Jill Planeta
Lexington,MA
Summary
Certified Project Management Professional (PMP) - 2011
Licensed Independent Clinical Social Worker (LICSW) - 2003
Overview
7
7
years of professional experience
Work History
Director of Behavioral Health Operations
Point32Health
07.2021 - Current
- Lead Behavioral Health (BH) Department BH Service Navigation, Quality, Compliance, Program Management and Resource teams' business operations
- Designed and implemented a BH Service Navigation program, a key component of the organization's BH strategy
- Develop Corporate Project Management Office (CPMO) business cases for corporate initiatives
- Served as interim Mental Health Parity Program Director, and developed and implemented enhanced organizational structure, processes and tools for enterprise program
- Represent BH leadership in meetings with external stakeholders including BH trade organizations, ACO partners and EOHHS
- Develop annual workplan for BH, Community Health Worker and Health Engagement
- Manage large cross-departmental projects
Senior Manager of Legal Operations
Tufts Health Plan (now Point32Health)
02.2017 - 07.2021
- Managed department operations including corporate governance, risk management, dispute resolution, legal and administrative support
- Developed reports, tools and standardized processes to support department operations and management
- Supported strategic planning activities for department in alignment with corporate vision and goals
- Developed and executed annual department business plan
- Developed and presented business cases to Corporate Project Management Office (CPMO)
- Managed Managed vendor relationships and department budget
- Managed large cross-departmental projects as well as enterprise-wide Pandemic Response Program during COVID-19 pandemic
- Nominated for and participated in 2018 Tufts Health Plan Fellows Program
Product Implementation Director
BMC HealthNet Plan (now WellSense)
2012 - 2016
- Led procurement and/or implementation of new lines of business including SCO, OneCare, MassHealth CarePlus, QHP, and other high visibility or enterprise-wide initiatives
- Led strategic planning, development and submission of state bids (RFR responses) and CMS applications for the procurement of new lines of business
- Collaborated with key members of leadership to develop integrated Model of Care
- Managed relationships with sate and federal regulatory entities (EOHHS and CMS) during procurement and readiness phases of work
- Identified key stakeholders, secured resources, and defined governance structure, roles and responsibilities
- Supported creation of new functional areas and hiring of new staff
- Developed dashboards and presented status reports to executive team
- Oversaw all aspects of project work to ensure that organizational objectives were accomplished within the constraints of budget, schedule and consumer experience
- Developed governance structure and metrics for post go-live program oversight
Manager of Office of OCA Project Management
BMC HealthNet Plan (now WellSense)
2010 - 2012
- Managed portfolio of initiatives for the Office of Clinical Affairs (OCA) departments that included Behavioral Health, Care Management, Utilization Management, Quality, Pharmacy, Provider Relations and Credentialing
- Developed business cases, demonstrating ROI, to support OCA projects and initiatives
- Trained, managed and developed team of project managers
- Developed operational metrics, dashboard reports and standardized tools
- Managed select OCA vendor relationships
Behavioral Health Quality Manager
BMC HealthNet Plan (now Wellsense)
2008 - 02.2010
- Managed the enterprise-wide project to outsource behavioral health services to a vendor
- Led cross-functional teams in developing metrics to monitor performance and ensure compliance with Quality Improvement Program and annual Quality Improvement Program Evaluation
- Developed and implemented strategic initiatives to improve clinical outcomes and achieve cost savings
- Defined and utilized metrics to measure progress toward goals
- Managed the MassHealth Behavioral Health Quality Goals including program design, implementation, tracking, reporting and evaluating the overall effectiveness of the programs
- Oversaw the functioning of assigned quality committees and programs to ensure compliance with NCQA standards and regulatory requirements
BH Program Consultant for Quality and Compliance
Blue Cross And Blue Shield Of Massachusetts
2007 - 2008
- Guided the behavioral health department through the NCQA reaccreditation process
- Ensured that the department's operations, policies and programs were in compliance with NCQA standards and regulatory requirements
