Health Quality Assurance

PROFESSIONAL HIGHLIGHTS

I have held responsible positions in the health care industry, managed care

industry, and academic community.

EMPLOYMENT HISTORY

ValueOptions* Northern Virginia 1990-June 2010

Privacy Officer (4 years)

Director, National Compliance (6 years)

As the Director of National Compliance at ValueOptions I was responsible

for developing, implementing, and maintaining a compliance program for

relevant national departments and local service center operations including

clinical, claims, provider relations, network operations, and customer

service. I directed and coordinated company-wide activities ensuring

compliance with State and Federal laws, regulations, and customer

contractual standards including Medicare, Medicaid and commercial insurance

based obligations. I also worked in tandem with corporate and local

Quality Management departments in achieving a nationally recognized

(URAC/NCQA) accreditation status.

As Privacy Officer I was responsible for leading and assuring privacy

training activities. Because ValueOptions is a behavioral health specialty

managed care company (with covered lives in all 50 states) training

initiatives were particularly challenging due to the various complex

federal and state privacy and security legislation such as HIPAA, HITECH,

42 CFR Part 2, numerous state mental health confidentiality and medical

records law as well as state specific security mandates. During this time

I wrote and/or evaluated several training and information alerts on

protecting sensitive health information for internal staff, the

ValueOptions provider network, and ValueOptions business

associates/vendors. I also worked closely with the Information Technology

Department's Security Team in designing and monitoring the annual security

access reconciliation audits and actively sought the team's input in all

matters related to electronic protect health information. In 2010 we

developed the first joint Privacy and Security work plan taking into

consideration not only the appropriate safeguards for daily administrative

operations but also the technical safeguards necessary to support those

operations.

Quality Management Specialist, Corporate Quality Management (8 years)

Assisted with the development and execution of quality improvement plans.

Conducted internal NCQA and URAC accreditation surveys. Facilitated member

self-reported functional assessment studies.

Trainer, Corporate Provider Relations (2 years)

Conducted performance assessments on all direct line staff. Implemented

educational programs on changes in industry credentialing/recredentialing

standards and in-house policies and procedures. Trained new staff and

provided remedial learning opportunities for performance improvement.

Case Management Coordinator (3 years)

Supervised outpatient mental health utilization review activities. Trained

and completed performance assessments for all new outpatient care

management employees. Developed care management performance standards and

conducted Quality Assurance audits. Acted as a process consultant for

internal account executives, external benefit managers, and the third party

payers.

Case Manager (1 year)

Performed inpatient, outpatient, and catastrophic utilization review.

Volunteered as relief staffing for the Clinical Assessment and Referral

Department.

________________

*ValueOptions is a behavioral health managed care company servicing the

mental health and substance abuse needs of a membership located in all

fifty states across the country. With 18 offices and a network of about

50,000 health care providers, ValueOptions serves more than 22 million

people.

Blue Cross Blue Shield, Northeast Ohio 1988-1990

Review Analyst

Performed utilization review and disability evaluations for the Psychiatric

Division of the Medical Review Department. Provided oversight and

maintained a clinical database for reporting utilization of mental health

and substance abuse services. Served as a process consultant for Claims

Administration, Provider Relations, and the Legal Department.

Health Care Review Systems, Cleveland, OH 1987-1988

Review Coordinator

Performed prospective, concurrent and retrospective medical utilization

audits to assist clients in controlling health benefit costs. Co-developed

the specialty practice criteria for evaluating mental health and substance

abuse utilization.

Cuyahoga Falls General Hospital, Cuyahoga Falls, OH 1979-1986

Health Education Coordinator

Coordinated hospital-sponsored health education for patients, their

families, and the community at large.

Staff Development Coordinator

Oriented all new general practice-nursing employees to the health care

facility. Provided training on institutional policies and advanced

technologies.

Charge Nurse-Adult and Adolescent Psychiatric Unit

Supervised the provision of direct acute care.

University of Akron, Akron, OH 1978-1979

Faculty-College of Nursing, Department of Psychiatric Nursing

Participated in curriculum development and supervised student clinical

practice.

Fallsview State Psychiatric Hospital, Cuyahoga Falls, OH 1976-1978

Charge Nurse and Shift Supervisor

Supervised the provision of direct care.

HONORARIA/CERTIFICATIONS

. Charter member Sigma Theta Tau, Delta Xi

. Registered Volunteer with the Fairfax County Medical Reserve Corps (MRC).

. Certified in Healthcare Privacy (CHP)

. Certificate: Project Management: George Mason University-In Process

EDUCATION

. Virginia Polytechnic Institute and State University, 1996-2002, Science

and Technology Studies. Degree: MS. Thesis: The ELSI Research Program

and Genetic Nondiscrimination Legislation: A Study in Science and Public

Policy.

. Case Western Reserve, 1983-1985, College of Nursing. Post Graduate

Studies.

. Kent State University, 1972-1976, College of Nursing. Degree: BSN.

PUBLICATIONS

"Demonstrating the Value of EAP Services: A Focus on Clinical Outcomes."

Employee Assistance Quarterly: July/August 2005 (copy available upon

request).

Salary Requirement: $95,000/year

Currently licensed in Virginia; inactive status Ohio

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