Behavioral Health Senior Director
Resume:
PATRICIA RODRIGUEZ, JD, CHC
San Rafael, CA *****
********.************@*****.***
linkedin.com/in/patricia-r415/
COMPLIANCE, CONTRACTING & LEGAL AFFAIRS EXECUTIVE
Senior Director of Behavioral Health Compliance with over 23 years of experience in overseeing and ensuring compliance with multi-state Medicaid, Medicare, and Marketplace products. Proven expertise in risk management, regulatory frameworks, and health policy. Accomplished at navigating complex healthcare systems and implementing policies and procedures to safeguard compliance while optimizing operational performance. Strong leadership skills with expertise in guiding cross-functional teams, fostering collaborative relationships, and improving compliance outcomes within large, multi-state, and diverse organizations.
PROFESSIONAL WORK HISTORY
CENTENE MANAGEMENT CORPORATION (2001 – 2025*)
*In 2016, Centene acquired Health Net, Inc. and its subsidiary, Managed Health Network (MHN).
Senior Director, Compliance
August 2021 - Present
Ensure regulatory compliance with federal and state legal and regulatory requirements as it relates to Behavioral Health in Medicare, Medicaid and Marketplace requirements and relevant regulations. Responsibilities include development of cross-functional projects implemented by Enterprise Compliance Department.
Lead and manage the behavioral health compliance strategy for multiple Medicaid, Medicare, and Marketplace products across a broad multi-state landscape, ensuring adherence to federal and state regulations and guidelines.
Act as a subject matter expert on behavioral health compliance, providing strategic guidance on regulatory matters related to Medicaid, Medicare, and the Affordable Care Act (Marketplace).
Manage compliance operations, including monitoring and auditing to ensure full compliance with regulatory requirements, focusing on behavioral health services and programs.
Partner with colleagues to identify and mitigate compliance risks, working closely with legal, audit, and operational teams to establish risk management strategies.
Foster relationships with state and federal regulatory bodies, coordinating audits, responding to regulatory inquiries, and facilitating timely resolution of any compliance-related issues.
Develop and deliver comprehensive compliance training programs to all levels of staff, ensuring a strong understanding of applicable behavioral health regulations and policies.
Prepare and submit reports on compliance activities to executive leadership, ensuring timely identification and resolution of any non-compliance issues.
In 2021, also held an interim role as Interim Enterprise Parity Compliance Officer. These responsibilities began in 2021 and lasted through mid-2023 as part of a pilot program to increase awareness of the complexities related to parity compliance particularly in the area of non-quantitative treatment limitations (“NQTL”s”). Accomplishments include creation of an enterprise strategy, enterprise roadmap related to health plan compliance specific to federal parity and creation of an Enterprise Governance Committee.
Director of Contracting and Compliance Officer
May 20, 2018 – July 31, 2021
Promoted to Director of Compliance while maintaining oversight of Contracting team and renewals for commercial clients. Led a California Knox-Keene licensed entity as its Compliance Officer for Managed Health Network and Centene Advanced Behavioral Health.
Contracting:
Directed contracting for a specialized health care service plan and managed behavioral health care company, ensuring compliance with state and federal regulations for over 1,000 commercial clients.
Ensured adherence to California health care service plan laws, multi-state utilization review, and insurance-related activities and services.
Managed all group contracting issues with the Department of Managed Health Care and state insurance departments.
Participated in senior management team strategic planning sessions, providing legal counsel and advising business units on legal matters.
Ensured compliance with regulatory changes and updates, including All Plan Letters, impacting health care service plans and insurance activities.
Compliance:
Led the compliance department for a Knox-Keene licensed specialized health care service plan and managed behavioral health care company, overseeing all compliance functions.
Ensured compliance with state and federal regulatory requirements, laws, and regulations governing California health care service plans and insurance-related services.
Managed compliance with regulatory changes, including those outlined in All Plan Letters and updates from state insurance departments.
Oversaw all compliance-related matters with the Department of Managed Health Care and state insurance departments to ensure operational alignment with legal standards.
Implemented compliance strategies, ensuring company adherence to complex regulatory requirements across multiple states.
Manager of Contracts
Contracting & Network Development
May 2008 – May 2018
Promoted to Manager of Contracts to lead and manage the entire contract management process for the organization, ensuring compliance, risk mitigation, and alignment with strategic objectives.
Oversee a team of contract professionals, guiding them in negotiating, drafting, and managing contracts.
Develop and implement policies and procedures to improve efficiency and streamline contract workflows.
Manage high-level contract negotiations and performance monitoring across various departments.
Focus on minimizing contractual risks and driving continuous improvement across processes, resulting in stronger cross-department collaboration.
Senior Contract Administrator
Legal Department
May 2004 – April 2007
Managed complex contract negotiations, including high-value agreements and strategic partnerships.
Provided guidance to junior team members, enhancing their skills and ensuring high-quality contract execution.
Collaborated cross-functionally with legal, finance, and project management teams to ensure contracts were executed effectively and in compliance.
Focused on optimizing contract terms and conditions to safeguard the organization’s interests while maintaining strong relationships with external partners.
Contract Administrator
Legal Department
May 2002 – May 2004
Managed the creation, execution, and oversight of contracts, ensuring alignment with business goals and legal standards.
Worked closely with stakeholders to negotiate favorable terms, resolve disputes, and ensure compliance throughout the contract lifecycle.
Strengthened attention to detail and developed a solid understanding of balancing legal, financial, and operational considerations in contract management.
Contract & Compliance Analyst
Legal Department
July 2001– May 2002
Supported the contract management process by reviewing contract terms and conditions and ensuring adherence to company policies.
Assisted in compliance audits, helping to ensure that the organization met all regulatory and internal requirements.
Developed a strong foundation in contract law, risk assessment, and compliance strategies while maintaining thorough documentation.
Provided support to senior team members, contributing to the smooth execution of various contractual processes.
EDUCATION & CERTIFICATION
San Francisco Law School
Doctor of Jurisprudence
1998-2002
Certificate in Healthcare Compliance (CHC)
Health Care Compliance Association
Certifications in 2019, 2022
Florida State University
Bachelor of Science Degree, Criminology and Criminal Justice
1988-1992
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