Work end-to-end provider claim and call quality, ease use of physician portal and future service enhancements, and training and development of external provider education programs, Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.) and practice managers, Directs and implements strategies relating to the development and management of the provider network, identifies gaps in the network composition and services to assist the network contracting and development of staff in prioritizing contracting needs, identify and remedy operational short-falls and remediate claims• Gathering data from relevant systems (Claims, data warehouse, payment integrity, EDI/Portal reporting, customer relations systems) and business partners; contracting and claims.• Communicating and advocating providers’ needs to internal stakeholders on order to drive creation of solutions that meet mutual business goals.• Developing resources and programs to assist and educate providers (web-based training, quick reference guides, FAQ documents)• Working with internal groups to identify, understand, and/or improve internal tools, resources, systems, and capabilities that can maximize provider, member, or company performance. • Summarizing and communicating provider network outcomes (recruitment and retention) to internal and external stakeholders while implementing improvement/expansion opportunities to provider services.• Ensuring that provider data (demographics, fee schedule) is accurate through audits, re-credentialing, an/or outreach.• Coordinating with internal and/or external resources to implement provider solutions while ensuring that solutions meet the providers needs and increase provider satisfaction by simplifying processes.

Work end-to-end provider claim and call quality, ease use of physician portal and future service enhancements, and training and development of external provider education programs, Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.) and practice managers, Directs and implements strategies relating to the development and management of the provider network, identifies gaps in the network composition and services to assist the network contracting and development of staff in prioritizing contracting needs, identify and remedy operational short-falls and remediate claims• Gathering data from relevant systems (Claims, data warehouse, payment integrity, EDI/Portal reporting, customer relations systems) and business partners; contracting and claims.• Communicating and advocating providers’ needs to internal stakeholders on order to drive creation of solutions that meet mutual business goals.• Developing resources and programs to assist and educate providers (web-based training, quick reference guides, FAQ documents)• Working with internal groups to identify, understand, and/or improve internal tools, resources, systems, and capabilities that can maximize provider, member, or company performance. • Summarizing and communicating provider network outcomes (recruitment and retention) to internal and external stakeholders while implementing improvement/expansion opportunities to provider services.• Ensuring that provider data (demographics, fee schedule) is accurate through audits, re-credentialing, an/or outreach.• Coordinating with internal and/or external resources to implement provider solutions while ensuring that solutions meet the providers needs and increase provider satisfaction by simplifying processes.

Trained to assist in the development of Provider Education Programs that would meet the overall strategy and priorities of the organization, while building and maintaining strong professional relationships with the provider community, both contracted and non-contracted providers.• Trained to educate Providers on all aspects of the Managed Medicaid Program, including claims, quality measures, utilization management, and compliance.• Assessed competitor information and implemented recommendations.• Identified trends and implemented plans to improve member satisfaction.• Collaborated with the care management team regarding implementation of products and communication related to improved health status of our members, achieving NCQA accreditation and HEDIS measures.

Overall Responsibility for Des Moines and Iowa City, Iowa Supervised Apartment Living for At-Risk Youth• Manage 15-18 staff, to include performance management, training, and education on policy, program requirements and state requirements, to ensure quality assurance of all program documentation.• Experience with Claims issue resolution• Responsible for State and Licensing Audits; Serve as primary point of contact for client documentation and meeting audit requirements.• Provide case management services for four Supervised Apartment Living houses with a maximum occupancy of six clients per house. • Develop Initial Treatment Plans, Quarterly Reports, and Discharge Summaries for each client. • Coordinate and attend Court Hearings, Family Team Meetings, Staffings, and Healthcare appointments, serving as an advocate and making recommendations on client cases.• Ongoing collaboration with Schools, Juvenile Court, Families, and DHS on client needs, concerns and progress.

Developed and Implemented Aftercare Services Program for two Residential Treatment Facilities in Ames and Waverly, Iowa• Responsible for ongoing curriculum development and implementation, as well as meeting performance measures outlined in the grant for the After-Care Program.• Managed a team of 8, to include ongoing performance management, training and education on program requirements.• Responsible for Staff Training: Trauma Centered Care and Family Interactions• Provided leadership and guidance to Employees, Families and Youth involved in the program. • Reviewed all clinical and behavioral documentation to ensure data integrity. • Responsible for quality assurance process in the program.

• Designed and implemented rehabilitation programs, to help facilitate a smooth transition for youth returning to their families and schools, upon completing their programs at Woodward Academy. • Responsible for State and Licensing Audits within my case scope; served as primary point of contact for client documentation and meeting audit requirements.• Developed Initial Treatment Plans, Quarterly Reports, and Discharge Summaries for each client. • Coordinated and attended Court Hearings, Staffings, and Healthcare appointments, serving as an advocate and making recommendations on client cases.• Collaborated with Schools, Juvenile Court, Families, and DHS on client’s needs, concerns and progress.• Guided the course of treatment and ensure that all involved providers were working together toward common goals. • Coached cross country teams, demonstrating ongoing commitment to the youth and their development in the program.