Douglas W. King

***** ** ****** **** ***** ? Wilsonville, OR 97070

503-***-**** ? ab86ry@r.postjobfree.com

HIGHLIGHTS OF QUALIFICATIONS

Energetic, collaborative and results-driven operations professional with

more than 20 years of expertise in building and maintaining relationships

with current and prospective stakeholders. Highly organized and decisive

business leader with an accomplished record of driving project management

and business development strategies to achieve profitable growth within

specified areas of performance. Excellent team coach focused on developing

corporate-wide bench strengths in department leaders to reach clearly

defined goals. Dynamic management approach and a unique ability to

communicate high-level information in easily relatable terms with

demonstrable value to involved partners.

Career expertise:

. Budget Development

. Negotiation

. Business Development

. Needs Assessments

. Team Dynamics

. Strategic Planning

. Communication Strategies

. Group Facilitation

. Media Relations

. Change Management

. Process Improvement

. Establishing Key Metrics

. Project Management

. Building Consensus

. Regulatory Compliance

NOTABLE ACHIEVEMENTS

< Managed State and Federal audits with progressively improved

results each year up to a score of 99.

< Developed constructive business relationships within all 9 regions

representatives within TN.

< Implemented productivity and performance standards which improved

efficiency by 8% year over year.

< Obtained MBA in an accelerated Executive Program while maintaining

full-time employment.

< Earned University of Tennessee's Professional MBA Marketplace

Master Award for demonstrated excellence in corporate program

design, strategic planning and successful implementation.

EDUCATION

Master of Business & Administration - Emphasis in Strategy and Management

Executive/Professional MBA Program University of Tennessee,

Knoxville, TN

College of Business & Administration,

2002

Master of Social Work - Emphasis in Industrial Social Work

University of Southern California; Los

Angeles, CA

School of Social Work, 1993

Bachelor of Science - Emphasis in Human Services

California State University Fullerton;

Fullerton, CA

School of Human Services, 1991

PROFESSIONAL EXPERIENCE

HEALTHNET, INC - TIGARD, OR

Manager Compliance and Reporting

5/2012 - Present

Assess and improve compliance with regulatory and accreditation standards.

Serves as liaison to regulatory and accreditation bodies and to Health

Plans meeting their standards. Manages regulatory and compliance

implementation efforts. Provides leadership for continuous monitoring and

communication with internal departments to ensure compliance. Serves as a

subject matter expert providing regulatory requirement information within

Health Net. Manages development and implementation of corrective action

plans resulting from audits.

Top Accomplishments:

. Develops and coordinates the implementation of data collection tools,

tracking/trending, analysis, monitoring and reporting of quality

measures.

. Analyzes standards and develops measures of internal compliance.

Reports on status of compliance.

. Develops, reviews, updates departmental and organizational policies

and procedures and forms for assuring quality of service and

regulatory compliance.

. Performs proactive compliance work, including conducting internal

compliance audits to sample processes and reviewing performance files

to ensure compliance.

Case Manager II

9/2009 - 5/2012

Recruited to improve direction to neglected Medicare Case Management team;

infused department vision with much-needed execution of objectified

details. Designed / implemented mission-critical assessment tools and

contracted provider relationship tactics to capture increased quality and

performance outcomes which complemented improved customer services metrics.

Top Accomplishments:

. Designed and initiated electronic discharge planning tool for

concurrent reviews of member recovery rates utilizing objective

measurement scores which better control expenditures.

. Developed case load tracking tool with automated acuity level

management mechanism to assist Case Management team with organizing key

member information and cost saving interventions.

. Facilitated education sessions specific to enhanced operational

opportunities to reduce costs based upon improved utilization of

referral criteria for Medicare members.

REGENCE BLUE CROSS / BLUE SHIELD - PORTLAND, OR

3/2007 - 8/2009

Manager, Health Care Service

Operational management of multiple teams while providing business and

quality development initiatives to staff and contracted providers in

Oregon, Washington, Idaho and Utah. Communicated clear expectations of

revenue objectives to professional service representatives, including

holding regular business meetings and weekly communications with top

management of project and departmental progress, assisting with goal

clarification and conducting regional conference calls.

Top Accomplishments:

. Implemented operational improvements and staff accountability measures

that reduced per member per month costs by $8.45 for the Medicare line

of business.

