Toya Creel

Provide strategic oversight for a team of 140 Social Workers, ensuring compliance with Medicare, Medicaid, NCQA and Health Plan regulations/standards.

● Develop and implement end to end policies, training programs and workflow that enhance service delivery and patient outcomes.

● Foster collaborative relationships with interdisciplinary teams, including care management, physicians and community-based agencies to drive high quality business goals

● Develop national metrics and dashboards to monitor alignment with contract requirements, quality outcomes and affordability targets

● Oversee budgeting, staffing and resource allocation, optimizing team productivity while maintaining cost efficiency.

● Utilize data-driven decision-making to enhance service effectiveness and improve patient satisfaction scores.

● Provide ongoing clinical management of existing programs and address changes in clinical model requirements

● Provide oversight and implementation of new processes to ensure appropriate care coordination for the DSNP population. Education and training around Medicaid Managed Care including LTSS services and coordination of benefits for the Care Management teams.

● Support clinical workstreams for new capabilities and model components to support differentiation and market competitiveness Enterprise wide

● Lead quality improvement in reducing hospital readmission rates and enhancing care transition processes.

● Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities.

● Identifies and resolves technical, operational and organizational problems outside own team.

Works autonomously to identify issues, craft action plans and implement changes to positively impact business functions and to lead, develop and coach a team of 18 transition specialists across 5 Service Delivery Areas (SDAs).

• Identify and resolve technical, operational, and organizational issues within my team ● accountability, customer and provider satisfaction, and quality improvement in accordance with state guidelines.
• Direct and support transition specialist in resolving highly complex member or staff concerns related to transition planning.
• Track and trend data to identify opportunities for improvement in training, communication, multidisciplinary collaboration, and create standardized best practices while maintaining compliance with all regulatory requirements

Assist individuals, ages 15-21,receiving STAR KIDS medicaid in navigating the healthcare system and health transition into adulthood.

● Assess individuals through the lens of social determinants to identify and mitigate gaps in care.

● Address barriers to appropriate medical care and psychosocial services through customized person centered care plans.

● Provide extensive education on and assistance in accessing community, state, and national resources.

● Navigate multidisciplinary teams and resources to provide wrap around support for the individuals we serve.

● Maintain compliance to state contracts and internal procedures

● Maintain community involvement to enhance contractual relationships while educating community partners on the STAR KIDS Program.

● Culture Ambassador and active member of the Culture Captain team which provided monthly presentations to encourage a value based mindset to the issue we face daily while fostering accountability.

• Implemented change management strategies which reduced employee resistance during critical organizational transitions.

Conducted assessment, led discharge planning, assisted with advance directives, IDTs, and coordinated care for residents in long-term care facilities all while maintaining compliance with State and Federal regulation.

● Provided Medicare and Medicaid benefit counseling to residents and their family.

● Coordinated services between the long term care facilities and outside agencies including but not limited to: DADS Guardianship Program, APS, Home and Community Support Programs, and LIDDAs.

● Coordinated care transition planning and discharge planning with physicians, home health/hospice agencies, hospital, behavioral health entities, and DME companies.

● Consulted with long term care facilities on training and continued education programs for social workers. Provided services for Executive Directors and Department Heads as needed.

● Conducted internal facility investigations including compliance reporting as required to the State. Participated in State inspections and complaint investigations provind plans of correction as appropriate.