Lory Joseph
Elk Grove,USA
Summary
Highly knowledgeable Health Program Specialist II with broad experience in planning, developing, and implementing health programs. Strengths include strong research skills, ability to analyze data for program improvement, and exceptional communication skills for stakeholder engagement. Demonstrated capacity to influence health policies and procedures that enhance healthcare delivery and patient outcomes. Experienced in compliance management, policy development, program management, risk mitigation, and operational planning. Proven track record of maintaining regulatory compliance and addressing systemic issues. Collaborative approach with business managers to build strategic alliances and enhance department standing.
Overview
37
37
years of professional experience
Work History
Health Program Specialist II
California Correctional Health Care Services
Elk Grove, CA
07.2014 - Current
- Monitored performance metrics associated with the program's goals and objectives while gaining the support and commitment of others
- Reviewed existing policies and procedures related to the health program ensuring compliance with applicable regulations
- Use an adjustable approach and behavior in real time to match the shifting demands of different situations
- Audit and monitoring processes, implementation of controls, performance dashboard trending, root cause analysis, and effective management of corrective action plans
- Provide high-level health program expertise and assistance on the most difficult and sensitive policy or program review to meet
- Assistance on the formulation of the most difficult and sensitive assignments independently coordinates significant policy and program issues with stakeholders, management, and executive staff
- Work collaboratively with operational leadership to provide input in the development, approval, and review of the delegation agreement and associated responsibilities
- Oversees the gathering and analysis of data from various sources to improve the procedures for department processes and audits, e.g., surveys, meetings, trends, and other sources of feedback
- Identify, implement, monitor, and analyze relevant non-clinical metrics models, and implement effective interventions based on results
- Resolves highly complex, sensitive, and confidential health program issues raised by executive and management staff using strong problem-solving skills and in-depth knowledge of management, CCHCS health care policy, and state and federal regulations
- Independently responds to and makes decisions regarding critical and ongoing issues involving health program functions on behalf of management
- Leads and conducts internal audits of non-clinical operational functions related to regulatory and contractual requirements, including creating and updating audit tools, and preparing results
- Collaborates with management on the development and implementation of critical healthcare initiatives
- As a subject matter expert (SME), I evaluate and provide recommendations on health program policy development and implementation
- Oversee the most complex and sensitive statewide issues and projects, ensuring deadlines, requirements, and inquiries related to court mandates and stipulated agreements
- Issues internal and external corrective action plans for non-compliance with plan policies, regulatory, and contractual requirements; works collaboratively to ensure remediation of corrective action plans
- Preparing action plans resulting from meetings, directives, or court orders, and facilitating workgroups and action plan meetings
- Assigning project leads by identifying who is responsible for each task and following up with each responsible party to ensure they are keeping within appropriate timeframes
- Independently conducts extensive research and analysis to complete projects and assignments
- Creates, monitors, and updates reports
- Evaluates the impact of proposed legislative, program, court, and policy issues related to CCHCS' health care policy in order to make recommendations to management
IT Specialist/Project Manager, PMO
California Correctional Health Care Services
Elk Grove, CA
01.2023 - 06.2023
- Developed documentation related to IT policies, processes, standards
- Coordinated with vendors for procurement of IT products or services as needed
- Ensured compliance with relevant laws or regulations regarding information security
- Managed project-related contracts to ensure the contract is adhered to and deliverables are submitted timely
- Reviews and provides first-level approval on deliverables and invoices
- Collected, analyzed and reported on data for use in operational planning
- Managed, controls, and reports on assigned, prioritized IT projects and initiatives
- Developed project management plans, processes, and schedules to adhere to PM standards
- Led technical teams to complete complex enterprise IT projects and initiatives
- Contributes to the business relationships with customers by ensuring requests are understood, resolved timely and consistently, and escalating any unresolved issues to management