- Developed and implemented reports and activities for oversight and monitoring
- Led cross-functional teams in the development, implementation and evaluation of quality initiatives
- Trained and coached clinical staff members on applicable behavioral health NCQA standards
- Leveraged provider performance data to identify and implement provider-specific initiatives to further improve clinical and financial outcomes
Behavioral Health Regional Network Manager
Massachusetts Behavioral Health Partnership
2005 - 2007
- Managed southeast provider network operations and performance as liaison between providers and internal stakeholders
- Defined and implemented provider programs as part of a cross-functional regional team
- Reviewed performance metrics and reports with providers, and collaboratively developed action plans to meet performance goals and address opportunities for further improvement
- Managed large-scale project of internal and external stakeholders to improve prompt and appropriate placement of children requiring an acute admission
BH Concurrent Review Clinician
Massachusetts Behavioral Health Partnership
2004 - 2005
- Utilized medical necessity criteria to evaluate and authorize appropriate inpatient and diversionary services for a Massachusetts Medicaid plan
- Educated providers on plan benefits, care management programs and network services ad part of comprehensive aftercare planning
- Participated in cross-functional regional team to develop and implement initiatives to achieve regional and corporate goals
Behavioral Health Concurrent Review Clinician
Beacon Health Strategies (now Carelon)
2003 - 2004
- Utilized medical necessity criteria to evaluate and authorize appropriate services for Rhode Island child and adolescent Medicaid plan
- Educated providers on plan benefits, clinical programs, network services and community resources as part of comprehensive aftercare planning
Behavioral Health Appeals Coordinator
ValueOptions, Inc. (now Carelon)
2002 - 2003
- Coordinated appeals process, ensuring compliance with NCQA standards, state and federal regulations
- Counseled members and providers on appeal rights, policies and rationales for determinations
- Supported cross-functional teams in quality improvement and NCQA accreditation initiatives
- Conducted internal audits and medical record reviews to ensure that documentation standards were met and staff training needs identified
Case Manager
McLean Hospital
2001 - 2001
- Served as member of multidisciplinary inpatient treatment team working with adults with mental health and substance use disorders
- Counseled patients and their families during inpatient admission
- Developed treatment and aftercare plans in collaboration with patients, families, inpatient treatment team and outpatient providers
Education
Women's Executive Leadership Program
Bentley University
Waltham, MA2013
MSW -
Simmons College Graduate School of Social Work
Boston, MA2001
Bachelor of Arts - Psychology
Providence College
Providence, RI1996
Timeline
Director of Behavioral Health Operations
Point32Health
07.2021 - Current
Senior Manager of Legal Operations
Tufts Health Plan (now Point32Health)
02.2017 - 07.2021
Product Implementation Director
BMC HealthNet Plan (now WellSense)
2012 - 2016
Manager of Office of OCA Project Management
BMC HealthNet Plan (now WellSense)
2010 - 2012
Behavioral Health Quality Manager
BMC HealthNet Plan (now Wellsense)
2008 - 02.2010
BH Program Consultant for Quality and Compliance
Blue Cross And Blue Shield Of Massachusetts
2007 - 2008
Behavioral Health Regional Network Manager
Massachusetts Behavioral Health Partnership
2005 - 2007
BH Concurrent Review Clinician
Massachusetts Behavioral Health Partnership
2004 - 2005
Behavioral Health Concurrent Review Clinician
Beacon Health Strategies (now Carelon)
2003 - 2004
Behavioral Health Appeals Coordinator
ValueOptions, Inc. (now Carelon)
2002 - 2003
Case Manager
McLean Hospital
2001 - 2001
Women's Executive Leadership Program
Bentley University
MSW -
Simmons College Graduate School of Social Work
Bachelor of Arts - Psychology
Providence College
Similar Profiles
Jamie JohnsonJamie Johnson
Intake Coordinator at Point32HealthIntake Coordinator at Point32Health
Kyle GreerKyle Greer
Provider Enrollment Supervisor at Point32HealthProvider Enrollment Supervisor at Point32Health
Fatima Cabrera WoodsonFatima Cabrera Woodson
Vice President, Provider Network Contracting at Point32HealthVice President, Provider Network Contracting at Point32Health
Celina Collazo DellaMorteCelina Collazo DellaMorte
Sr Compensation Analyst at Point32HealthSr Compensation Analyst at Point32Health
Lily BerberianLily Berberian
Teen Leadership Corps at Cradles To CrayonsTeen Leadership Corps at Cradles To Crayons