SUMMARY Seeking a position where I can utilize my accomplished leadership skills in nursing, management and organization to provide projected, qualitative client and business outcomes. To utilize my nursing and leadership background and extensive knowledge of Managed Care, including Commercial, Medicare, and Medicaid experience, in an environment where excellence, professionalism, and vision are valued. Talented interviewer Strong presentation skills Accomplished leader and team builder Strategic planning capability Meets Medicaid statutes and Quality improvement competency regulations Promotes positive behavior Independent judgment and decision making HISTORY to Current Regional Director of HealthCare Services, Case Management Molina Healthcare - California -Long Beach, CA Direct and oversee Case Management Regions to develop, implement and/or monitor standardized protocols for both clinical and non-clinical team activities. Develop, implement and monitor standardized protocols to facilitate integrated pro-active care review and management Collaborate with and keep the AVP and VP of Healthcare Services informed of operation issues, staffing, resources, system and program needs and present solution action plans for issues Facilitate and participate in committees, task forces, work groups and multi-disciplinary teams, as needed, to promote standardized Molina enterprise wide approach to Care Management programs Ensure monthly auditing is occurring with appropriate follow-up Oversee Clinical Training Department and Transitions of Care Department Develop and mentor Healthcare Managers and Supervisors Implementation of clinical policies and procedures to ensure compliance with NCQA, CMS, DHCS, DMHC mandates Responsible for applying SNP (Special Needs Population) standards to meet NCQA/CMS standards for all qualifying SNP members

Highlights:

• Management
• Cms
• Integrate
• Medicare
• Assessments
• Leadership
• Planning
• Quality
• Quality Assurance