Strategic Performance Improvement Specialist with a background assisting in policy, procedure and contract review processes. An eclectic MENTAL HEALTH ADVOCATE with over 19 years of experience ranging from mentoring to leading and working alongside teams that foster growth, independence and goal achievement. Known for ving exemplary organizational, decision-making and problem-solving talents.
Progressive individual with expertise in prioritizing and recommending improvements. A confident Performance Improvement Specialist ensuring that all processes meet regulatory and legal requirements.
Intelligent Performance Improvement Specialist skillful creating Performance Improvement plans, all while tracking and trending Critical/ Sentinel Incidents to that initiate root cause analysis. Competent professional knowledgeable in driving quality improvement programs.
Effective at maintaining clinical credentials, demonstrating procedures and operating devices according to standard procedures.
Competent in gathering and reviewing information to evaluate quality and reliability of different products, processes and procedures. Devoted to completing in-depth reviews and proposing strategic solutions. Knowledgeable about developing visual graphs and models of workflows and proposed changes. Previous experience from Tennessee, Delaware and Pennsylvania.
• Monitored Client/Employee Incident Reports for investigation of potential Recipient Rights issues, Critical/ Sentinel Event and Risk Management analyses.
• Advocated and assisted consumers in filing recipient rights complaints, grievances, local appeals, Medicaid fair hearings, local dispute resolutions and request for second opinions.
• Monitored and maintained daily, quarterly, and annual customer service reports, including consumer deaths.
• Served as a member of the Health and Safety, Peer Review, Utilization Management and Risk Management committees.
• Annual revision of policies and procedures related to recipient rights, sentinel events and credentialing.
• Provided customer service, boundary and incident reporting training to all new hires as part of New Hire Orientation.
• Conducted internal audits, analyze, aggregates information from the audits, and submitted reports to the Manager of Performance Improvement for review and submission.
• Ensured compliance with training, licensing, NPI, CAQH, QMHP, OIG, MVR and Medicaid and Medicare exclusions verifications with SWCS employees
• Performed intakes, assessments and evaluations to assess client needs and determine goals for treatment.
• Provided individual therapy and case management to individuals with substance abuse and psychiatric diagnoses. Assisted clients with recognizing triggers of substance abuse and developing appropriate coping mechanisms to continue recovery while preventing relapses
• Communicated with legal service and local judicial systems regarding client's enrolled in (MDOC) Michigan Department of Correction program.
• Coordinated the process of transitioning clients from detoxification/residential to outpatient treatment.
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