. Designed and implemented staff productivity metrics and performance

standards which improved team performance measurements by 8% year over

year.

. Successful negotiation of vendor contracting for the provision of a web-

based CMS Policy search tool.

. Improved organizational compliance through the creation of a best

practice guideline that delineated between State regulations, Federal

mandates and organizational policies.

. Effectively lead a team of 47 staff with 3 Supervisor direct reports

over a 4 state territory.

. Successful preparation and completion of State and Federal audit

reviews for Medicare, Medicaid and Commercial lines of business while

demonstrating a consistent improvement in results year over year.

. Directed a vendor based multi-departmental project management activity

for the testing, launch and maintenance of a web-based medical

management documentation and claim interaction system.

. Provided leadership for an organizational Impact Team in 2009 that

successfully reduced over-utilization expenditures to a 2007 cost trend

and developed of a more aggressive concurrent review process.

COMMUNITY TIES OF AMEREICA - BRENTWOOD, TN

1/2006 - 2/2007

Statewide Director of Case Management

Represented complete management for daily operations for service provision

within all 9-regions of the State. Established and maintained critical

relationships with state referral agencies, and delivered compelling

presentations to potential clients and external vendors for enhanced

revenue opportunities. Negotiated contracts and terms and provided follow-

up to build customer brand loyalty and trust

Top Accomplishments:

. Provided Human Resource, Management and Marketing duties for all Case

Management staff across TN.

. Increased client population by 100% in first year of employment.

. Aligned staffing resources and salary variances to appropriate levels

to maximize operational efficiency.

. Developed constructive community and client referral relationships

within all 9 regions of Tennessee.

. Performed training and educational sessions for staff members on

compliance and regulatory requirements.

CARITEN HEALTHCARE - KNOXVILLE, TN

10/2003 - 1/2006

Employee Assistance Counselor / Trainer / Consultant

Organizational development and executive coaching provided to corporate

client accounts. Boosted revenue through requested follow-up sessions and

creation of custom sessions geared to drive new business development

opportunities.

Top Accomplishments:

. Facilitated Organizational Development training and educational

sessions to client companies.

. Provided management and departmental consulting services for large

corporate accounts specific to methods for improved managerial metrics,

individual, team and departmental performance.

. Earned Qualified Substance Abuse Professional (Q-SAP) certification

during tenure.

. Performed Executive Coaching, departmental mediation, and career

counseling services.

PENINSULA LIGHTHOUSE OUTPATIENT SERVICES - KNOXVILLE, TN

2/1998 - 10/2003

Administrator (Covenant Health)

Progressively promoted department manager providing program development

leadership to all staff. Analyzed and revised all policy and procedures to

meet specific regulatory requirements and alignment with program goals.

Integrated facility marketing and customer-centric values into company

culture to build loyalty and affinity within existing program services.

Top Accomplishments

. Development and disbursement of a $2.1 million dollar annual

operational budget.

. Increased employee productivity levels by approximately 30%.

. Improved facility's monthly fiscal performance by $159,000.00 over 3-

year period.

. Successfully navigated 3 JCAHO audits with last facility score of 99

out of possible 100.

. Provided managerial oversight for 25 direct report employees, including

employee hiring, termination, progressive disciplinary measures and a

reward and recognition program.

PARKWEST HOSPITAL - KNOXVILLE, TN

7/1996 - 2/1998

Supervisor - Inpatient Social Services (Covenant Health)

Provided complete clinical services and supervision for Social Work team.

Facilitated assessment sessions on-demand for all hospital departments as

well as implemented team collaboration approach for service plan generation

and review sessions.

Top Accomplishments

. Provided operational and clinical supervision for all Social

Work services on psychiatric unit.

. Re-designed clinical services and educational curriculum to better

address identified patient treatment.

. Developed a clinical team approach to enhance the psychosocial

assessment process.

. Provided case consultations to physicians, nursing and other staff as

requested.

PROFESSIONAL DEVELOPMENT

. State of Tennessee Licensed Clinical Social Worker, (LCSW); awarded

1996

. State of Oregon Licensed Clinical Social Worker, (LCSW); awarded 2011

AFFILIATIONS / INVOLVEMENT

. City of Wilsonville, OR - Development Review Board; Panel A; term began

2009.

. Willamette United Soccer Club, West Linn, OR - Head Coach 2008 - 2011.

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