Lori Dillard Email & Phone Number

Hartford, Connecticut, US

Hartford, Connecticut, US

• Responsible for successful execution and performance of all health services functions including Utilization Management, Care Management, Social Determinants of Health (SDOH) programs, and Behavioral Health/Physical.
• Lead in all external stakeholder engagements that require input on Health Services operations, care delivery programs, policies, and outcomes.
• Represent the health plan to corporate shared services and the overall enterprise for all health services operations issues specific to the health plan.
• Single point of contact between on health services operations between the health plan and clients/regulators including the Agency for Health Care Administration.
• Responsible for ensuring compliance with Florida Medicaid and CHIP contracts as it relates to health services operations.

Alexandria, VA, US

• Provide daily operational oversight and management control of CMS PRIME contract responsible for medical claims review audits of Medicare managed care organizations.
• Responsible for timely submission of all project deliverables and management of all tasks in project plan.
• Oversee and advise program staff including Medical Review Manager and Project Coordinator.
• Prepare bi-weekly status reporting as well as monthly reporting due to CMS and executive management
• Coordination with managed care plans and cost audit contractors to ensure timely completion of managed care audits.
• Oversight of implementation of case management system to document medical claims review exception findings.

Miami, FL, US

• Provide direction and oversight to ensure effective implementation for client utilization management/grievance and appeals programs including software development design, business rule documentation, and workflow.
• Optimize system processes and workflows to achieve successful quality outcomes and benefit maximization within the scope of responsibility.
• Act as a subject matter expert liaison for Clinical Services and/or a leader on cross-functional teams.
• Ensure proprietary software platform is compliant with all applicable state and federal regulations impacting utilization management and grievance/appeals.
• Ensure regulatory reporting resulting from software platform is accurate and compliant with regulatory requirements including CMS audit universes, ODAG reports, state mandated reporting.
• Assist clients with CMS and state audit preparation.

• Direct management to 4 health plan staff overseeing Contract Compliance, Fraud, Waste, and Abuse Prevention and Detection, and Delegation Oversight.
• Establishment and maintenance of comprehensive compliance program to prevent illegal, unethical or improper conduct
• Establishment and maintenance of internal audit function for all operational activities of the health plan.
• Primary point of contact for all regulatory and compliance matters relative to the managed care plan’s Florida Medicaid contract.
• Successful and timely submission of all health plan regulatory reports and submissions due to the Agency for HealthCare Administration (AHCA)
• Development, initiation, maintenance, and revision of all health plan policies and procedures.

• Integral Quality Care is a not for profit Medicaid Provider Service Network (PSN) health plan serving members in 3 regions across Florida.
• Direct management to 3 health plan managers overseeing Care Management, Utilization Management, Retrospective Review, Physician Review Services, and Project Management.
• Overall management of over 75 health plan staff.
• Served as senior project lead for implementation of statewide Medicaid managed care plan including communication with state regulators, implementation and monitoring of project plan, creation of health plan policies.
• Successfully implemented clinical care management system health plan wide
• Serve as liaison with regulatory and accrediting agencies.

• Direct management to 10 operations health plan staff
• Direct responsibility for health plan operations including claims, call quality, informatics, project management, credentialing, and community outreach.
• Provide day-to-day leadership and management to health plan operations staff. Interface with corporate office staff as required.
• Assist the health plan’s COO in collaborative efforts related to the development, communication and implementation of effective growth strategies and processes. Directed and assisted with implementation of new.
• Communicate, motivate and lead a high performance management team. Attract, recruit, train, develop, coach, and retain staff. Foster a success-oriented, accountable environment within the health plan and within.
• Direct responsibility for all delegated vendors for the health plan and responsible for successful implementation those vendors.

Tampa, Florida, US

• Completed concurrent review for inpatient psychiatric hospitalizations and partial hospitalization programs for Medicaid and Medicare members in Florida, New York, and Missouri.
• Utilized InterQual Inpatient Psychiatric and Partial Hospitalization Psychiatric guidelines to certify medical necessity.
• Referred cases, as appropriate, to consulting psychiatrists for final approval or denial of inpatient hospitalization days.
• Managed average daily census of 20-25 cases.

Minneapolis, MN, US

• Completed brief telephonic integrated assessment and referral for counseling services for service members and their families.
• Provided case management services such as resource linking, specialty consultation referrals, and psychoeducation to service members and their families.
• Utilized electronic records system and concurrent documentation of all cases.
• Provided telephonic crisis intervention to service members and their families.
• Maintained strict adherence to established schedule as required in call center environment.

• Provided direct clinical and administrative supervision to four master’s level therapists and one bachelor’s level intern
• Monitored budgetary compliance of program including productivity standards of clinicians and other expenses
• Performed clinical review of client charts to ensure agency standards of documentation and provision of treatment
• Revised necessary clinical documentation including biopsychosocial evaluation to ensure compliance and efficiency
• Provided departmental trainings on variety of clinical issues based on clinical need

• Provided individual and family therapy to caseload of over 80 children and their families with a range of mental health diagnoses
• Coordinated treatment with community referral sources such as foster care case managers as well as internal referral sources such as psychiatric staff or case managers
• Completed biopsychosocial assessments and treatment plans on all clients
• Used standardized assessment tools and incorporated those results into assessments
• Provided specialized trauma-focused treatment to victims of abuse, neglect, and other traumas and involved both biological and foster parents in this treatment
• Provided agency supervision in trauma-focused cognitive behavioral therapy model

Master Of Education (M.Ed.), Mental Health Counseling/Counselor

Ed.S., Mental Health Counseling/Counselor

Bachelor Of Science (B.S.), Psychology

Diploma, High School/Secondary Diplomas And Certificates