Lori Dillard

Lori Dillard Email and Phone Number

Managed Care Professional Specializing in Health Services Operations and Regulatory Compliance @ Aetna, a CVS Health Company
Lori Dillard's Location
Greater Tampa Bay Area, United States, United States
Lori Dillard's Contact Details
About Lori Dillard

A highly experienced professional with 16 years of managed care experience, who has demonstrated the ability to lead diverse teams to new levels of success in Regulatory Compliance, Operations, and Clinical Management. Demonstrated exceptional clinical, analytical, communication, collaboration, and relationship-management skills with a proven ability to analyze business requirements, identify deficiencies, and develop action plans for opportunities. Skilled at leadership coaching and staff development resulting in staff promotion to leadership roles.

Lori Dillard's Current Company Details
Aetna, a CVS Health Company

Aetna, A Cvs Health Company

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Managed Care Professional Specializing in Health Services Operations and Regulatory Compliance
Lori Dillard Work Experience Details
  • Aetna, A Cvs Health Company
    Chief Operating Officer For Aetna Better Health Of Florida
    Aetna, A Cvs Health Company Nov 2022 - Present
    Hartford, Connecticut, Us
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  • Aetna, A Cvs Health Company
    Chief Health Services Officer For Aetna Better Health Of Florida
    Aetna, A Cvs Health Company May 2021 - Nov 2022
    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 Health Integration.• 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.
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  • Integrity Management Services, Inc.
    Program Director--Cms Medical Claims Review Mco Contract
    Integrity Management Services, Inc. Sep 2019 - May 2021
    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.• Maintained the highest degree of quality for all activities performed in the contract and adhered to contract required quality measures.
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  • Independent Living Systems, Llc
    Director Of Utilization Management
    Independent Living Systems, Llc Jan 2016 - Sep 2019
    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 processes.• 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.• Ensure system functionality and reports meet regulatory and accreditation requirements (e.g., CMS, NCQA, URAC, AAAHC)• Conduct system testing as part of system development processes to ensure system compliance prior to release to client.• Periodically assess software system to identify potential compliance risk areas.• Maintain current knowledge of regulatory and accreditation standards and propose recommended system changes to ensure compliance is maintained.
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  • Integral Quality Care
    Compliance Officer
    Integral Quality Care 2015 - 2015
    • 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. • Company-wide compliance with all provisions of the Florida Medicaid Contract as well as all applicable laws and regulations. • Chair of Compliance Committee and Policy Committee. • Respond to alleged violations of rules, regulations, policies, procedures, and standards of conduct by evaluating or recommending the initiation of investigative procedures. • Act as an independent review and evaluation body to ensure that compliance issues and concerns within the organization are appropriately evaluated, investigated, and resolved. • Institution and maintenance of effective compliance communication program for the organization including promoting use of compliance hotline, awareness of code of conduct, and understanding of compliance issues. • Oversight of health plan’s fraud, waste, and abuse (FWA) program including oversight of the health plan’s Special Investigation Unit (SIU). • Oversight and maintenance of health plan’s delegation oversight program including pre-delegation and annual audits of all subcontractors as well as assessment of subcontractor operational compliance.
  • Integral Quality Care
    Sr. Director Of Utilization Management And Care Management
    Integral Quality Care 2013 - 2015
    • 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 and procedures, and subject matter expert on all health plan operations.• Successfully implemented clinical care management system health plan wide• Serve as liaison with regulatory and accrediting agencies.• Consistently exceeded all department metrics including turn around times, member engagement rates, and call center metrics.• Provide enhancements to business processes, policies, and infrastructure to improve operational efficiency including processes that cross multiple business functions.• 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 individual departments• Implemented health plan’s hybrid accountable care organization (ACO) and patient centered medical home model (PCMH) with large provider groups.• Responsible for benefit configuration direction provided to health plan’s third party administrator and claims payor.Accomplishments  Implemented statewide managed care contract with no corrective action items imposed by state regulator Successfully managed and implemented clinical care management system across all departments Developed and implemented behavioral health integration program for care management team Subject matter expert and trainer for Motivational Interviewing techniques for care management staff
  • Integral Quality Care
    Director Of Operations
    Integral Quality Care 2011 - 2013
    • 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 programs, services, and preparation of bid proposals.• 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 individual departments.• Direct responsibility for all delegated vendors for the health plan and responsible for successful implementation those vendors.• Health plan subject matter expert on all matters related to behavioral healthNotable Accomplishments  Developed and implemented health plan’s delegation oversight program for all delegated vendors Assisted in creation of health plan’s RFP response to statewide Medicaid managed care contracts Leadership coaching resulted in promotion of two staff to management roles Creation of call center SharePoint resource site for use by all health plan call center staff. Project lead for successful implementation of health plan’s delegated behavioral health and dental vendors
  • Wellcare
    Behavioral Health Care Manager, Utilization Review
    Wellcare Mar 2010 - Jan 2011
    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.
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  • Ceridian
    Military One Source Consultant
    Ceridian Sep 2009 - Mar 2010
    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.
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  • Directions For Mental Health, Inc.
    Children'S Outpatient Supervisor
    Directions For Mental Health, Inc. May 2008 - Jun 2009
    • 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
  • Directions For Mental Health, Inc.
    Children'S Outpatient Therapist
    Directions For Mental Health, Inc. Jun 2002 - May 2008
    • 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

Lori Dillard Skills

Medicaid Behavioral Health Healthcare Mental Health Healthcare Management Managed Care Medicare Training Hipaa Family Therapy Psychotherapy Treatment Crisis Intervention Utilization Management Clinical Research Health Insurance Case Managment Cbt Social Services Motivational Interviewing Credentialing Community Outreach Health Policy Healthcare Industry Clinical Supervision Hmo Adolescents Group Therapy Psychology Disease Management Counseling Psychology Utilization Review Mental Health Counseling Inpatient Ncqa Provider Relations Dbt Infant Mental Health Adults Anger Management Nursing Self Esteem Hedis Psychiatry Therapists Medicaid Managed Care Prevention Program Evaluation Case Management Services Workshop Facilitation

Lori Dillard Education Details

  • University Of Florida
    University Of Florida
    Mental Health Counseling/Counselor
  • University Of Florida
    University Of Florida
    Mental Health Counseling/Counselor
  • University Of Florida
    University Of Florida
    Psychology
  • St. Pete High
    St. Pete High
    High School/Secondary Diplomas And Certificates

Frequently Asked Questions about Lori Dillard

What company does Lori Dillard work for?

Lori Dillard works for Aetna, A Cvs Health Company

What is Lori Dillard's role at the current company?

Lori Dillard's current role is Managed Care Professional Specializing in Health Services Operations and Regulatory Compliance.

What is Lori Dillard's email address?

Lori Dillard's email address is ld****@****tym.com

What schools did Lori Dillard attend?

Lori Dillard attended University Of Florida, University Of Florida, University Of Florida, St. Pete High.

What are some of Lori Dillard's interests?

Lori Dillard has interest in Social Services, Children, Civil Rights And Social Action, Human Rights, Animal Welfare, Health.

What skills is Lori Dillard known for?

Lori Dillard has skills like Medicaid, Behavioral Health, Healthcare, Mental Health, Healthcare Management, Managed Care, Medicare, Training, Hipaa, Family Therapy, Psychotherapy, Treatment.

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