Dedicated and compassionate healthcare leader with a track record for aligning strategy to achieve business goals and building a culture of accountability with people who are results driven, innovative and committed to excellence.
Human resource management
Health Services and Quality:
Oversight and participation in medical management, including staffing, quality scores, monthly accrual analysis, and Population Health programs.
Adept at the development of organization's business plan, quarterly reviews and course corrections. Oversee budgeting, financials, and capital budgets. Strong strategic thinking with problem solving skills.
Highest ranking department within Health Plan for associate satisfaction, willingness to refer new associates, and intent to stay with the company.
Launched the WA Amerigroup Health Plan in 2012.
Established operating processes for health care team, remedied service issues, implemented new programs and supported all areas of the Health Plan to accomplish established business goals.
Built broad based support among key decision-makers and influencers to promote activities to achieve favorable organizational impact.
Promote Mission and Culture:
Demonstrated success in building teams with a culture committed to execution, collaboration, communication, and a positive learning environment for associates and the members served.
Vice President, Health Care Management April 2012 to CurrentAmerigroup (Anthem) - Seattle, WA
Development, implementation and oversight of integrated Medical
Management in the Health Plan. Initiatives include the establishment of
indicators for monitoring and evaluating quality care, appropriateness,
continuous improvement, member satisfaction, utilization and case management
services across the continuum of care to members.
Directs and provides leadership for designing,
developing and implementing Health Plan integrated medical management program
to meet the demographic and epidemiological needs of the population served.
Collaborates with key health care professionals
towards identification of opportunities for improvement, trend analysis,
education, and development of actions plans to meet organizational goals.
Establish and execute objectives and annual
goals to meet Health Plan initiatives.
Foster teamwork and collaboration to ensure the sharing of information and best practices across the corporate structure.
Manage successfully in a matrix model business environment which includes collaboration with HR, IT, Finance, Underwriting, Legal, Compliance/Risk Management, and Shared Services such as the National Call Center.
Executed successfully NCQA Health Plan accreditation.
Director, Workers' Compensation and Medicaid Division June 2005 to April 2012Qualis Health - Seattle, WA
Expertly planned, coordinated, organized and directed all operations for care
management services for the State of WA Medicaid and Labor and Industries Departments.
Fiscal responsibility for the department including
contract deliverables to the State of WA (review timeliness, ROI, etc.).
Strategic planning/Contract negotiations with providers.
Ensured department fully met with all required
legal, contractual, and accreditation standards.
Primary point person for collaboration and
communication between providers, Qualis Health, and State of WA.
the integrity and high quality of care management delivery utilizing LEAN
in Point Platinum Awards Finalist. According to Dorland Health, these awards aim to
recognize the most successful and innovative UM programs working to improve
healthcare across the care continuum.
Director of Utilization Management - East Region August 1988 to November 1992Group Health Cooperative - Redmond, WA
Created, directed, and managed the utilization management program for
Eastside Hospital, six outpatient clinics, and contracted hospitals in
Everett and Bellingham, WA.
Created and organized departmental resources
that supported the corporate strategic plan.
Assisted in corporate
selective contracting for services provided outside of HMO.
Monitored contract administration of external services.
Responsible for the achievement of clinical,
utilization, and quality outcomes with established performance measures.
Collaborated with HMO physicians, hospital
leaders, and external providers to establish and implement clinical programs
that supported the objectives and growth initiatives of the organization.
Assured effective and
efficient utilization of facilities and services through ongoing monitoring and
Associate Administrator of Clinical Services August 1986 to August 1988Greenery Rehabilitation Center - Seattle, WA
Directed all clinical services for this facility within the framework
of the established philosophy and objectives of the national corporation.
Negotiated contracts for funding
sources from private insurers, Medicare, and Medicaid.
for the design, coordination, and implementation of rehabilitation programs.
liaison with the corporate office, medical staff, funding sources and
management staff for strategic planning.
and evaluated services rendered to improve quality of care and utilization of
staff and services.
in community educational health programs for head-injured patients.
Nurse Manager - Pediatrics May 1985 to August 1986Swedish Hospital - Seattle, WA
Responsible for the direct and indirect nursing care of patients on a
newly opened 30 bed pediatric unit.
and managed unit capital and operating budgets.
Executive Director Nursing Services July 1983 to May 1985Lynn Hospital - Lincoln Park, MI
Operational responsibility for the management of all nursing service
functions in a 240 bed hospital.
goals and objectives for the department to complement and support the
Developed and managed department capital and operating budgets.
Decentralized accountability for patient care and budget management to
the unit level.
nursing practice standards and quality assurance programs.
and implemented DRG phase-in program.
liaison for union contract negotiations.
Master of Science : Health Services Administration, 1985University of Detroit - Detroit, MI
BSN : Nursing, 1980Mercy College of Detroit - Detroit, MI