Sandy Potter, Lcsw, Mba Email & Phone Number

Albuquerque, Nm, Us

Philadelphia, Pa, Us

Clinical Operations Medicaid Care Management; Behavioral Health Strategy and Population Health Training

Philadelphia, Pa, Us

Arlington, Tx, Us

UTA School of Social Work - Teaching undergraduate research and Macro Social Work Practice III

Arlington, Texas, Us

With a focus on population health, my mission is to make behavioral health part of every healthcare interaction and improve overall health and well-being of individuals in North Texas. Overall leadership for behavioral health services at THR including emergency assessments across the THR system (average 1800 a month) 5 inpatient units (200 beds), The Recovery and Wellness Center (80 beds), and 19 outpatient locations. Significant achievements in first year: aligned payor contracting across the units, expanding the system of care, and reduced ER wait time for assessments from 70 minutes to 28 minutes by implementing telehealth use at a rate of 85% of all assessments.

Chicago, Il, Us

Government Programs Clinical Operations Solutions Team:• Improve member health outcomes and operational performance for Government Programs;• Responsible for Clinical Solutions ensuring achievement of organizational goals;• Responsible for clinical operations reporting;• Charged to lead teams to identify inefficiency in products, programs and systems of care;• Engage with organization partners to achieve strategic goals;2015-2017 based in Albuquerque, NM:• Responsible for all Medicaid UM Programs and NM Centennial Care Care Coordination;• Engaged clinical teams to achieve operational goals, eliminate penalties, eliminate revenue loss and close gaps to achieve NCQA re-accreditation and audit performance improvement.Improved performance for care coordination to meet contract compliance in 6 months. Developed an innovative solution to manage fax-based requests through clinical triage to exceed contract performance. Developed and implemented a reporting and management solution which reduced errors and improved clinical management achieving overall program compliance for the LTSS program for Centennial Care.

Norfolk, Va, Us

Improve outcomes and performance in pursuit of the mission to help people live their lives to the fullest potential.• Oversee, monitor and ensure NorthSTAR Contract and URAC Compliance• Expand Texas Market and Provider Contracts• Identify efficiencies in products, programs and systems of care• Work with ValueOptions organization partners to oversee the execution of excellence in local operations• Work closely with the management team and local stakeholders to ensure the implementation of relevant recovery oriented system of care programs and best practices to improve outcomes for NorthSTAR Enrollees • Accelerate and strengthen the business relationship with Providers and Stakeholders to improve overall outcomes for the NorthSTAR Program• Ownership of the revenue, expense, margin and other financial factors impacting the P/L of the NorthSTAR ProgramReduced pharmacy costs by 30% through negotiating a new contract at NADAC pricing and expanded pharmacy access from 13 locations to over 50 across 7 counties. Advocated through state and county government for best practices and expanded funding for mental health services. Improved contract compliance to exceed performance targets. P&L accountability for all ValueOptions of Texas programs and contracts.

Norfolk, Va, Us

Spearheaded and lead implementation of the national Stamp Out Stigma program (www.stampoutstigma.com). Development and implementation of clinical decision support measures and tools to track clinical / quality outcomes and demonstrate the return on investment. Responsible for advancing population health, evidence based and best practices, expanding recovery and resiliency focused programs and improving the integration of care through state-of-the-art care management, utilization management and health home programs. Clinical oversight and Strategic Planning for all ValueOptions Risk accounts with over 4 million covered lives. Responsible for medical expense oversight, and leadership of corrective actions for all ValueOptions Risk accounts. Direct matrix clinical leadership for the following contracts: Volunteer State Health Plan- Tennessee; MVP- New York; NYC including Emblem Health; MBHP UM Program; NorthSTAR - Texas; and South Western Pennsylvania. Promoted from VP to SVP 2013.

Norfolk, Va, Us

Responsible for operations, program development, implementation and accountability for all contracts managed by ValueOptions of Texas, Inc. Accountable for medical expense, budget development and oversight. Responsible for contract and regulatory compliance.

Norfolk, Va, Us

Responsible for clinical management of the Texas NorthSTAR program, The District of Columbia Medicaid, Maryland Medicaid Substance Abuse program, and Children’s Health Insurance Program, Chartered Commercial, and Texas STAR/STAR+ clinical programs. Direct supervision of the clinical staff including clinical care managers, managers and team leaders. Accountable for NorthSTAR medical expense, and budget development and oversight. Responsible for contract and regulatory compliance including URAC standards.

Responsible for ensuring appropriate behavioral health services system wide across Dallas County; Administrative and clinical oversight of Adult Outpatient Services, ACT, Crisis Services, Transitional Services and 4 Behavioral Health Outpatient Clinics providing service to 14,000 clients annually; Staff Development; Program Development; Quality Improvement Projects; Business Development; budget development and oversight; Grant Writing and implementation.Crisis Team (ER and Mobile Crisis Team) Part-time August 1989 – July 1995

Hospital Admissions Director. Management of Psychiatric Intensive Care Unit; coordinate court hearing dates; court orders; discharge planning; and management of social work processes and staff on unit.

Us

Mba, Business

Mssw, Social Work

Bsw, Social Work

Postgraduate Coursework, Veterinary Social Work

Postgraduate Certification In Psychedelic Assisted Psychotherapy