Responsible for the Utilization Management, Provider Relations and Quality Departments of CBHA.-Led organization to transition from internally derived medical necessity criteria to nationally recognized criteria-Updated training program through the use of an internet platform-Led organization to update security program and policies based on recent audit

• Interviewed and trained new call takers on MBHO processes• Directed increase in staffing to double size of office within two months. Grew training and management oversight to match increased size.• Acted as liaison with MBHO for issues related to processes, procedures and other issues• Oversaw development of training program for Customer Service Reps• Organized process to have all call takers work from home during Covid-19 emergency• Established QA process for call takers• Instituted system of developing call takers for leadership roles, including coaching and development of call taker skills.• Moved resources to bring call center up to standards and consistently meet contracted standards.• Established system of disseminating updated information in a rapidly changing environment

• Met or exceeded medical action plan goals related to my team.• Maintain positive relationship with large volume behavioral health providers.• Oversee for a team of clinicians, supervisor, team lead and customer service reps in an MBHO call center setting. Team members located both onsite and offsite.• Lead regular meetings with large providers to discuss utilization measures and any quality of care concerns.

• Responsible for all client company reporting, including quarterly, annual and performance standard reporting• Developed and reviewed annual Quality Improvement Work Plan.• Responsible for company compliance with state and federal regulations• Led working group to develop and implement new IT system for MBHO.• Developed telephonic case management program within utilization management program• Serve as subject matter expert for the organization concerning regulatory issues and changes.• Managed relationship with client-company, benefits broker and medical TPA• Advocated for the inclusion of evidence based treatments in client company coverage and make plans for management of those services• Negotiated contracts with facilities and hold increases to company goals• Oversaw all aspects of the credentialing process, including audits of delegated credentialing.• Investigated complaints/grievances against providers.• Worked with medical director and statewide autism experts to develop program to manage ABA benefits in an MBHO.* Interfaced with medical TPA to create two behavioral health solutions- Physicians Consultation Program and Behavioral Health Care Management Program-for their members.* Assured that care is authorized consistent with Utilization Management standards.* Assured that provider network has adequate coverage for service area.

• Supervised Clinical Care Managers (CCM) and customer service personnel in a call center setting, as well as staff clinicians in a separate EAP office • Provided consultations to managers/supervisors/HR contacts at client companies about employee issues, policy and the EA program, as well as consultation with Account Executives.

• Responsible for authorization of EAP/MHSA services, as well as consultations with human resources, supervisors and account management.• Appointed as “go to” person for certain high touch accounts

• Launched new internal EAP office, providing assessments, referrals, trainings and consultations.

• Provided behavioral health case management services, as well as emergency department evaluations and trainings to client companies

• Responsible for assessments, referrals, trainings, CISD’s and account management activities.

• Provided assessments, trainings, consults and CISD’s in a staff model EAP.