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Click here or scroll down to respond to this candidateCandidate's Name
New York City Metropolitan AreaEMAIL AVAILABLE PHONE NUMBER AVAILABLELINKEDIN LINK AVAILABLESummaryMPA, LCSW-R with over twenty-five years in health care management, consulting and quality improvement. Over fifteen years of consulting and contract work experience, assisting a broad array of providers adapt to rapid change.Refined communication, organization and writing skills. Proposals, policy & procedures, program evaluation, change management/implementation, quality assurance, project management, process improvement and audits. Presently preparing to take the Project Management Professional (PMP) exam. Data analysis skills: Advanced Excel skills and working knowledge of SQL/SAS, Tableau, and WebFocus. EHRs: NetSmart, Foothold FCM, Epic, Salesforce, GuidingCare, CareConnect, Facets. Ability to independently manage multiple projects, resources i.e. money, materials, time, and people. Supervise, recruit, train and lead diversely qualified teams of two (2) to two hundred (200). Build productive relationships between departments, clients, payers and regulators in remote, hybrid and in person environments.30 Years of experience in behavioral health: Person centered, trauma informed and driven by health equity and recovery. Conversant in BH Care Collaboratives, IPAs, Clinical Integration, value based care, and SDOH platforms. Member of Columbia University's monthly seminar for directors and consultants in the drug treatment field since 2010.Management and Director roles in Managed Care since 2014: In depth knowledge of psychiatric and substance use requirements of health plan members. Mastery of of managed care systems, protocols and regulatory reporting requirements. Ability to successfully interface with regulatory entities and cross functional departments. ExperienceIndependent ConsultantNYC area Behavioral Health organizationsJun 2005 - Present (18 years 10 months)Contracted Turnaround Consultant: Interim management, performance improvement, program planning/ development, Corrective Action Plans, proposals, audit and accreditation preparation. Care management, supportive housing, substance use and mental health providers. Several short term contract projects have morphed into longer roles. QA methodologies: OKRs, KPIs, PDCA, Agile, Lean. Candidate's Name - page 1Roles are often intense and can involve non-disclosure agreements. If you'd like to discuss an opportunity, please don't hesitate to message me. PDF of my resume can be obtained above in the Featured section.Director of Behavioral Health - Health PlansVNS HealthAug 2021 - Jan 2024 (2 years 6 months)Directed, planned and evaluated Behavioral Health for four (4) specialty managed care plans: Medicaid HIV-SNP, Medicaid Advantage Plus DSNP, Medicare Advantage DSNP, Medicare Advantage HMO. HIV SNP plan is rated highest in NYS, and MA plans achieved 4.5 Stars. Leader in a $2.5B corporation providing health insurance and direct services. Ensured compliance with HEDIS, Gaps in Care, UM, CM, HARP, and Health Homes. Oversaw performance of UM-CM-Claims vendor: Carelon Behavioral Health-Beacon Health Options. Served as BH champion/expert: Presentations to medical management CM and UM staff across enterprise. Provided crisis intervention to persons with SMI and co-occurring SUD. Represented health plan at regulatory meetings NYS OMH, OASAS, DOH and NYC DOHMH. Oversaw behavioral health staff, assessment, referral processes throughout insurance plans. Implemented Critical Time Intervention long term programs for highest need members. Ensured BH screenings result in referrals, and referrals resulted in sustained linkages to care. Collaborated with Designated AIDS Centers and the Alliance for Positive Change. Worked with IT to configured EMR (GuidingCare) to provide scripts, activities and notifications. Developed and implemented workflows, objectives, key results, metrics, QI initiatives, and