Walter Linney Email & Phone Number

Durham, Nc, Us

Manager for Medicaid Managed Care Organization (MCO) behavioral health provider network spanning 31 counties in NC.- Design innovative programs and service models to create and enhance access to quality behavioral healthcare.- Apply network configuration and incentive-based payment models to improve the quality of services provided.- Support the implementation of new contracting and claims databases to ensure compliance with NC Medicaid contracting and billing standards.- Department lead for major initiatives impacting Medicaid 1915(b), Medicaid 1915(c), Medicaid 1915(i), and Home and Community Based Service (HCBS) waivers and benefit plans. - Negotiate and re-negotiate provider organization contracts in collaboration with legal team.- Coordinate specialty rate setting for practitioners and agencies serving members with advanced support needs.

Morrisville, North Carolina

Administrator for Care Management Department, supporting diverse care coordination teams to address the unique health needs of 9,000 patients with intellectual and developmental disabilities, mental health concerns, and substance misuse disorders.- Managed MCO Care Management program for members receiving Medicaid 1915(b), Medicaid 1915(c), and Home and Community Based Service (HCBS) waivers and benefit plans (includes individuals with an intellectual and developmental disability (IDD), traumatic brain injury (TBI), a severe or persistent mental illness (SPMI) or substance use disorder (SUD), and patients transitioning from an institutional level of care to an independent living environment). - Led major agency initiatives to design and implement an integrated care management model. Introduced a multi-disciplinary approach (Care Manager, Behavioral Health Clinician, RN, and Community Health Worker) to providing care management across the organization.- Assisted with department-wide configuration and implementation of an electronic health record (EHR) to enhance the collection and monitoring of member-level population health data and improve coordination of care. - Coordinated agency, State, and Federal policy changes impacting care management with NC DHHS and NC Medicaid. - Drafted RFA responses for Medicaid Managed Care contracts, new programmatic scopes of work, as well as agency and department policies and procedures.- Created and presented new onboarding training curriculum for all care management staff.- Interviewed, hired, and trained all department managers and supervisors. - Developed agency Community Health Worker (CHW) program to resolve social drivers of health (SDOH) issues for members with complex support needs in tandem with NCCARE360 platform.- Oversaw major operational changes as a result of the COVID-19 pandemic and supported agency response to internal and external stakeholders.

Raleigh-Durham, North Carolina Area

Managed care coordination services for patients with intellectual and developmental disabilities (IDD) receiving Medicaid Home and Community Based Services (HCBS).- Led team of 80 Care Coordinators to support the unique service needs of over 1900 Medicaid C beneficiaries with intellectual and developmental disabilities (IDD).- Developed department onboarding curriculum to advance operational, experiential, and administrative training tools. - Designed electronic supervision platform to standardize performance management practices for Supervisory team.- Chaired Home and Community Based Services (HCBS) Waiver Stakeholder Group. Duties included collecting and providing feedback to NC DHHS on how to improve standards of care for Medicaid C Waiver beneficiaries diagnosed with an intellectual and developmental disability (IDD).

Raleigh-Durham, North Carolina Area

Oversaw contract management, service development, and specialty Statements of Work (SOW) for large Managed Care Organization (MCO) behavioral health provider network.- Supported business development and service expansion for network providers. - Managed provider contractual and programmatic support needs.- Negotiated and renegotiated contract terms and rates.- Facilitated regular meetings with high impact providers.- Addressed Network gaps and needs through specialized program development.

Raleigh-Durham, North Carolina Area

Directed business and clinical operations for 29-chair dialysis facility with $8 million budget and supervision of 16 clinical staff, dietician, social worker, biomedical technician, and assistant.-Worked with interdisciplinary team and Medical Director to ensure clinical outcomes meet CMS and internal organization standards, as well as all federal and state compliance regulations. -Managed facility staffing for patient care needs, including recruiting, hiring, training, supervising, coaching, and performance. Provided timely and constructive feedback/coaching to employees to improve performance and retention, as well as regular formal evaluations and career mapping for professional development. Organized activities and trainings to boost morale, strengthen team relations, and improve retention.-Monitored standard of clinical care for 110 patients diagnosed with kidney disease and end-stage renal disease (ESRD), including treatment adequacy, infection, medication review, and patient satisfaction. -Regional lead for Consumer Assessment of Healthcare Providers (CAHPS) survey.

