• Responsible for working with Medicaid/Medicare health plans to ensure compliance with NCQA standards • Work on national and market-level quality improvement activities, projects, and initiatives, • Provide ongoing oversight of health plan quality program work plan and evaluation.• Conduct clinical quality audits of NCQA standards.• Leads NCQA survey process from beginning to end including evidence development, preparation and organization• Facilitate and support assigned quality committees.• Reviews the work of others at health plan and team level

• Supervised training supervisor whose responsibilities included development and implementation of training program, development and maintenance of P&Ps and supervision of Credentialing Grid Preparation Team.• Completion of Green Belt Training.• Participated in several Op-X projects including the redesign of a paperless and electronically driving the credentialing process.• Designed and implemented internal auditing process including tools, P&Ps and reporting metrics for the newly consolidated National Credentialing which is responsible for the credentialing and recredentialing of multiple UHG health plans.• Supervised dedicated Quality Auditor who performed internal quality audits.• Represented National Credentialing at UHG health plan audits including NCQA, HEDIS, URAC, Medicaid/Medicare, DOI, Market Conduct and other regulatory audits. • Addressed regulatory and accreditation concerns from all health plans regarding credentialing process to assure compliance.• Prepared files for all audits mentioned above.• Prepared file review reports for all audits mentioned above.• Prepared and implemented all Corrective Action Plans as needed.• Developed and maintained Business Continuity Plan

• Reviewed provider treatment plans, provided treatment recommendation and authorization of care. • Intensive case management of members deemed high risk for utilization of service.• Provided referrals and crisis intervention.• Reviewed Partial Hospitalization / Intensive Outpatient programs and Inpatient care• Coordination of continuity of care.• Provided interpretation of mental health benefits.• Team meetings/clinical peer review.

THE OHIO STATE UNIVERSITY, OSU/HARDING BEHAVIORAL HEALTH AND MEDICINE - Columbus, Ohio, 2002 - 2003 -Admissions Coordinator, Adult Partial Hospitalization ProgramDOCTOR’S HOSPITAL WEST - Columbus, Ohio, 1997 - 2002 (Part-Time) -Admissions Coordinator/Emergency Psychiatry ServicesRIVERSIDE METHODIST HOSPITALS - Columbus, Ohio, 1989 - 1997 - Emergency Psychiatry Services -Outpatient Counseling Center -Adult and Older Adult Inpatient Programs