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September 11, 2020

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  • Developed and managed implementation of a care management program with a population health focus for a plan with a predominantly Medicaid and Medicare population. Programs included transitions of care, complex care management and disease/condition management
  • Developed an administrative query tool to identify children with special health care needs for a health plan's performance improvement project
  • Conducted readiness review preparations, Medicaid managed care compliance audit preparations, corrective action plan management, reporting and response
  • Performed Medicaid managed care contract and compliance reporting
  • Managed project to connect care management tool with alerts from local health information exchange
  • Managed project to integrate data from electronic health records, health plan claims data, and health information exchange to support proactive panel management, risk stratification, and patient engagement
  • Supported accountable health communities deployment
  • Medicaid global payment model: served as an integral partner with health plan from initial proposal development through implementation, including planning, documentation, internal and external communications, and system changes
  • Facilitated health plan attribution model development and managed internal, external and system implementation
  • Developed health plan Early and Periodic Screening, Diagnostic and Treatment (EPSDT) communications and training, conducted process improvement and compliance, and updated policies