Rebecca Foster

Executive leader of Utilization Management (UM) team for home health and durable medical equipment (DME) services for Medicare and Medicaid members across multiple states. Key contributor within Onehome executive team; collaborative team leader and agent for change within rapidly evolving mergers & acquisitions culture. Led operational team of Medical Directors, Clinical Review Nurses, and Intake Coordinators. Implemented and managed new UM delegation agreements across multiple states.

• Implemented cross-functional initiatives across departments to achieve rapidly evolving business goals. Collaborated strongly with IT, Quality, and Compliance leaders to exceed business operational outcomes. Increased clinical quality outcomes by 20%.
• Modernized and improved operational procedures to increase productivity and profitability while tightly controlling costs. Identified opportunities to improve business process flows and subsequently increase overall departmental productivity.
• Designed, implemented and revised operational policies and guidelines in accordance with regulatory requirements. Updated all UM policies to adhere to NCQA guidelines. Reduced out-of-compliance case review TATs by 22%.
• Created team and individual KPIs and provided regular, actionable feedback. Designed PowerBI dashboards to effectively increase data communication across organization. Increased UM Clinical nurse reviews per day by 10%.
• Resolved wide-scale proprietary software deficits through in-depth analysis with IT partners using creative problem solving and extensive department-wide testing.
• Identified and diminished regulatory risks by overseeing adherence to payer contract SLAs, NCQA requirements, and CMS regulations across all projects.

Executive leader for organization and directly responsible across three service offerings: 1. Utilization Management division that was NCQA-accredited as a Managed Behavioral Health Organization (MBHO), 2. A fully contracted Provider Network for mental health and chemical health services, and 3. A care delivery division that provided behavioral crisis assessments in Emergency Departments across multiple states. Dynamic and forward-thinking collaborative leader with deep understanding of behavioral health landscape. Data-driven decision maker with numerous years of experience across multiple roles related to healthcare operations. Excelled within a matrix leadership team environment for the Mental Health and Addiction Service line of a large multi-hospital health system.

Seventeen years of behavioral healthcare experience through roles of increasing responsibility and scope: Intake Coordinator 2005-2006, Intake Supervisor 2006-2007, Provider Relations Manager 2007-2013, Behavioral Health Manager 2013-2015, Director of Operations & Regulatory Compliance 2015-2020, and System Executive Director of Mental Health & Addiction Service Line 2020-2022.

• Oversaw annual operating budget of $12 million; saw growth of $3 million over last two years in position due to increase in behavioral clinical service product growth and additional leadership scope.
• Designed and implemented innovative emergency behavioral health services and telemedicine care delivery models that were responsive to customers' needs and supported highest patient safety and clinical effectiveness while providing exceptional customer service and optimal financial performance.
• Increased on-demand crisis assessment services from operating during weekday business hours at only two locations to operating 24/7 at thirty-six locations across multiple states.
• Subject matter expert on telemedicine service delivery in behavioral healthcare. Increased utilization of telemedicine service delivery by 136% over three years.
• Implemented and achieved highest award of National Committee for Quality Assurance (NCQA) accreditation as Managed Behavioral Healthcare Organization (MBHO). Maintained highest level of accreditation throughout tenure with organization.
• Ensured that daily operations continually met NCQA requirements for Utilization Management and Care Management programs. Directly managed numerous NCQA surveys and audits to ensure results.
• Provided direct oversight and change management leadership during restructuring from independently managed subsidiary to wholly owned service line within parent organization. Integrated entrepreneur-style small business into larger parent company health system; accountable leader to ensure that governance, resources, EMR systems, and synergies between the two organizations were successfully executed.
• Researched, designed and executed numerous budget-neutral organizational re-alignments of existing staff and resources to meet expanding and changing business needs.
• Developed and implemented operational policies, systems and procedures to assure consistency and standardization across operating units.
• Led weekly Business & Clinical Operations meetings with Clinical Dyad partner and department Directors. Oversaw daily operational decisions and maintained directives to align with organizational perspective.
• Extensive experience in: Patient Access, Provider Contracting, Health Plan Contracting (Medicare, Medicaid, Commercial Payers), Account Management, Care Management, Business Operations, Budgeting and Finance, Analytics and Reporting, Team Building & Resource Allocation, Technology Design & Solutioning, and Regulatory & Compliance.