Melissa Robinson
McKinney
Summary
Strategic program manager with expertise in cross-functional collaboration and operational efficiency optimization. Utilizes budget management and data analysis to align projects with organizational objectives. Fosters individual and team success within a culture of respect and accountability.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Sr. Manager, Programs & Budget
Health Care Services Cooperation
Richardson
11.2019 - Current
- Oversaw budget and staffing for TX Clinical Operations, ensuring resource allocation met operational needs.
- Supported VP with data analysis and budget monitoring, facilitating informed decision-making on staffing.
- Led projects for VP of TX Clinical Operations, aligning initiatives with organizational goals.
- Acted as a liaison between upper leadership and other areas of HCSC.
- Acted as a liaison for all leadership and staff under VP regarding payroll and human resources.
- Tracked and developed projects related to commercial and exchange products to ensure alignment with company objectives.
- Produce staffing models based on need, contracts, and requirements for different membership.
- Provide statistics analysis of data related to clinical operations.
Clinical Program Manager, BH Clinical Operations
Health Care Services Cooperation
Richardson
03.2014 - 11.2019
- Led projects for AVP of Behavioral Health Clinical Operations, ensuring alignment with strategic objectives.
- Conducted statistical analysis of clinical operations data, supporting data-driven decision-making.
- Tracked and developed projects for commercial, exchange, and government program products, enhancing product delivery at HCSC.
- Oversaw budget and staffing for all behavioral health lines of business, ensuring effective resource allocation.
- Produce complicated staffing models based on need, contracts, and requirements for different populations.
- Serve as a liaison between upper leadership and other areas of HCSC.
Unit Manager Behavioral Health Appeals
Health Care Services Cooperation
Richardson
03.2013 - 03.2014
- Supervised the enterprise appeals team for Behavioral Health business of 16 clinical and non-clinical staff members.
- Implemented tracking systems that ensured compliance timelines for appeals processes were met.
- Assisted in the development of relationships between members of the BH appeals team and other areas of HCSC including Appeals Triage, BH Clinical Operations and Government Programs staff.
- Developed workflow processes, standard operating procedures, job aids, and policies for new product lines to enhance operational efficiency.
- Tracked progress and completion of projects, including letter change requests and implementation of new criteria and product lines, to ensure timely delivery.
- Respond to inquiries from account executives, groups, management, full-service units, members, families, facilities and providers.
- Complete statistical analysis for a variety of review types, including cost of IROs and concordance rates for internal medical directors.
Sr. Supervisor Behavioral Health Utilization Management
Health Care Services Cooperation
Richardson
06.2010 - 03.2013
- Supervised a team consisting of 13 to 14 independently licensed clinicians and non-licensed staff.
- Ensured authorizations for mental health and substance abuse treatments were completed in a timely manner.
- Ensured production, performance, and other matrixes were being met by direct reports.
- Managed staff performance daily, weekly, monthly, and annually to align with organizational goals.
- Facilitated clear communication with staff regarding regulations, documentation, processes, and procedures.
- Provided timely feedback to staff on performance, production, attendance and projects.
- Conducted chart/phone audits monthly.
- Respond to inquiries from account executives, groups, management, full-service units, members, families, facilities and providers.
- Executed special projects for management, including statistical analysis, proposal writing for unit reorganization, report preparation, and leading focus groups with staff.
Care Manager
TMHP/Texas Medicaid/Aetna
Dallas
09.2008 - 06.2010
- Provided clinical care coordination for the aged, blind and disabled population enrolled in the PCCM Plus + program of Texas Medicaid.
- Oversaw a clinical case load ranging from 100 to 130 patients, focusing on delivering quality care.
- Collaborated with clinical and non-clinical staff to address social and medical needs of the diverse population served by the program.
- Executed quarterly quality audits on closed cases to maintain quality continuum across clinical and non-clinical staff.
- Contributed to the conversion team that changed software from one server to another and tested for proper functioning.
- Completed special projects for management staff including monthly chart audits on staff charts for scorecard and quality analysis.
- Contributed to research action team that developed HIV Medical Case Management Certification.
- I was a trainer for clinical staff in the department on job duties, regulations, documentation and software used.
School Social Worker
Rio Rancho Public Schools
Rio Rancho
08.2005 - 08.2008
- Provided crisis intervention services to enhance safety and well-being of the entire student population.
- Supported special education children with emotional challenges through social skills training, coping strategies, and crisis intervention.
- Collaborated with teachers, administrators, parents, and staff to address and fulfill social, emotional, and educational needs of children effectively.
- Provided clinical supervision for SW seeking clinical level licensure.
Treatment Coordinator
LaFamilia, Inc.
Albuquerque
03.2004 - 08.2005
- Managed case load of up to 8 treatment foster care cases, ensuring individualized attention and support for each child.
- Facilitated communication among legal guardians, biological families, therapists, psychiatrists, treatment foster parents, and schools to promote integrated care.
- Coordinated services for emotionally disturbed children in treatment foster care, enhancing their access to therapeutic support.
- Ensured funding from various insurance companies for services provided.
- Handled on-call duties for the treatment foster care program, assisting with urgent needs.
