Description
UCARE - MINNEAPOLIS, MN January 2018 - Present Senior Investigator: Medicare, Medicaid, and Commercial Compliance Investigations * Provide risk-based auditing & analytics, consulting, data mining and investigative services across all departments and business process components of UCare's corporate compliance program * Manage large, complex investigations, providing guidance to investigative and operational teams utilizing multiple data systems and external resources to identify and respond to areas of risk exposures * Support special projects, critical casework, audits and various needs of federal, state and local regulators including collaboration with law enforcement * Experience working with and understanding complex interrelationship of data, information and evidence that is obtained or observed during an investigation * Subject matter expert (SME) responsible for detecting and investigating alleged or suspected fraud, waste and abuse by network providers or enrolled members * Serve as a resource for departments to research and resolve integrity inquiries and assist in identification of improvements to internal practices that may detect, reduce and prevent fraud, waste, and abuse * Develop policy and program management recommendations to analyze alternative solutions to complex issues and convey them to diverse audiences WEST DES MOINES POLICE DEPARTMENT, WEST DES MOINES, IA September 2012 - November 2016 Chief of Police: 70 sworn personnel / 21.5 non-sworn personnel * 2016 Budget 9.3 million / 2015 Budget 9.1 million / 2014 Budget 8.8 million / 2013 Budget 8.8 million * City Manager - Council form of government / Total general fund budget of 58.1 million / 369 Full-time staff * 64,771 Population /141,502 Daytime population / 47.3 Square mile city / 1.01 Officers per 1000 population * Directed turnaround of operations through execution of strategic plan and annual business plans * Successfully exceeded all operational standards established by the Commission on Accreditation of Law Enforcement Agencies (CALEA) for certification of best practices for assessment cycles * Architected and implemented an executive level critical incident response leadership team to work collaboratively with community stakeholders in preparation for emergency management responses * Developed and implemented a matrix of professional development standards in leadership development and building internal leadership capacity * Leveraged technology as a force multiplier to maximize responsiveness and effectiveness through design and application including data sharing, forecasting, analytics and routine reporting by incorporating intelligence-led, data driven decision- making, and hot spot policing techniques * Served as principle project manager for facility remodel, renovation and workplace improvements * Optimized organizational branding, marketing, and communications through development of department website and social media, creating transparent and timely communications * Developed and implemented employee training programs to meet annual certification requirements as well as continuous development objectives - increased from 26 hours per employee to 133 hours per employee for annual reporting period through design and implementation of new work schedules for union and non-union employees UNITEDHEALTHCARE - MINNETONKA, MN June 2010 - August 2012 Director of Compliance Investigations - Government Programs Investigations Agent - Broker Misrepresentation and Misconduct / Ethics and Integrity / Fraud, Waste and Abuse * Provided oversight, direction and practical leadership for a corporate compliance investigation program including accountability for performance and outcomes through multiple layers of management and senior executive leaders * Responsible for the intake, assessment, investigation, and disposition of complaints regarding matters of agent/broker misrepresentation and misconduct, ethics and integrity and fraud waste and abuse for Medicare and Medicaid beneficiaries * Designed the implementation of compliance-wide metrics reporting to assess performance (Performance Scorecard), investigative results and trends to identify investigative practice improvement opportunities * Coordinated with segment Compliance Officers to create alignment of investigative processes and ensure investigative standards were met based on corporate and federal regulations * Facilitated the development of training, awareness and communication of investigative standards and expectations throughout the division * Led and conducted complex agent case investigations and prepare case summaries OWATONNA POLICE DEPARTMENT - OWATONNA, MN December 2004 - June 2010 Chief of Police: 36 sworn personnel / 14 non-sworn personnel * 2010 Budget 4.0 million / 2009 Budget 4.2 million / 2008 Budget 4.0 million / 2007 Budget 3.7 million 2006 Budget 3.5 million / 2005 Budget 1.98 million / 2004 Budget 1.87 million * City Administrator - Council form of Government * 24,725 Population /14.1 Square Mile City / 1.5 Officers per 1000 population * Developed and implemented professional standards in leadership development requirements and built internal leadership capacity under the philosophy of "Every Officer as a Leader" * Implemented proactive community policing initiatives through neighborhood policing districts and action officers incorporating intelligence-led, data driven decision-making, hot spot policing, and predictive analysis * Leveraged technology to maximize responsiveness, outreach and service delivery * Revitalized the Crime-Free Multi-Housing Program and City of Owatonna Landlord Association (COLA) * Optimized agency branding and communications through website and development thereof, creating transparent communications for all stakeholders * Commander of the South-Central Drug Task Force serving four county regions BLOOMINGTON POLICE DEPARTMENT - BLOOMINGTON, MN January 1993 - December 2004 Commander: Special Operations/Patrol Administration, 2003 - 2004 * 2003 Budget, $6.0 million / Patrol Division - 84 Personnel * Regional-State Bomb Squad / SWAT Team / Dignitary Protection, Light Rail Transit Call Response and Tactical Operations (LRT), Mall of America Police Services and Special Events Coordinator, Grant Writing and Coordination - Federal / State / Local, Proactive Police Services - Community Policing Hallmark Program Initiatives Additional Roles with Bloomington Police, prior to 2001: * Commander: Administration, 2001 - 2003 * Sergeant: Proactive Police Services Unit, 1999 - 2001 * Sergeant: Patrol Supervisor, 1998 - 1999 * Detective: Crimes Against Persons Unit, 1996 - 1998 * Patrol Officer: 1993 - 1996
Accomplishments
Job Skills
Keywords