projects in the pursuit of organization's overall strategic goals. Designed and led Projects that involved PMO and cross functional teams (Vendor Management, Care Management, Claims, Encounters and Compliance):*EMR migration*Article 44 DOH audits*MAP behavioral health carve-in*OMH/DOH/CMS reporting*Mental Health Parity NQTLs.Enterprise wide Committees:*NCQA Health Equity Accreditation,*SDOH/HRSN,*MA Member Retention,*CAHPS,*STARS. Utilized EHRs, (GuidingCare, CareConnect, Filemaker, Foothold), Excel, Tableau, HIEs/RHIOs,(Healthix, Careport), Visio, Asana and PSYCKES.Candidate's Name - page 2Senior Quality AnalystThe Execu Search GroupMar 2020 - Jan 2021 (11 months)Contractor role with data analytics department of a regional MCO with Medicaid, Medicare Advantage, Exchange and Commercial accounts.Assisted Pharmacy department with CMS audit, prescription monitoring and outsourcing UM. Generated scorecards for ACOs to improve HEDIS/CMS Star metrics and control costs. Researched Medical and Pharmacy claims for SIU and other departments. Utilized Excel, Tableau and SQL/SAS to manage projects and reports. Documented processes in SOPs and DLPs.Senior Clinical Transformation Consultant - Population Health UnitedHealth GroupFeb 2019 - Mar 2020 (1 year 2 months)Identified and implemented process improvements to provide clinical and administrative oversight to health homes and care management agencies:Utilized EHRs, Excel, Tableau, HIEs/RHIOs, PSYCKES and Visio. Collaborated with Optum UM and CM re: members with SMI or SED.Gaps in Care, ED and inpatient utilization, chart audits, case conferences, JOC meetings. Interim Director - Medical and Behavioral Care Management Mental Health Providers of Western Queens, Inc.Oct 2018 - Feb 2019 (5 months)Contracted consultant to a health home care management agency serving several populations: Mainstream, HARP, Children, SMI, AOT, Non-Medicaid and Adult Home. Person-centered services focusing on health equity, SDOH and cultural competence: Oversaw three supervisors and thirty (30) Care Coordinators providing services to 900 members. Services were provided in Spanish, Urdu, Hindi, Bengali, Punjabi and Gujarati. Lead health homes included CHN, QCCP, HHC, CCMP, CBC and Mt Sinai HHSC. Provided crisis intervention to persons with SMI and co-occurring SUD. Turnaround Management: Profit & Loss Management: Transformed program's fiscal viability. Integrated program into medical practices, OMH Article 31 and OASAS 822 clinics. Transitioned program to new Director.Interim Director - Medical and Behavioral Care Management Uptown Healthcare ManagementApr 2018 - Aug 2018 (5 months)Contracted consultant to health home care management agency operated by a privately held medical network accredited by AAAHC, PCMH level 3, DSRIP 3ai and most MCOs. Turnaround management:Candidate's Name - page 3 Increased revenue by expanding program to thirty (30) care coordinators serving 1800+ members. Extensive work regarding quality, compliance, SDOH/HRSN, staff recruitment and retention. Provided crisis intervention to persons with SMI and co-occurring SUD. Led BH-medical integration across network serving 7000+ patients a year. Improved relationships with lead Health Homes: BAHN and HHC. Evaluated program for senior leadership.Manager - Behavioral Health QualityFidelis CareSep 2016 - Mar 2018 (1 year 7 months)NCQA accredited MCO with over 2M members, predominantly mainstream Medicaid and HARP. Oversaw the 30 FTE Quality & Care Transition Unit": Supervisors, care managers, associates. Developed and implemented HEDIS initiatives: data, policies, workflows and reports. Department bridged UM and CM to ensure 10,000 members were successfully linked to aftercare each year.Accomplishments: Established and managed a statewide network of twenty (20) critical time intervention providers. Designed and implemented process improvements for UM and CM teams. Improved HEDIS scores, despite staff turnover during Centenes acquisition. Manager - Quality ManagementBeacon Health