Directs the activities related to the development, optimization, and maintenance of the physician and provider delivery system for Medicaid members. Manage team of 11 associates to procure competitive provider contracts, enhance the integrity of provider data, and deliver market-leading provider relations. Institute and lead cross-functional meetings in order to improve communication and workflows in a matrix environment. Represent health plan across multiple enterprise initiatives. Responsible for establishing Value-based payment arrangements with qualified providers. Directs communication and compliant resolution strategies between physicians, hospitals, members, and the public.

Responsible for Hospital and Value -Based Contracting and provider relationships in the Rochester and Buffalo regions. Also responsible for Ancillary Contracting and provider relationships across the MVP Network. Work with leaders inside and outside of company to develop, negotiate, oversee and implement Value Based Contract Models including: ACO Shared Savings and Risk Models, Capitation, Global Payments, Incentive Plans and other non FFS reimbursement models. A lead participant in Payment Reform activities and contributes to the analysis and design of payment and quality incentive models. Represent MVP on Regional Collaboratives.

Responsible for Value Based Contracting and provider relationships in the West region. Work with both internal and external leaders to develop, negotiate, oversee and implement Value Based Contract Models for the West Region including; ACO Shared Savings and Risk Models, Capitation, Global Payments, Incentive Plans and other non FFS reimbursement models.

Responsible for the oversight of the data analysis and reporting functions for key Quality Improvement initiatives such as HEDIS/QARR, Accreditation, Pay-For-Performance, and Accountable Care Organizations. Key member of management team for the development and implementation of action plans in addressing areas of opportunity for HEDIS/QARR/STARS measures.Key Accomplishments:• Implemented 4 efficiency improving initiatives which increased speed of analysis performed by staff and automated processes allowing for a greater volume of work to be completed.• Developed comprehensive review of a full menu of quality metrics in order to micro-target key areas for improvement.

Responsible for multiple facets of analysis, reporting and training relating to the implementation of network reform strategy, including the transformation of Primary Care initiatives, Medical Home models, Shared Savings programs, and Accountable Care Organizations. Program manager for software used throughout the company to assist in evaluating the efficiency and effectiveness of physicians and medical practices. Developed and analyzed information from this program, trained internal and external constituents, and recommended strategy for tool and report deployment.Key Accomplishments:• Designed proprietary report to assist primary care physicians in selecting high-quality/low-cost specialists which was identified by the software company as highly innovative.• Developed training module for clients to understand analysis from network software program and achieve buy-in for use of analysis in quality incentive arrangements.

Thrived as primary analyst for company-wide Patient Centered Medical Home (PCMH) and Accountable Care Organization (ACO) initiatives across enterprise. Designed and implemented complex analysis to accurately attribute members to physicians and practices across the entire coverage area of MVP Healthcare. Acted as liaison to project managers of PCMH pilot project in the Adirondack Region. Coordinated additional payments to physicians and practices to encourage PCMH philosophy. Completed analysis on multiple quality indicators enabling evaluation of PCMH and ACO initiatives. Actively participated on multiple senior-level committees dedicated to developing long-term strategy of the company.Key Accomplishments:• Developed proprietary program that accurately evaluated members’ needs for care management services and producing reports for distribution to providers.• Completed complex analysis to evaluate various healthcare quality metrics and distributed over $3 million in 2014 to physicians as payments to incentivize quality improvement.• Designed and implemented a novel methodology that improved the company’s ability to attribute members to practices and physicians across the MVP enterprise network. • Lead analyst and subject matter expert for software product used throughout the company to assist in evaluating the efficiency and effectiveness of physicians and medical practices.• Performed detailed, complex analyses to assist management in developing contracts for PCMH and ACO arrangements.• Created procedures to maintain data integrity after discovering errors in a vital database which would have subjected the company to financial losses and distribution of erroneous information. • Integral member of team which redesigned payment process between various departments creating operational efficiencies.

Liaised with diverse clients and offered targeted Technology solutions. Demonstrated ability to consistently address unique needs and apply in-depth knowledge of Healthcare industry.

Excelled in dual roles, offering in-depth analysis on key departmental and interdepartmental trends, facilitating Primary Care Practice transition to Patient-Centered Medical Home (PCMH), and successfully implementing growth-oriented processes and standards. Demonstrated value of data analytics to URMC Medical Center, rapidly identifying and capitalizing on improvement opportunities. Key Accomplishments:• Oversaw operations and defined long-term strategy for Medicine in Psychiatry Service (MIPS) Primary Care Practice while simultaneously facilitating transition to Patient-Centered Medical Home (PCMH). • Reduced incomplete adverse event reports by over 80% within 3 months via diligent review of incidents and ensuring appropriate follow-ups. • Served as Subject Matter Expert in Epic, managing implementation, offering dedicated user support, and collaborating with builders and data analysts in addressing unique needs. • Streamlined Quality Assurance audit process and enhanced efficiency through Excel program offering intuitive interface for data input and production of graphical results. • Increased charting compliance 15% through audits and offering personal coaching to clinicians. • Led Performance Improvement project resulting in 20% gain in patient and clinician compliance with regards to receiving/administering pneumococcal vaccine. • Liaised closely with clinicians in revising methods of discussing medications with patients, resulting in significantly improved patient satisfaction scores. • Established standard method of conducting operations and ensured employee compliance with regulatory measures through developing comprehensive Policy and Procedure Manual. • Recognized by management for guiding 10-member team responsible for reviewing/updating policies in The Psychiatric Nursing Policies and Procedures Manual in preparation for Joint Commission accreditation survey.

Offered 1-on-1 care and support to at-risk patients, creating and leading psychotherapeutic groups heightening patient knowledge and distress tolerance skills. Served as primary trainer spanning 5 units responsible for staff safety and de-escalation techniques. Enhanced efficiency of patient care and staff communication through introducing measures summarizing psycho-educational teaching and encouraging logical continuation of patient treatment goals. Recognized by clinical leadership as outstanding trainer and supervisor of newly hired psychiatric technicians, offering guidance geared towards long-term success. Key Accomplishments:• Reduced incidence of restraint 65% as well as staff injuries over 3-year period on Adolescent Psychiatric Inpatient unit through developing specialized training module on restraint and de-escalation techniques. • Chaired interdisciplinary committee and instituted extensive procedural changes to structure and efficiency of inpatient psychiatric unit, resulting in significant staff retention gains and reduction in adverse patient events. • Bolstered productivity of nursing staff through modules for patient treatment goals and therapeutic groups, reducing preparation time required for group therapy sessions. • Prioritized staff compliance with departmental policies/procedures, leading orientation classes for all psychiatric nursing employees as well as instructing physicians on hospital and state-mandated policies regarding therapeutic restraint and seclusion. • Empowered nursing staff and minimized issues through instituting method of self-scheduling. • Noted for outstanding leadership capabilities and expertise in behavior management and patient management. Selected by peers as Employee of the Year 2003.

Facilitated countrywide research project examining mental status of children entering foster care system, coordinating across multiple sites and primary researchers to determine appropriate level of mental health services. Served as primary research assistant for 3 faculty members, managing multiple priorities and maintaining detailed documentation. Interacted with Child & Adolescent Inpatient Psychiatry Unit patients, completing self-report questionnaires for psychologist review. Supervised total of approx. 20 undergraduate students. Key Accomplishment:• Co-authored innovative paper on group therapy based on research findings.