- Directly responsible for national joint ventures with ASO's, Providers. and Hospital Systems.- Lead and or participated in the development and implementation of multiple client/provider engagement ventures (IPANS, CMG, BMS, Addabbo, SOMOSin need of Clinical, Quality, and Revenue/Operational Cycle Transformation opportunities. My embedded direct reports and I are responsible for the development of short and long term strategic products and client action plans in support of Clinical Provider Enablement sales and profitability objectives. - Lead internal program assessment and analysis to address contract leakage opportunities (i.e. Vivity Contract and claims payment). Identified over $1.5 million in incorrect claims payment to Vivity Founders. Report lead to correction of claim protocols and amending system to avoid future overpayments.- Successfully lead embedded operational team from implementation phase through strategy, action planning, and strategic alignment of provider and operational performance measures to improve quality related indicators, identify and close gaps in care, enhance member experience and care delivery/execution, improved clinical documentation and provide ongoing transformation support and education to sustain best in class care delivery. Designed Practice Transformational plans that enabled CMG physician practices to increase revenue, mitigate cost overages and administrative inefficiencies. Client also conducted an internal survey of our Practice Transformation value and my team received a 98% success rate and “highly recommend.”-BMS: Provided operational strategy that successfully reduced patient wait times by 50% within first month. Increased patient satisfaction and practice experience.

Director of Meddicare and Medicaid Compliance with direct oversight of regulatory compliance, privacy, HIPAA, and Fraud Waste & Abuse units.- managed all regulatory filings with DMHC, CMS and other governing bodies.- responsible for overseeing DMCH audits and responses on behalf of the organization. - Re-built Privacy and FWA units and received "Best in Class" confirmation from DMHC

- Direct oversight of Commercial telephonic clinical/non-clinical care management delivery teams (Outpatient Precertification, Transition Assistance & Specialty Medical Management– East/West/and Central regions) including Business Change Management and Reporting/Analytics Team. - Project managed all on/offshore vendor clinical and non-clinical related activities (AIM & Accenture) to meet/exceed all SLA performance and cost mitigation measures and improved clinical outcomes.- Incorporated new enterprise process delivery and reporting models (on/offshore) to ensure consistency, operational efficiency, and sustainability.- Lead, facilitated, acted as SME for Enterprise-wide, State, and Pilot related projects including Cost of Care, System Innovations/Migrations, and Enhancements i.e. ACMP and Watson). Initiatives streamlined processes in which providers submitted outpatient authorizations. Reducing approval/review time and increased provider satisfaction in dealing with Anthem.- August 2011 –May 2014 GBD Operations: Direct oversight of Government Business Division (GBD) Post Service Clinical Claims Review, West Region UM/CM Clinical Operations, Onshore Intake/ A&I, Medicare Operational Compliance, Clinical Rationale Team, Audit Team (Clinical and Non-Clinical), as well as oversight of vendor (Accenture) Projects (Outpatient PreCert Team, Post Discharge, Telephonic and Non Telephonic Call & Fax teams, and Post Service Clinical Claims Review). Oversight of dedicated Business Analysts, Business Change Directors supporting ICD9/10 migration, STARS strategy/improvement/delivery, HCC coding, - Designed and implemented clinical tools and IVR capabilities - (Clinical Decision Support Tools, MD Sort Tools, Targeted Inbound/Outbound Member Outreach dialer initiatives – member alerts related to screenings, MD visits, Medication adherence reminders).

- Site Director: Direct oversight of Clinical Managers, Supervisors, in-direct oversight of 66 Registered Nurses, and 16 Administrative Support Staff. Overall Cypress CA site accountabilities included 168 total fte’s.- Project Lead to overhaul new member call outreach delivery model which resulted in a 36% increase in consumer contacts/enrollments in disease management programs (CAD/Diabetes). Leveraged data from Analytics team to identify chronic condition members for dialer campaign. Treatment Decision Support and Transitional Case Management teams ensured patients had support mechanism to get to/from doctor’s office post discharge, medication adherence, adherence to disease management protocols, and ensure members are current on health related screenings and vaccinations. Projects lead to a reduction in unnecessary ER/Urgent Care related visits.- Developed telephonic educational IVR for chronic condition members to obtain access to condition management resources, in-home scale which allowed monitoring of member’s weight, activity, behavioral health, and mobility related issues.

- Co-lead corporate initiative to create, develop, and implement new Medicare Special Needs Plan (SNP) and Part D offerings in 7 states. Directly accountable for all regulatory filings with CMS, direct oversight of operational modeling for (Sales & Marketing, Clinical Delivery, Enrollment, Membership Accounting, Risk Adjustment Reconciliation, Encounter Data/Reporting) budgeting, and benefit development. Initial responsibilities for overseeing Sales and Marketing Team/Strategy and Clinical Operations until subsequent staffing acquired. This was Molina Healthcare’s first expansion in programs beyond Medicaid. First year revenue from MA SNP program was $125 million, year two - $272 million.- Developed corporate compliance Audit Program to ensure corporate and individual state preparedness for CMS audits and adherence to regulations.- Utilized extensive experience in problem identification and corrective action plans to successfully integrate risk adjustment, encounter data, enrollment and disenrollment, and PDE tools to facilitate health plan financial recoveries and improve data integrity. Result of new process afforded the recovery of $1.2 million in retroactive risk adjustment payments.- Created member centric reporting to ensure condition management, appropriate coding, set alerts for upcoming screenings.- Orchestrated enrollment and eligibility automation process increasing productivity, organizational efficiencies, and increase audit functionalities to ensure accuracy in member data and payment.- Government Contracts/Compliance: Medicaid – California Medicaid Health Plan: Jan 2005 – Dec 2005. Responsible for state filings, monitor changes to both Federal and State laws to ensure compliance, correspondence, compliance reports, audits and investigations of fraud/abuse, and risk identification/mitigation for California Health Plan.