- Maintained a positive working environment, encouraged stakeholders' cooperation by providing timely feedback and updates, including control agencies, project sponsors, executive management, and customers
- Served as a liaison that bridges the gap between business and technical staff
- Advised internal and external stakeholders in interpreting and appropriately applying complex IT policies and best practices on projects to comply with state mandates
- Independently identifies and analyzes business problems and works with technical staff to write up IT impact analysis and develop solutions
- Assists internal and external stakeholders on the CCHCS's Stage Gate Process for initiating new solutions, products, hardware, and software
- Worked with customers to complete the appropriate stage gate documentation to present to the IT Governance Board
- Leads workgroups to formulate strategies, plans, and policies about IT planning, management, and solution delivery processes
- Independently monitored the IT change control process and recommends solutions to upper management
- Provided continuous support to the PMO by identifying and analyzing performance indicators, and determining improvements and efficiencies in PM processes, plans, policies, and tools
- Shared and applied lessons learned and uses PM best practices
- Develops high-level reports for project sponsors, stakeholders, and management
- Contributed to team meetings
Associate Health Program Advisor
Department Of Managed Health Care
Sacramento, CA
12.2011 - 07.2014
- Managed communication between faculty members, administrators, staff members, and external organizations regarding program initiatives
- Conducted research and planning necessary to assist with program evaluation, assessment, and annual reports
- Worked directly with customers in a service, risk management, or healthcare-related role, disseminating complex information orally and in writing to customers, staff, and clinicians
- Analyzed programs and objectives to make projections and assess program needs and resource requirements
- Managed large caseload under the Knox-Keene Health Care Service Plan Act of 1975 (Act), the California Code of Regulations, Title 28 (Regulations), and program policies and procedures
- I have performed complex research projects and regulatory analyses related to various substantive areas of critical importance to DMHC, including compliance, fraud, health plan relations, conflicts of interest, research compliance, and privacy
- Expressed ideas assertively, clearly, and concisely in oral and written form
- Exercised tact and diplomacy in dealing with others to secure information and cooperation
- Developed robust assessment and analytical skills, including synthesizing, distilling concepts, drawing conclusions, and identifying implications
- Functioned with high autonomy in researching, analyzing, and responding to unique and often unprecedented compliance and regulatory issues and inquiries
- Conducted follow-up reviews to evaluate compliance with corrective actions, preparing regulatory reports on health plan compliance with state and federal mental health parity requirements, including preliminary, final, and summary monitoring plan activities, and preparing policy memos and enforcement referrals
- Secured and deployed resources effectively and efficiently
- Organized people and resources to solve problems and identify opportunities
- Presented findings to executive management, senior-level peers, and regulators
- Evaluated and recommended courses of action on contractual matters related to compliance (e.g., attestations of compliance with HIPAA required by commercial payers)
- Analyzed core elements for compliance with statutes and regulations in quality assurance, access and availability, utilization management, and grievance systems; reviewed denial, appeal/grievance files, complaints, and Independent Medical Reviews; collected and analyzed data and reports from health
- I gathered and promptly produced requested documents from various sources, including, but not limited to, billing systems, the electronic medical record (EMR), policies, and procedures, to provide a complete response to the regulatory requestors
- Conducted thorough reviews and analyses of all automated/complex denials for accuracy and appropriateness of outpatient, inpatient, professional, and facility coding, billing, and regulatory-specific issues associated with the request
TP-Contracts Administrator
Coventry Health Care
West Sacramento, CA
09.2006 - 12.2011
- Built networks: Effectively built formal and informal relationship networks inside and outside the networks
- Maneuvered comfortably through complex policy, process, and health plans while using compelling arguments to gain support and commitment for the networks and health plans
- Illustrated in-depth knowledge of the healthcare and managed care industry, its products, services, and significant business processes
