Working in payment innovation and quality compliance within value based contracting market. Currently manage contracts representing 50% of government healthcare lives to include PPO, HMO, Medicaid, Medicare and ACA products valued at over $250 million dollars. I oversee the contracting and performance for a large, award winning health system and also the largest physician practice in the region. I also manage the qualified health plan program for value based contracting and continuously strive to create innovative ways to disrupt the market and be a true partner to providers and health systems with the goal of improving health outcomes and keeping healthcare affordable for our members.

Create and implement independent audit tools to gather, track, and evaluate data as it pertains to the various clinical and operational standards of production for Medical Management staff-clinical and non-clinical. Analyze audit findings. Identify opportunities for process improvement and quality initiatives,Meets work standards by tracking production, productivity, quality and customer-service (discharge planning) standards; assist in resolutions for identified operational deficits and assist with development of work process improvement initiatives. Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure Serves as liaison to the Compliance Department as it pertains to Medical Management/UM functions and serves as clinical compliance contact for Health Plan related audit/reporting requests as they relate to UM. Serve as Subject Matter Expert to Training Department for UM related training, specifically training of clinical staff. Serve as principle trainer for new hire training, on-boarding, and chair side training.Participate in departmental and staff specific training as it relates to audit findings, health plan corrective action plans, identified process improvements and quality initiatives. Ensure compliance and integration regarding new policies, job aids and new procedures established and how these changes impact other areas. Collect, analyze and organize all data as required by the individual Health Plans for monthly and quarterly reporting.Process, analyze and coordinate Annual Health Plan Audits as they relate to UM functions and responsibilities. Track and monitor all regulatory changes and update all necessary Policies and Procedures pertaining to the UM Department. Track, analyze, and perform, if necessary, Inter-Rater Reliability Audits on Medical Management Staff.

Daily oversight of clinical case management team. I assist in managing work loads, addressing complex cases and patient needs, work with an interdisciplinary team to provide the highest quality of care while maintain the highest level or resource management and allocation. Act as a leader in managing departmental compliance to policy and regulations, maintain fiscal responsibility to the company objective, clinical trainer for new hire nurses. program and process development.

Combat nurse that served in OIF. Worked the combat support hospital and forward surgical team as well as Medi-vac coordination and medical records. Worked on OPSEC detail. Managed the medical records at Fort Hood housing over 50,000 active participants. Worked as a PACU nurse in William Beaumont Army Medical Center