Work Experience

2020.12 – 2021.12

Health Home Administrator
Evolent Health, New York, NY

• Worked closely with SOMOS Community Care, Evolent's only physician-led network of Performing Provider Systems, to maintain optimum levels of communication to effectively complete projects.

• Assisted senior management with monitoring performance measures and design methods for improving quality of care and services delivered by care management agencies.

• Assisted in development, review and revision of standard operating policies and procedures in collaboration with senior management.

• Responded to regulatory agencies regarding population health initiatives and clinical concerns.

• Supervised coordinators with program specific caseload of over 2000 enrollees with co-occurring disorders.

2015.11 – 2020.11

Healthcare Management Professional
Centene Corporation, New York, NY

• Promoted within 12 months for achieving 94% (overall average) on NCQA audits vital to program and plan accreditation.

• Served as Project Manager for behavioral health teams pilot project for restricted recipient high utilization members, resulting in lower per-member, per-month costs for value-based care contracts.

• Aided in increased patient satisfaction scores by 1% within PY 2019 with improvement above industry average two years consecutively; WellCare's best performance to date achieving.

• Facilitated workgroup meetings with Medical Directors to find effective solutions to members’ social determinants of health.

• Analyzed key performance indicators through interdisciplinary team partnership to assess and manage risk, evaluating member care and creating procedural changes to increase efficiency.

• Managed care from admission to discharge, including member assessments, care planning, health education and discharging support to over 20 members daily.

• Performed ongoing review to evaluate mental health needs, working with multidisciplinary team to develop, initiate, manage and modify individualized plans of care.

• Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping members regain or improve coping abilities to prevent further disability.

• Interpreted regulations to identify regulatory requirement criteria and established systems to achieve compliance.

• Educated and evaluated clinical and support staff regarding care quality management regulations and standards of care.

2013.7 – 2020.1

Clinical Consultant/Project Manager
The Child Center Of NY, Queens, NY

• Served as clinical lead in consultative, administrative, and supervisory capacity on implementation of MTM value-based services contractor increasing service delivery data into actionable information that both clinicians and administrators used to make objective decisions about models of care.

• Consistently complied with applicable laws and regulations ensuring viability for unique dually licensed OMH/OASAS Integrated outpatient clinic adhered to Medicare and Medicaid regulations.

• Facilitated communication between office team of 10 technical and clinical professionals.

• Increased automation and workflow efficiencies through qualitative and quantitative documentation and data collection to eliminate time and resource waste.

• Previous titles held within this agency included Clinical Manager, Sr. Social Worker, and Social Worker IV.

• Certified Case Manager (CCM)

• Licensed Clinical Social Worker (LCSW)

• Certified Advanced Social Work Case Manager (C-ASWCM)

• Project Management Professional (PMP)