HEDIS) measures to identify opportunities for improvement; tracked improvement; monitored modification for such issues (Colorectal Cancer; High Blood Pressure; Medications, etc
In the geriatric population
Assisted with HEDIS improvement efforts using telehealth to monitor and track annual screenings in aging populations.
UM MH/SA Care Manager
The Guilford Center/Sandhills
05.2011 - 05.2013
Evaluated the medical necessity, clinical appropriateness, and effectiveness of authorizations; Person-Centered Plan Review; ensured Compliance with DHHS policies, procedures, and guidelines; Ensured that information regarding the quality and completeness of authorizations and supporting documentation; authorized MH/SA state-funded services
Leadership: provided training to all untrained staff and assigned caseload to the team
Performed concurrent reviews for outpatient care to measure the performance and improvement of the population by reviewing person-centered mental health plans by providers of services and other clinicians to determine the effectiveness of the delivery of mental health care services and different levels of care as allowed by scope of practice and experience; Performed quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment; Provided information to members and providers regarding mental health managed care programs and company policies and procedures, and criteria; Interacts with Medical doctors to discuss clinical and authorization questions and concerns regarding specific cases; Participated in quality improvement activities; Maintained a busy workload by Managed Care performance standards; Worked with community agencies as appropriate
Proposed alternative treatment plans when service requests do not meet medical necessity criteria; Advocates for the patient to ensure treatment needs are met
Interacts with providers in a professional, respectful manner that facilitates the treatment process
Used medical necessity to reduce hospital readmissions by providing members with outpatient care within seven days of discharge.
Education
Master of Science in Social Work - Social Work
COLUMBIA UNIVERSITY SCHOOL OF SOCIAL WORK
Bachelor of Arts in Psychology - Psychology/Human Services
RUSSELL SAGE COLLEGE
Certification
North Carolina Licensed Clinical Social Worker, C006338, 03/2025
National Association for the Dually Diagnosed (IDD/MH), Present
Medicaid Redesign Analyst at NYS DOH/Division Of Program Development And Mgmt.Medicaid Redesign Analyst at NYS DOH/Division Of Program Development And Mgmt.
MEDICAID REDESIGN ANALYST I at NYS DOH Social Care And Community Support BureauMEDICAID REDESIGN ANALYST I at NYS DOH Social Care And Community Support Bureau
Medical Assistance Specialist 2 at NYS DOH Office Of Health Insurance ProgramsMedical Assistance Specialist 2 at NYS DOH Office Of Health Insurance Programs