Hospital Social Worker
Presbyterian Hospital
Albuquerque
04.2004 - 11.2004
- Coordinated weekend discharge services for patients, ensuring smooth transitions to home care.
- Developed comprehensive discharge plans for patients
- Arranged transportation and home health care for patients to facilitate recovery at home.
- Collaborated with social worker to provide comprehensive coverage for the entire hospital.
Treatment Social Worker
State of NM; Children, Youth & Families Department
Albuquerque
03.2003 - 03.2004
- Legal guardian for children in the custody of the Children, Youth, & Families Department.
- Collaborated with biological families to implement court-ordered treatment plans, fostering engagement and compliance.
- Advocated for child’s needs through comprehensive assessments and coordinated services.
- Acted as a legal guardian for children on caseload in all realms, including medical and educational.
- Testified in court as to progress on treatment plans and child’s needs.
- Addressed urgent situations promptly, ensuring safety and support for children in crisis.
District Safety Officer
Laredo Independent School District
Laredo
03.2002 - 12.2002
- Evaluated safety protocols across all campuses and departments to enhance protection for staff, students, and visitors in the Laredo Independent School District.
- Conducted monthly statistical analysis of workers’ compensation injury rates, payments, and accident types to identify trends and inform safety initiatives.
- Counseled injured workers on their rights and options, facilitating informed decision-making during recovery.
- Provided supervision for workers’ compensation staff, workers’ compensation reports and office staff.
- Implemented several public health programs into elementary schools, including Henry the Hand.
Assistant Director-Family Support Services
United Cerebral Palsy of Greater St. Louis
Sant Louis
10.2000 - 03.2001
- Coordinated respite services for families of United Cerebral Palsy consumers, determining reimbursement procedures and qualifications based on diagnosis and home situation to enhance service delivery.
- Provided assessments of consumers/families for psychosocial, monetary, and physical needs.
- Supervised and trained direct care staff of 70 full-time and 60 part-time, ensuring integrity of care through effective leadership and support.
- Participated as an organization representative on the Productive Living Board of Greater Saint Louis.
- Maintained consumer files in accordance to all local, state, and national regulations.
Lead Program Assistant
Sandy Oaks Group Home
Denton
10.1998 - 10.1999
- Supervised direct care staff across three group homes for developmentally delayed individuals, ensuring appropriate care and effective staff reinforcement.
- Developed individualized habilitation plans biannually for each consumer based on assessments of skills, abilities, and consumer goals.
- Coordinated daily activities for residents to ensure a structured environment.
- Assisted staff in developing and implementing care plans for each resident.
- Facilitated communication between families, staff, and external service providers.
Counselor
Camp Summit
Dallas
05.1997 - 08.1997
- Facilitated camper participation in preferred activities to enhance enjoyment and foster inclusivity.
- Coordinated and led engaging leisure activities for campers, enhancing their summer camp experience.
- Supported camp participants of diverse ages and abilities in completing activities of daily living to promote independence and engagement.
Education
Master of Social Work -
Saint Louis University
Saint Louis, Missouri01-2002
Master of Public Health -
Saint Louis University
Saint Louis, Missouri01-2002
BS - Rehabilitation Studies
University of North Texas
Denton, Texas12-1999
Skills
- Budget management
- Healthcare budgeting
- Financial forecasting
- Compliance oversight
- Project leadership
- Strategic planning
- Process optimization
- Cross-functional coordination
- Data analysis
- Quality enhancement
- Staffing strategies
Affiliations
- National Association of Social Workers
- American Public Health Association
Certification
- Certified Case Manager (CCM)
Credentials
- LCSW
- MSW
- MPH
- CCM
Leadership Style
I believe that people are the greatest resource any organization can possess. I actively promote a workplace culture where we celebrate each individual's success as a success for the business as a whole. I will include others in important decisions, give credit where it's due, and do my best to help everyone reach their full potential.
Timeline
Sr. Manager, Programs & Budget
Health Care Services Cooperation
11.2019 - Current
Clinical Program Manager, BH Clinical Operations
Health Care Services Cooperation
03.2014 - 11.2019
Unit Manager Behavioral Health Appeals
Health Care Services Cooperation
03.2013 - 03.2014
Sr. Supervisor Behavioral Health Utilization Management
Health Care Services Cooperation
06.2010 - 03.2013
Care Manager
TMHP/Texas Medicaid/Aetna
09.2008 - 06.2010
School Social Worker
Rio Rancho Public Schools
08.2005 - 08.2008
Hospital Social Worker
Presbyterian Hospital
04.2004 - 11.2004
Treatment Coordinator
LaFamilia, Inc.
03.2004 - 08.2005
Treatment Social Worker
State of NM; Children, Youth & Families Department
03.2003 - 03.2004
District Safety Officer
Laredo Independent School District
03.2002 - 12.2002
Assistant Director-Family Support Services
United Cerebral Palsy of Greater St. Louis
10.2000 - 03.2001
Lead Program Assistant
Sandy Oaks Group Home
10.1998 - 10.1999
Counselor
Camp Summit
05.1997 - 08.1997
Master of Social Work -
Saint Louis University
Master of Public Health -
Saint Louis University
BS - Rehabilitation Studies
University of North Texas