Durham, Nc

Ensured Network of 2,000 providers maintained compliance with established care standards, contractual obligations, and federal and state regulations for large behavioral health MCO.-Addressed quality of care concerns and grievances for over 200,000 Medicaid beneficiaries.-Provided recommendations to Network Providers (clinics, home/community healthcare agencies, and hospitals) to improve quality of care.-Analyzed agency complaint data to identify quality improvement activities.-Led special projects to design processes/procedures to enhance IDD Provider Network operations and service delivery. Deliverables included revised procedure for tracking and submitting quarterly progress reports, pilot implementation of remote monitoring service line using smart home technology, and new process/procedure for agency Care Coordination Department to facilitate annual patient Individual Support Plan (ISP) meetings between Care Coordinators, Providers, and patients/families.-Assisted beneficiaries to gain access to care and provided insurance/benefit plan counseling to address behavioral health needs.

Raleigh-Durham, North Carolina Area

Managed five large-scale Medicare-funded projects for a patient population of 700,000 and 18 national End Stage Renal Disease (ESRD) Networks over a two-year contract period.-Created 2014 - 2015 patient engagement strategy to improve educational resources available to patients diagnosed with ESRD nationwide.-Developed, piloted, and implemented national Medicare ESRD grievant satisfaction survey. The survey enables patients to provide feedback on how their ESRD Network addressed their concern(s). Responses were used to create quality improvement activities for individual Networks and providers.-Designed process to standardize data entry and reporting for Medicare ESRD grievance database. Assisted in the development of reporting requirements, reporting categories, and process/procedure for data entry. The new system increased the amount of qualitative data that was able to be collected and helped administrators to identify more impactful quality improvement activities.-Facilitated focus groups, meetings, and trainings for National Patient and Family Engagement (NPFE) Coalition – a group comprised of patients/family members dedicated to improving quality of care.-Coordinated quarterly provider training events with the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) for the National Healthcare Acquired Infection (HAI) Network.

Nc - All Regions

Developed and directed Medicaid home and community healthcare service program for patients diagnosed with intellectual and developmental disabilities (IDD) for national home healthcare company. -Designed start-up home and community based service (HCBS) program for individuals diagnosed with intellectual/developmental disabilities.-Managed clinical program and business operations for six NC office locations. Annual operating budget of $1 million. Monitored labor and other costs/expenses to sustain profitability.-Hired, oriented, trained, and supervised 20 direct support professionals and one Program Director.-Created staff orientation, training, and educational materials to provide overview and continuing education on core values, compliance, safety, and continuous quality improvement. -Developed and implemented plans for strategy, health and safety, performance/quality improvement, including their respective policies and procedures.

Asheville, North Carolina, United States

Provided strategic planning, facilitation, and program analysis for the Center for Disease Control and Prevention’s (CDC) ACE Study; National Science Foundation (NSF) EPSCOR Project, National Forest Service (NFS), and Office of Veterans Affairs (VA).-Provided strategic planning and program analysis for the National Science Foundation’s (NSF) EPSCOR Project: supporting researchers at multiple universities from across the country to identify key areas of scientific research that would benefit from a $20 million dollar federal grant.-Supported strategic planning efforts for the publication and promotion of the Center for Disease Control and Prevention’s (CDC) Adverse Childhood Experience (ACE) study; one of the most widely publicized and referenced public health studies conducted in the last half century.-Facilitated conflict resolution workshops with NSF and VA to improve productivity and teamwork.

Asheville; Burlington; Greensboro, Nc

Managed Medicaid home and community healthcare services for patients with mental health disorders and intellectual and developmental disabilities (IDD) for national home healthcare company.-Directed program clinical and business operations for three NC office locations, including hiring, training, and supervision of 60 direct care personnel and multiple Associate Directors.-Provided treatment recommendations to Case Managers to aid in the development of patient care plans.

Ma, Conflict Studies And Dispute Resolution, 4.0

Courses include: Mediation Facilitation Conflict in Communities Dispute Systems Design Cultural Conflict

Bs, Psychology, 3.27