Valerie M. Kemo

• Management of daily operations of clinical and non-clinical staff responsible for self-funded workers' compensation administration including claim reporting, case management, utilization management and provider bill payment.
• Serves as clinical specialist and provides support for associated State funded workers' compensation MCO as part of lead and team clinical and supporting services and processes.
• Assists in development and implementation of quality management program and URAC accreditation activities.
• Identifies variances and develops policies and workflows to resolve problems.
• Performs staff evaluations and develop and implements corrective action plans as necessary.
• Collaborates and partners with applicable internal and external partners to ensure workflow processes and interdependencies are identified and addressed on ongoing basis.
• Serves as MCO's assigned CAT Coordinator with the Ohio Bureau of Workers' Compensation.
• Provides case management supervision and services in accordance with URAC accreditation, CMSA standards of practice, professional licensure and certifications.

• Developed and managed clinical and operations and processes focused on improving clinical and financial outcomes, member engagement and satisfaction for Ohio State funded and self-funded workers' benefit administration, short term disability and FMLA administration.
• Monitored performance and administrative benchmarks to ensure compliance with regulatory, accreditation, and program requirements.
• Responsible for all URAC accreditation activities including application and annual measures submission.
• Served as liaison with regulatory and accrediting agencies and applicable business units.
• Developed and participated in presentations and consultations to The Health Plan senior leadership, auditors, and regulators.
• Directed/provided enhancements to business processes, policies and infrastructure to improve operational efficiency.
• Developed Employer Services Division quality improvement program description, annual work plan, monitoring of indicators and developing action plans to correct deficiencies. Served as department representative on Quality Improvement Committee.
• Served as technical, professional and business resource across multiple business functions.
• Responsible for all facets of case management and utilization management services as related to specific program requirements.
• Performed staff evaluations and develop and implements corrective action plans as necessary.
• Collaborated and partnered with applicable internal and external partners to ensure workflow processes and interdependencies are identified and addressed on ongoing basis.
• Served as intermediary for employer clients to all parties including claimant, legal representatives and medical provide
• Assisted in development of marketing pieces, program publications and web design and content.
• Promoted clear vision aligned with company values and direction and set specific challenging and achievable objectives and action plans.
• Provided case management and utilization management services to assigned employer client's injured workers.

Essential job functions of these positions included:

• Ensure compliance with Ohio Licensure, Medicare and Medicaid certification for long term care facilities, home health agencies and MRDD facilities.
• Hired as Surveyor, promoted to Nurse Educator and promoted into position of Assistant District Office Supervisor.