OptionsDec 2015 - Aug 2016 (9 months)Behavioral Health QM for NYC accounts: Affinity, Amidacare, Emblem, Metroplus and VNS Health. Presented Quality Department data and initiatives to clients: NYC based MCOs. Client facing role: Supported MCOs' pursuit of HEDIS/STARS measures. NCQA and URAC accreditation research and analysis. Designed and implemented workflows for new initiatives: HARP, Health Homes and HCBS. Developed, implemented and evaluated Quality Improvement activities. Established and monitored Key Performance Indicators (KPIs). Employment took place during Beacon Health Options' acquisition of Value Options. Senior Quality Management Clinician - Quality Management Beacon Health OptionsJun 2014 - Dec 2015 (1 year 7 months)Team Lead for behavioral health quality department, which utilized my Quality and Clinical experiences. Quality Assurance: Audited providers: Outcomes involved CAPs, Provider Partnerships and NYS Office of Professions. Responded to audits: NYS DOH Article 44, VNS Health, MetroPlus, Emblem, Oscar. Developed and implemented QM initiatives to improve HEDIS and STAR ratings. Wrote clinical practice guidelines and QM work plan. InterQual, Milliman Care Guidelines (MCG), ASAM and LOCADTR. Quality and SIU monitoring: Incidents, triggers and complaints. Candidate's Name - page 4Clinical work: Clinical Lead for NYS Attorney General Mental Health Parity settlement. Supported UMs and CMs as auditor and clinician for inpatient SUD and MH. Visited psychiatrists throughout NYC area to improve HEDIS scores. Director - Evaluation and Quality ImprovementThe Fortune SocietySep 2012 - May 2014 (1 year 9 months)Oversaw Quality: Alternatives to incarceration, mental health and SUD clinics, supportive housing, care management, education and employment.Interim Director of several programs: Supportive Housing, Transitional Housing and OASAS 822 clinic. Provided crisis intervention to persons with SMI and co-occurring SUD. Assured quality, cost-effective, culturally sensitive, regulatory compliant services: Expanded department to three Program Analysts, each covered an agency division. Extensive work with OMH Article 31, OASAS 822 programs, and SAMHSA grants. Improved KPIs, OKRs and audit results despite agency turnover rates that exceeded 50%. Composed housing PIPs and CAPs: HUD, OASAS MRT, OASAS NY/NY III, DOHMH NY/NY III, OTDA. Increased adherence to Seeking Safety PTSD and SUD treatment model. Manager - Government ContractsBreaking Ground (NYC Permanent Supportive Housing) Apr 2011 - Sep 2012 (1 year 6 months)Proposal writing and contract management for supportive housing and Homeless Street Outreach. Funder facing role: NYC Continuum of Care and regulatory agencies. Developed budgets, work plans and revenue projections. Completed HUD APR reports using HMIS data.In conjunction with Program Directors and Finance Department, ensured compliance with contract reporting and deliverables :-OTDA: HHAP, Youth Foyer, SHP, Transitional Age Youth-DHS: Shelter, Street to Home, Safe Haven, SRO Support-HRA HASA and HOPWA: Emergency and Permanent Housing-DOHMH: NY/NY III Scatter Site, FUSE, Congregate Supportive Housing.-HUD/HPD: Shelter Plus Care, SRO Mod, Project Based Vouchers, SRO Support, Section 202. Interim Administrator - Early InterventionJamaica HospitalNov 2009 - Jan 2011 (1 year 3 months)Led and evaluated program for families speaking Spanish, Urdu, Hindi, Tagalog, Bengali, Punjabi, and Gujarati.Turnaround Management: Expanded relationships with NICUs and pediatric clinics. Candidate's Name - page 5 Reduced fiscal deficit via increased oversight of financial services vendor. Created business plan focusing on recruitment of FFS providers and patients. Improved quality as per DOHMH OPRE, IPRO, the Compliance Department and external CPA firms. Director of AdministrationCenter for Independence of the Disabled, New YorkJul 2006 - Jul 2009 (3 years 1 month)Performance and contract management for an advocacy organization: Health insurance, housing and benefits. Acquired