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Health Care Management

Location:
Grosse Pointe, Michigan, United States
Posted:
January 11, 2017

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JOAN Patrick- Morris

Volunteer Work at Beaumont Hospital

acx8hx@r.postjobfree.com

Summary

Senior Healthcare Administration Professional

Remarkably enthusiastic, hardworking, tenacious, and highly dedicated professional result-driven, detail- oriented, in Health Care Management. Comprehensive experience in operations management, strategic planning and implementation, Continuous process improvement and facilities management, member concerns and resolutions. Skilled in pharmacy formulary criteria and step-therapy, medical record management, resource management, provider relationships liaison. Well-informed of all required reporting at federal, state and local levels. Knowledge and training in the Affordable Care Act (ACA), Health Care Reform and Health Care Market Place. Adept at strategizing integrative approaches to risk management, regulatory compliance and standards, performance improvement and patient safety. Excellent organizational skills in directing initiatives for organizations workflow design execution as well as achievement of goals and objectives. Strong focus on mentoring and staff education to implement proactive risk management and continuous quality improvement programs

Experience

Volunteer Work at Beaumont Hospital

April 2016 - Present (3 months)

Volunteer in the ER 4 hours a week.

Healthcare Consultant at PatrickMorris & Associates, LLC April 2014 - Present (2 years 3 months)

PATRICK MORRIS & ASSOCIATES INC: Grosse Pointe, Michigan Apr 2015-Present Consultant Healthcare Management

Contracted independent health care consultant for project management assignments to meet CMS regulatory standards for client’s complaints and grievances process. Medical record review, NCQA accreditation standards. Project Manager for compliance program revisions and updates to meet Health Care Reform and HIPAA standards.

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SERVICE FOR OLDER CITIZENS: Detroit, Michigan Apr 2014-Present Volunteer

Assist seniors with ‘meals on wheels’ home delivery service. Advocate for senior health care coordination in home and following acute care discharge. Assist with special event programs, fund raiser activities. Manager,Clinical Operations at Total Health Care, Inc. January 1990 - December 2013 (24 years)

Cross- Functional leadership and collaboration and ability to connect productivity services, facilities, equipment and employee training in alignment with the organizations expected outcomes and timelines. Responsible for supervising and managing utilization review department, case/disease management and support staff; ensure staff perform services in accordance with State and Federal Regulatory guidelines. Responsible for generating and evaluating new strategies and systems. Facilitate discussion of strategic planning process & continuous quality improvement projects. Projects & Accomplishments

•Development policies and procedures for waste, fraud, abuse and risk management programs. Internal and external review protocol for resolution with the advice of legal counsel for regulatory oversight that impact compliance.

•Chief consultant to the Medical Director on Utilization Management policies and procedures, concurrent reviews, retrospective reviews, appeals and denials, referrals, catastrophic case management, pharmacy step-therapy and cost containment reporting. Member bed days per 1000 and continuous quality improvement over-site.

•Implemented utilization practice patterns for contracted physicians, hospitals, nursing facilities and ancillary providers.

•Facilitator for the Health Plan's initial three year, NCQA Accreditation and two re-accreditation's.

.Team leader of risk management, sentinel events, fraud and abuse resolutions.

.Government Affairs liaison for special projects, verbal and written presentations, compliance program policies affecting Medicare, Medicaid revisions and oversight.

•Monitored all activities related to the Grievance and Appeals processes to ensure compliance with State and Federal regulations.

Managed the health plan's .Children Special Health Care Service Program'. Health and Wellness program implementation and over- site. Page3

Languages

English

Skills & Expertise

Healthcare Management

Hospitals

Nursing

Healthcare

EMR

Medical Terminology

Patient Safety

Healthcare Information Technology

Medicaid

Program Development

HIPAA

Managed Health Care

NCQA Accreditation

Disease Management

Complaint and Grievances

Tribunal Hearings

Grievance & Appeals

Education

Davenport University

Master of Business Administration (M.B.A.), Health Care Management, 2016 - 2020 University of Detroit Mercy

Bachelor of Science (B.S.), Health Services Administration Volunteer Experience

Volunteer for special events and assist with 'Meals on Wheels' home delivery coordination. at Services for Older Citizen's

January 2014 - Present

Organizations

The Cotillion Society of Detroit Educational Foundation (TCSDEF) Board of Trustee

July 2014 to Present

The TCSDEF is a 501 (c) (3) nonprofit organization to promote and develop socially astute young boys and girls; to foster the ideas of education and community service, Development of these youngsters into good citizens; and sponsor programs of educational value to the community at large. Page4

Founded in 2010 under the leadership of Renita Barge - Clark, MD. The organization is proud to present 'The Debutante Ball' annually.

Interested sponsors can visit the organizations website at www.TCSDEF.org Certifications

Health Care Compliance Certification Program

Seton Hall School of Law June 2015

Managed Care Nursing

American Association of Managed Care Nurses (AAMCN) November 2015 Managed Care Nursing

American Board of Managed Care Nursing License 15-3297 November 2015 Courses

Independent Coursework

Health Care Related Webinars

Health Care Compliance Certification Program

CMS Diagnosis Coding certificate

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JOAN Patrick- Morris

Volunteer Work at Beaumont Hospital

acx8hx@r.postjobfree.com

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