- Applied knowledge of the regulatory guidelines governing network development and contracting efforts
- Used knowledge of business, economic, demographic, and political trends, general healthcare and managed care developments, and provider network development and operations
- Worked with HMO, PPO risk plan contracts, use of acquisitions, document, and apply regulations about healthcare services reimbursements
- Participated in negotiations for payer agreements assigned to hospitals, professional, and ancillary providers
- Coordinated closely with operational departments to ensure the success of contract performance and work through any contract disputes
- Developed and drafted language, contract review, including review for compliance, and network development and operations
- Engaged in positive, powerful persuasion with individuals or groups with diverse opinions and agendas
- Influenced and facilitated senior executive teams as needed to manage complex, multi-faceted projects effectively
- Enlisted cooperation and built teams committed to carrying out initiatives in environments that may be resistant to change and not under the incumbents' direct authority
- Applied assessment and analytical skills, including synthesizing, distilling concepts, drawing conclusions, and identifying implications
- Deployed resources effectively and efficiently; organized staff and identified opportunities
Transportation Manager
UC Davis Health System
Sacramento, CA
10.1994 - 11.1998
- Managed staff, drove, and dropped off patients at various locations via van, wheelchairs, and gurneys
- Overseen the team, ensure their satisfactory performance, and recruit, hire, and train new driver employees
- Managed and surveyed aspects of the patient transportation experience, and interacted with drivers, patients, facility medical staff, and patients' guests
- Ensured vehicles and equipment assigned to the office were functional, transferred, used, and stored appropriately
- Communicated any problems or out-of-service items correctly and promptly and coordinated the repair/replacement
Principle Manager Nutrition/Dietary Aide
UC Davis Health System
Sacramento, CA
01.1989 - 05.1993
- Managed the food purchase program, production, and timely service of meals
- Inventoried management and control
- Used my leadership skills to supervise and secure the cooperation of the dietary personnel, including ongoing training, counseling, and development
- Plans and assists teaching staff in implementing a health/nutrition education and safety curriculum, obtaining input from other staff
- Monitored food preparations, meal services, storage areas, equipment, and supplies, including vehicles used to transport food
Information Technology Supervisor Technician
Healed College
San Jose, CA
07.1987 - 01.1989
- Led and supervised three other interns while performing journey-level tasks in IT client services concerning analyzing
- Installed information technology equipment, such as monitors, printers, and essential software, to support IT services and systems
- Worked on HelpDesk calls while monitoring and using troubleshooting techniques, such as standard remote access tools, and remotely logging into staff workstations to resolve their software issues
- Opened a trouble ticket in an automated problem/request response tracking system
- Generated service disruption IT reports to monitor workload priorities
- Sent out email notifications to staff regarding interruptions and restoration of various services
Education
Graduate Health Care Compliance and Privacy Certificate -
University of Phoenix
Sacramento, CA05-2025
Bachelor of Science - Business Management
University of Phoenix
Sacramento, CA01.2023
Certificate - Paralegal Studies
MTI College of Business and Law
03.2006
Associate of Arts - Business
Sacramento City College
Sacramento, CA06.2002
Skills
- Strong assessment and analytical skills
- Policy analysis
- Strong project management skills
- Process and Procedure Creation
- Strong Process Improvement Skills
- Articulate Strategies
- Resourcefulness
- Accountable/Persuasive
- White/Yellow Belt
- Interdisciplinary Collaboration
- Problem-Solving
- Program Evaluation
References
References available upon request.
Timeline
IT Specialist/Project Manager, PMO
California Correctional Health Care Services
01.2023 - 06.2023
Health Program Specialist II
California Correctional Health Care Services
07.2014 - Current
Associate Health Program Advisor
Department Of Managed Health Care
12.2011 - 07.2014
TP-Contracts Administrator
Coventry Health Care
09.2006 - 12.2011
Transportation Manager
UC Davis Health System
10.1994 - 11.1998
Principle Manager Nutrition/Dietary Aide
UC Davis Health System
01.1989 - 05.1993
Information Technology Supervisor Technician
Healed College
07.1987 - 01.1989
Graduate Health Care Compliance and Privacy Certificate -
University of Phoenix
Bachelor of Science - Business Management
University of Phoenix
Certificate - Paralegal Studies
MTI College of Business and Law
Associate of Arts - Business
Sacramento City College
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