and managed 20+ government and foundation contracts. ACCES VR, DHCR, DOH, RSA, DOHMH, DYCD, Nutrition Consortium, PAVA. Managed operations, contracts, compliance, reporting, finance, HR and IT. Regional administration of HCBS programs (TBI and NHTD), peer counseling and advocacy. Provided crisis intervention to persons with SMI and co-occurring SUD. Accomplishments: Programs consistently did well on programmatic and fiscal audits. No budget deficits.Assistant Division Director - Behavioral Health Services Goddard RiversideJul 2004 - Jun 2005 (1 year)Programs included Mental Health Clubhouse, ACT, Homeless Outreach, Supportive Housing and Employment. Composed reports to OMH, DOHMH, VESID, DHS, HUD, HRA HASA and foundations. Quality assurance, fiscal monitoring, performance management, policies and procedures. Provided crisis intervention to persons with SMI and co-occurring SUD. Accomplishments: Enhanced partnership with CUCS's Homeless Psychiatric Outreach program, aka Janian Psychiatry. DOHMH program audits in November 2004 resulted in no cites requiring corrective action. No budget deficits.Director - Children's Mental Health ServicesUniversity Settlement Society of New YorkJan 2000 - Jul 2004 (4 years 7 months)Oversaw two children's mental health programs: Intensive Case Management: a supervisor and 15 Case Managers. Home Based Crisis Intervention: a supervisor and 4 Crisis Intervention Specialists. Accomplishments: Expanded relationships with behavioral health clinics and referral sources. Provided direct services to families with children with SED. Launched program for children at imminent risk of psychiatric hospitalization. Composed proposals to OMH, DOHMH and foundations which doubled funding. Awarded grant by a family foundation to enhance services to sexually abused children. Earned excellent fiscal and programmatic audit results from IPRO, DOHMH and OMH. Candidate's Name - page 6 No budget deficits.Senior Clinical Social Worker - Group HomesThe Children's VillageJun 1996 - Dec 1999 (3 years 7 months)Supported adolescent males in foster care. Quality metrics included educational success, work experience, family reunification, housing stability, and criminal justice involvement.Trained staff and MSW interns.Progress notes, psycho-socials, court reports and FASPs.Extensive collaboration with the agency's RTC, RTF and Crisis Residence.Member of agencys Quality Assurance Committee (TJC, COA, NYS OCFS, NYS OMH).After hours work with OMH SED HCBS.Pre-MSW Direct Service rolesVarious Behavioral Health organizationsMar 1989 - May 1996 (7 years 3 months)Learned the fundamentals through direct service roles and internships, almost 30 years ago: Pax Christi Mens Shelter, Port Jefferson, NY. 1993-1996 Westwood Lodge psychiatric hospital, Westwood, MA. Summer of 1994 and 1995 Saint Josephs Addiction Treatment and Recovery Center, Saranac Lake, NY. 1992 - 1993 Foodshare, University of Dayton, Dayton OH. 1989 - 1992 EducationNew York UniversityCertificate in Program Accounting and Government Reporting, Nonprofit Accounting 2008 - 201015 credits of graduate level accounting and compliance courses Stony Brook University College of BusinessMaster's Degree, Management and Public Policy1994 - 1996MPAStony Brook University Graduate SchoolMaster's degree, Clinical/Medical Social Work1993 - 1995MSW. New York LCSW-R earned in 1999University of DaytonBachelor's Degree, Business/Managerial Economics1987 - 1992Candidate's Name - page 7Licenses & CertificationsLicensed Clinical Social Worker, LCSW-R - New York State Education Department Issued Sep 2004 - Expires Nov 2024R052154-1National Provider Identifier, NPI Number - Center for Medicare and Medicaid Services, CMSPHONE NUMBER AVAILABLECertified Field Instructor, Seminar in Field Instruction "SIFI" - Fordham University SkillsHealthcare Industry Budgeting Change Management Quality Control Program Planning Clinical Consultation Quality Management Program Evaluation Managed Care Healthcare ManagementCandidate's Name - page 8 |
