In this role, I drive successful communication and resolution of member issues by serving as the primary liaison between state and CMS regulators. I manage reporting requirements, corrective action plans, and ad hoc requests with precision. As a key coordinator, I lead state and CMS audits for AETNA's MMP, ensuring compliance and operational excellence. I am instrumental in enabling adherence to relevant CMS mandates and regulatory requirements across various operational areas, including case management, appeals and grievances, provider relations, and quality assurance. Through systematic tracking and rollout, I ensure these processes are consistently aligned with regulatory expectations.The achievements include:* Earned Six Sigma Yellow Belt and Medicare Expert certifications.* Secured a deficiency-free outcome in the 2023 comprehensive external quality review audit.* Succeeded in implementing complex regulatory guidance for the dual Medicare and Medicaid plan.* Strengthened network adequacy and contractual compliance by partnering with provider network and vendor management for first, downstream, and related entities (FDRs).

During this tenure, I formulated and executed effective healthcare strategies for Managed Care Organizations and nonprofit clients, with a focus on maternal, child, and mental health as well as chronic disease management. As a trusted advisor, I provided expert guidance in navigating public health systems, troubleshooting issues, and crafting robust solutions. I was responsible for designing and overseeing the creation of intervention plans, outcome measures, and system designs to optimize care responses. Additionally, I steered the design and rollout of Managed Care Entity Responses for Proposals (RFPs), directly contributing to significant contract wins.A small selection of my achievements included:* Obtained a $1.08B annual contract award for a Children's Behavioral Health Specialty plan.* Established and refined dashboards for Managed Care Plans to track and meet critical contract stipulations.* Enabled advancement of healthcare solutions by acting as a subject matter expert in maternal and child health.* Led conceptualization and strategy development for multiple Managed Care plans across the country, resulting in attainment of various successful RFP awards.

Here, I transitioned funding procedures to prioritize health outcomes and data-driven grantmaking, aligning them with the state health improvement plan and other key initiatives. I also designed continuous quality improvement plans and developed technical assistance protocols, utilizing a life course model to enhance maternal and child health outcomes.The highlights of this tenure included:* Led development and deployment of Ohio's first Pay for Success Rate Card for Home Visitation.* Headed daily operations of the Bureau, while ensuring compliance with federal and state regulations and achieving Ohio's first flawless Title V Block Grant review in 2018.* Directed cross-functional teams and over 100 staff members, administering three major federal projects with a combined budget exceeding $150M in state and federal funds.* Orchestrated state's home visiting system transformation as part of a five-year strategic vision, aimed at fostering interagency collaborations and integrating 31 state data sets to bolster predictive analytics for maternal health.* Pioneered the use of Agile Systems in the development of OCHIDS, leading toward streamlining of department's electronic medical record and billing system for optimal case management.

Throughout this tenure, I delivered operational oversight and provided strategic planning support for a statewide nonprofit organization, which was dedicated to children's public policy and advocacy. I established a robust policy-analysis system to monitor state and federal legislation, significantly elevating the organization's advocacy efforts and advancing its policy agenda.I was noted for the following:* Leveraged millions in federal funding to support children's health policy and advocacy initiatives.* Empowered members and advanced policy agenda by organizing multiple legislative events, advocacy training, and conferences.* Attained reduction in uninsured rate for children to 3% by authoring and securing largest grant in the organization's history.* Attracted over 800 members in grassroots strategies and legislative advocacy by building and implementing advocacy an effective action work plan.* Served as a recognized leader and expert in children's health policy, early care, and education, contributing to national boards and advocacy organizations.* Eliminated a budget deficit of $150K by forging and maintaining executive-level relationships with diverse funding sources, state agencies, and national associations.* Spearheaded creation and execution of a five-year strategic plan by conducting trend analysis to inform and exceed organizational objectives in child and maternal health policy.* Championed a cross-functional team in developing operational systems across human resources, fiscal, and training and development to enable compliance with nonprofit regulations, leading to three consecutive years of successful audits.

As the State Field Director and Chief Policy and Advocacy Officer for the Voicers for Ohio’s Children, I established and implemented a concise policy-analysis system to effectively monitor and track state and federal policies in various areas of child welfare, early care, education, and health policy, including coverage, prevention, and maternal health. I demonstrated expertise in children’s public policy, publishing multiple policy briefs, position papers, reports, and analyses. I also promoted and implemented grassroots strategies while building statewide networks with more than 800 members. Furthermore, I organized legislative events, advocacy training, and conferences while engaging with members and facilitating educational events. Aside from this, I spearheaded the 5-year strategic plan and analysis of trends affecting child and maternal health while consistently exceeding organizational expectations in constructing and facilitating the federal and state children’s public policy agenda. It was also part of my duty to oversee the Finish Line Project while researching and evaluating policies, programs, reports, policy briefs, and position papers. During my tenure in this organization, I proactively advocated for change and development processes in statewide Medicaid policy for presumptive eligibility for children, leading to the successful reduction of the uninsured rate for kids to 3% while leveraging millions of federal dollars. I was also acknowledged as a children’s health policy, early care, and education expert while coordinating resources to peers across countries. One of my significant milestones was being recognized and awarded for writing the organization’s largest grant in history to support children’s health policy and advocacy.

Tracked, monitored and analyzed state and federal policy in the areas of early care and education health coverage, access and policy and child welfare. Worked with elected officials and policy decision makers to develop sound public policy by lobbying legislators, recommending policy language, writing policy briefs, testifying in committee and building grassroots support at both the state and federal levels. Managed the grassroots efforts and established a Women’s Advocacy Action Network. Hosted annual advocacy day, statewide trainings and fund raising events. Solicit support of partner organizations and regional/local community influencers. Successfully wrote grant proposals to private funding sources, secured individual and private funding, managed fiscal budgets and complete required tracking reports. Identified sources for additional funding, training and relationship building opportunities.

Managed all aspects, including staffing, funding, material and training development of 24/7 in-house, hospital call center to support parents identifying high quality child and healthcare. Including oversight of 24-hour staffing, securing governmental and private funding and final budgeting. Wrote grant proposals, secured funding, managed fiscal budgets and completed required tracking reports. Identified sources for additional funding, educational opportunities and partnerships. Created and implemented marketing and outreach plans to include mass media, targeted market and grass roots components for all of Ohio. Planned and coordinated special events. Developed flyers, publications and marketing materials. Managed, researched, and developed additional community resources. Provided parenting and child abuse educational workshops/awareness campaigns for professional and community groups, as well as statewide elected officials. Supported Government relations in monitoring and lobby on legislation impacting child welfare and abuse and neglect impacting hospitals and providers and led Advocacy 101 and Legislative Process Sessions during Grand Rounds. Co-Led the campaign Pinwheels for Prevention, which became statewide to increase awareness of Child Abuse and Neglect. Interacted with cross system leadership, providers and front-line staff throughout the hospital and affiliates. Represented hospital on internal and external Leadership Committees. Cultivated relationships with internal and external stakeholders.