Evaluate compliance with applicable regulations and recommend corrective action plans, deliver training to FEPDO, Plans, OPM, and vendors. Consultant on audit activities and issues, develop audit programs, implementation of policies, training, and procedures designed to prevent program abuse relative to inefficient internal controls. Lead projects related to Program Assurance, provide support and assurance on FEPDO on Plan budget. Leads projects and provides oversight and guidance to other audit staff. Evaluates the level of compliance with federal regulations, contractual requirements, and Association policies and procedures at FEP Directors Office, Plans, the Vendors and the FEP Operations Center. Recommends, develops, and delivers training, to address potential risks at FEPDO and various Plans. Track and monitor corrective action plans from various audits performed by FEPDO and OPM. Acts as the point of contact and manager of the engagement within FEPDO for all issues related to assigned Plans, OPM and vendor audits. Lead project teams in completing various activities in the Program Assurance Plan, including the budget and cost review, service charge distribution, various incentive programs, quarterly Plan refund monitoring, quarterly Plan investment account reconciliation monitoring, quarterly cash management, monthly due diligence and daily SPI review. Acts as a SME with FEP financial policies and procedures to Plans and vendor management regarding the audit process; instructs audit flow facilitation; analyzes audit trends, best practices and risk; and, develops an effective overall audit strategy. Provides leadership, guidance, and oversight, as required, to other consultants during the audit process. Develop and present IPA training on an annual basis. Leader for teams in completing various activities related to Control and Performance Reviews, Plan Program Wide audits, Office of Personnel Management, vendor audits and other assigned audit activities.

Manage the Community Care Coordination department which oversees HCBS waiver services. This includes hiring, training, scheduling, monitoring work load, conflict resolution, performance evaluations, creating and implementing job expectations, oversight of caseloads, monitoring staff production metrics, auditing medical health records and plans of care.Training all community staff, including clinical and social services in a person centered approach to utilize natural supports in conjunction with behavioral health services. Working with leadership in development and strategic planning, as well as, the tracking of over and underutilization of services to identify opportunities for improvement, followed by implementation of policies and procedures to initiate and monitor the community care coordination activities.

Manage the Care Coordination program and SNP Model of Care and Compliance program for MI Health Link program. Ensures integration of evidence based clinical guidelines into member interventions; providing staff education both individually and on a group level; serves as the liaison for staff with the medical management leadership team; and participates with Disease Management in identification of members at risk for certain disease states.Coordinates, monitors, and evaluates the activities of the various Care Coordination teams involved in managing the care of Medical, CSHCS and Medicare members. This may include, but is not limited to collaborating with physicians, family members, other managed care workers, social workers, public health departments, community mental health, inpatient case managers, discharge planners, and ancillary providers to ensure an optimal level of functional status and wellness. Establishes multiple case finding mechanisms and population specific assessment tools, identifies and assesses individuals through Predictive Model with catastrophic, complex or chronic risk factors who meet established criteria for entry into the Care Coordination program. Responsible for the development and maintenance of MHP protocols and policies specific to Care Coordination and the SNP model of care for the MI Health Link program. Initiates auditing and monitoring of the timeliness of care coordination interventions designed to optimize patient outcomes/goals and address barriers, including patient and family response and compliance with the care plan.

Manage the day to day operations and lead in business development for the Long-term Care Division. Responsible for the overall operations of the division including the supervision of all staff, financials, HR, IT development, corrective action plans including rights, contract compliance issues and program management. Projects included the development and implementation of service delivery training modules and the development of policies and contracts. Responsible for working with funders and State entities.

Worked with physically and intellectually disabled individuals. Responsible for scheduling of all staff, medications coordination, hospital visits, employment placement, all medical documents and reporting. Supervised 15 staff on medications administration, personal care techniques and person centered care