Oversight of clinical, medical, and behavioral health staff and provided continuous professional development opportunities and training to maintain and strengthen competencies. Worked jointly with CEO leading analyzing key data strategy, overseeing management of the daily operations. Oversaw day-to-day clinical functions, outsourced physicians, managed services, rates, terms and salaries, member care, medical and administrative staff, clinical claims review and business activities. Guided staff in the referral of members to Peer Support aided in finding services like housing, shelter, food, utilities, health care, family, and community resources. Created plans to achieve organizational goals, promote employee wellbeing, promoted, recognized, contributions at work and deliver quality mental and physical health care for our members. Worked in partnership with pharmacy director clinical and formulary management program for Medicaid and Medicare Part D to improve the quality of care by helping member access their medications, keep track of medications and addressing medications errors. Implemented and educated on the lean model to improve efficiency and increase profit and minimize waste while maximizing member value.

Spearheaded Regulatory Compliance program to identify risk and controls in the financial,operational areas. Directed the internal audit plan to identify improvements. Implemented a regulatory compliance testing and audit remediation program. Partnered with internal and external team to maximize resources and program effectiveness. Established strategy for programs using evaluation outcomes and research to set goals and direction. Collaborated with stakeholders to support and execute internal and external communication efforts. Develop effective compliance training programs for all employees including training for new employees. Collected key data and analysis to support continuous improvement and organizational strategic planning. Analyzed and developed a gap and risk assessment tool to identify gaps in policies, procedures, or compliance controls to remediation needed to mitigate and to take corrective actions and update materials as necessary.

Oversight of the Managed Care population with high socioeconomic needs and the development of robust forecasting of care utilization, medical cost, member disenrollment, coverage disruptions and the integration of Care Management. Implemented and deployed business transformation strategies to increase performance, profitability, and business growth with of Optum services. Delivered hands-on assistance to committees and teams within department in policymaking decisions. Generated and implemented process and clinical procedures and policies. Partnered with Optum staff to create professional development plans to support clinical and business growth for a reconsideration program. Identified high risk and optimized expenditures through company-wide cost reduction initiatives. Led and motivated management teams to peak levels of performance, consistently developing leadership skills to increase overall productivity levels. Responsible for Managed Care Member reports with respect to medical statistics, access to care, mental health parity, preventive health care, and care management reports. Managed Utilization Management and Prior Authorization Team operation budget of staff members within the management teams.

Accountable for the vision and strategy for prior authorization management activities to implement quality and service driven objectives. Engaged in interdepartmental coordination to improve business transactions through data analysis. Devised and implemented a process plan with Sr Director Provider in the creation of a provider-payer network to support services requiring Prior Authorization. Generated and implemented business procedures and policies. Oversaw Prior Authorization and clinical reviews with internal audits to assess risk and monitor activities to ensure meeting local, city, state, federal and NCQA requirements. Drove client satisfaction and improved support services to increase retention. Partnered with staff to create professional development plans to support personal and business growth. Provide leadership, coaching, mentoring, and feedback to help others build more confidence, think more creative, take risk, and learn. Oversaw the Prior Authorization hiring and development of associates, creating and empowering a collaborative work environment. Maintained high standards in hiring staff, prioritizing flexibility, resourcefulness, and drive.

NCQA Certification 2005 @ 100%NCQA Certification 2006 @ 100%Sr Director Medicaid National Implementations - Director Utilization Management & Director Medical Claims Review - Director Disease Management – Case Management - Manager Prior Authorization - Prior Authorization Nurse and Behavioral Health care with carved out substance abuse services with crisis intervention.• Orchestrated strategic business and clinical plans and oversight of the execution of Implementations with state executive meetings to drive client satisfaction and approval to completion and financial alignment to finalization of the Programs Readiness Review and contract management, claims processing, provider network development, financial reporting, and analysis.• Championed the innovative marking strategy and execution and business development of the State Medicaid programs.• Administered the National State Medicaid program Implementations initiatives with profits of $12-$15 million per year.• Engaged in interdepartmental coordination to improve business transactions through data analysis and implementation of lean strategies.• Implemented the AZ/National State Medicaid Disease Management program with biopsychosocial screening for our High-Risk members.• Received State and NCQA recognition and certification of 100% the first week and ROI 7% for the program.• Oversaw operations and evaluations of clinical development programs to include clinical, utilization management disease management, claims operations, prior authorization, teams’ performance, motivational interviewing, policies and procedures, and standardized activities.• Generated and implemented business and state required procedures and policies.• Partnered with staff to create professional development plans to support personal growth.