• Led the development and oversight of…o Business Continuity Management program to minimize impact and ensure business continuity and recovery in case of an incident, crisis, disaster or other event.o Special Investigations Unit to prevent, detect, mitigate and investigate fraud, waste and abuse.o Vendor management oversight program to evaluate vendor risk and manage vendor performance and compliance.• Analyzed laws and regulations to provide guidance to the organization on new… Show more • Led the development and oversight of…o Business Continuity Management program to minimize impact and ensure business continuity and recovery in case of an incident, crisis, disaster or other event.o Special Investigations Unit to prevent, detect, mitigate and investigate fraud, waste and abuse.o Vendor management oversight program to evaluate vendor risk and manage vendor performance and compliance.• Analyzed laws and regulations to provide guidance to the organization on new and existing requirements. Show less

• Responsible for corporate compliance and corporate privacy and security initiatives, including:o Engaging leadership on compliance;o Evaluating and managing compliance risk;o Overseeing compliance standards and controls;o Developing and providing training and education;o Monitoring and auditing compliance;o Chairing the corporate compliance committee; ando Detecting non-compliance and enforcing corrective actions.• Maintained positive relationships with… Show more • Responsible for corporate compliance and corporate privacy and security initiatives, including:o Engaging leadership on compliance;o Evaluating and managing compliance risk;o Overseeing compliance standards and controls;o Developing and providing training and education;o Monitoring and auditing compliance;o Chairing the corporate compliance committee; ando Detecting non-compliance and enforcing corrective actions.• Maintained positive relationships with government oversight agencies.• Analyzed laws and regulations to provide guidance to the organization on new and existing requirements. Show less

• Led the compliance program as Care Wisconsin’s corporate Compliance Officer. Responsibilities included:o Developing and executing strategies to improve Care Wisconsin’s Star-ratings for its Medicare Advantage and Prescription Drug (MAPD) plan;o Managing regulatory deadlines using HPMS, interpreting CMS memos, and interacting with CMS personnel;o Implementing and overseeing CMS audit protocols and program audit readiness;o Preparing training and education materials;… Show more • Led the compliance program as Care Wisconsin’s corporate Compliance Officer. Responsibilities included:o Developing and executing strategies to improve Care Wisconsin’s Star-ratings for its Medicare Advantage and Prescription Drug (MAPD) plan;o Managing regulatory deadlines using HPMS, interpreting CMS memos, and interacting with CMS personnel;o Implementing and overseeing CMS audit protocols and program audit readiness;o Preparing training and education materials; ando Leading marketing material development, reviews and submissions while applying Medicare Marketing Guidelines.• Led the Regulatory Affairs Department, including management of compliance and internal audit staff.• Developed and maintained effective relationships with the Department of Health Services, the Office of the Commissioner of Insurance, and the Centers for Medicare and Medicaid Services.• Led privacy and security initiatives as the Privacy and Security Officer.• Managed and oversaw the Pharmacy Benefits Manager (PBM) contract, including owning the PBM relationship and negotiating contract terms. Show less

• Corporate owner for WellCare’s Special Needs Plans serving dual-eligibles. These were WellCare’s most profitable and administratively complex MAPD plans, serving over 30,000 members in 69 plans across 11 states.• Conducted regulatory, market and financial analyses and developed and implemented successful product strategies and benefit designs to ensure profitable membership growth and retention.• Led projects with cross-functional teams to develop operational and service enhancements… Show more • Corporate owner for WellCare’s Special Needs Plans serving dual-eligibles. These were WellCare’s most profitable and administratively complex MAPD plans, serving over 30,000 members in 69 plans across 11 states.• Conducted regulatory, market and financial analyses and developed and implemented successful product strategies and benefit designs to ensure profitable membership growth and retention.• Led projects with cross-functional teams to develop operational and service enhancements to support the products and meet state and federal requirements.• Led the development of pre- and post-enrollment marketing materials.• Served as organizational subject matter expert on issues related to integration of Medicare and Medicaid, including providing training and information to sales staff to support the growth and retention of membership.• Directed the activities of corporate departments and state and local affiliates and offices throughout the service areas to achieve and maintain effective administration of the MAPD plans.• Built and maintained effective relationships with executive leadership and other key stakeholders to influence the development, delivery and growth of products across target markets. Show less

Led, managed and oversaw...• Compliance and Regulatory Affairs for Community Care and its affiliates, including developing and implementing the following programs and plans from concept to reality:o Compliance program, including monitoring and audits;o Medicare Advantage Prescription Drug plans;o Privacy and security initiatives as the HIPAA Privacy and Security Officer; ando Language access initiative as the Limited English Proficiency Coordinator.• Medicaid and… Show more Led, managed and oversaw...• Compliance and Regulatory Affairs for Community Care and its affiliates, including developing and implementing the following programs and plans from concept to reality:o Compliance program, including monitoring and audits;o Medicare Advantage Prescription Drug plans;o Privacy and security initiatives as the HIPAA Privacy and Security Officer; ando Language access initiative as the Limited English Proficiency Coordinator.• Medicaid and Medicare contracts (Wrote and negotiated Medicaid contract language, and monitored compliance with the Medicaid and Medicare contracts); and• HMO compliance requirements (Spearheaded the initiative to create Community Care’s HMO and migrate its PACE and Partnership plans to the HMO). Show less