Develop and implement policies and procedures for clinical operations; determine standards of treatment; evaluate the effectiveness of program services provided by the Agency; oversee mandated and discretionary quality assurance mechanisms; determine priorities of services to be provided, including program expansion.

Healthcare consultant focused on Medicare and Medicaid, Disability Access and Program Development.

$4.3B provider of no- and low-cost health insurance in greater New York City area with 1.9M members. Responsible for 13 billion in medical management with a 300 million budget.Directed care management/utilization management strategy and implementation of innovative clinical partners (hospitals, non-profits, national organizations) to drive improved member health outcomes. Liaised with CEO, regulators, and medical employees on clinical quality initiatives. Proactively monitored/evaluated clinical department’s performance, quality, and budgets for effectiveness, compliance, and cost efficiencies. • Developed, and launched unique clinical care model across all business lines that contributed $20M in savings in 3 years. Built costing analysis across populations, established financial metrics, and identified/hired team to execute the plan.• Led a clinical compliance turnaround by bringing clinical operations into compliance following a significant audit failure brought with compliance deficiencies and risk to the company. This culminated in the closing of 43 out of 44 corrective action plans(CAPS) and passing all final audits.Reduced team’s 40% attrition rate to <5%, well below national 27–35% turnover rate.• Played instrumental role in DEI initiatives and creation of Employee Resource Groups supporting disabled populations through creation of complex care models. Led bereavement counseling and became advocate for disability rights, improving accessibility at Healthfirst HQ.• Ran weekly virtual groups with up to 4,000 attendees during 3 tumultuous years of global pandemic, spotlighting social injustice and war in Ukraine, promoting culture of awareness and sensitivity.

$137B healthcare provider. Med cost oversight 1 billion dollars. Staff: 300-400.Recruited to lead Medicaid managed care services, encompassing targeted waiver populations, long-term services and support (LTSS), complex care, intellectual/development disability (I/DD), and home and community-based services (HCBS). Oversaw care coordination and ongoing assessment delivered by team. Fostered relationships with Department of Medical Assistant Services, informing and moving policy. • Developed and implemented innovative Medicaid-managed long-term services and support program in Virginia, introducing managed care waivers to health-compromised and disabled demographics. Plan quickly became #1 in the state.• Created multi-pronged internal education program for nurses and social workers to inform them of program and Medicaid managed-care landscape. Built team of adult professional educators and trainers to ensure work streams aligned with audiences’ academic training. • Nurtured environment of support, engagement, and continuous learning, contributing to <6% attrition rate in 2 years compared to previous 35-40% turnover.

Business unit within UnitedHealth Group, providing health care and human services policy, analytics, and consulting.• Created policy focused on aging and disabled populations to facilitate and assist state’s clients through RFP process. Evaluated ongoing state programs targeting both Medicaid and Medicare. Managed long-term services and support and waiver programming for multiple states and various providers.

Nonprofit provider of public healthcare programs, including Medicaid, Medicare, and Marketplace. P&L: $1M. Staff: 250-300.Hired to build team and implant Duals Demonstration in partnership with state of Ohio and CMS. Also held role as Director of Special Needs Program. • Developed and piloted first dual Medicaid/Medicare demonstration in the United States. Awarded pilot test prior to demonstration in Ohio. Implemented program infrastructure, workflows, training, staffing models, and assessment tools.

$156M healthcare provider. Held 5 overlapping roles while operating in matrix structure and constantly changing healthcare environment. • Director, Change Management - Implemented enterprise-wide new business capable of responding with agility to change initiatives.• National Director for Aged, Blind, and Disabled (ABD) - Developed proof-of-concept and launched $39M national clinical intervention pilot program for ABD subset of Medicaid recipients. • Director, National Call Center - Boosted national call center productivity by introducing KPIs for measuring health care program costs and quality.• Interim Statewide Director, BlueChoice of South Carolina - Launched Anthem Blue Cross and Blue Shield line of Medicaid business in Ohio and grew membership to 133,000+ during time of state contract terminations.• Regional Director, Field Operations, Ohio Medicaid - Developed and executed close-out of Ohio Medicaid business following company decision to exit business.

Regional Director of the state. Responsiblilities included: Start up of a new line of business, 160,000 member lives, opened offices in three locations throughout the state, hired and trained staff, directed operations of claims payments, worked with providers and with members to promote the health of our communities.