Jacqueline Marcus-Ledford

**** *. ***** **.

Phoenix, AZ 85053

lvpsyk@r.postjobfree.com

602-***-****

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Experienced professional possessing skill sets in: medical and behavioral health integration, quality management and compliance. Proven track record in program development, implementation, monitoring, and evaluation. Working knowledge of State and Federal regulatory health care requirements.

Demonstrated ability to achieve business results through the use of Quality

Management processes: Developed Case Management utilization tool which showcased

43% decrease in unnecessary Medical utilization for members in Case Management

programs.

Innovative and proven skills in program development and regulatory compliance:

Created specialized medical, social work and behavioral health programs focused

on integration and coordination of care. Standardized program processes for

monitoring purposes. Ensured programs exceeded State and Federal regulatory

and contract requirements.

Diverse experience focusing on matrix relationships, internal/external customer

satisfaction and program effectiveness.

Proven track record working in a multi-tasked environment promoting teamwork and

collaboration.

Statewide provider trainings focusing on providing “The Right Care, in The Right

Place, at The Right Time”

Effective Team builder and mentor: Consistently achieved highest staff retention

rates. Practiced strengths based management.

Broad and extensive range of Health Care industry experience, knowledge and

expertise: Managed Care, Hospital, Home Health, Case Management, Hospice, Medical

and Behavioral Health expertise.

Operational Experience: Primary focus on State and Federal Compliance and

Regulatory Requirements Chronic Care/Quality Improvement Plans, Monitoring and

Evaluation Commercial, Medicaid, Medicare, SNP Plan knowledge and expertise

Operational and Financial Reviews, Request for Proposals, Quality Audits

Expertise in Policy and Procedure alignment with Compliance standards

PROFESSIONAL EXPERIENCE:

Self-employed – Independent Distributor of Premier Designs Jewelry (02/09) and Avon Products 01/10 - present

Aurora Behavioral Health, Glendale, AZ – Manager of Assessment and Referrals Department 3/12 – 6/12 (Interim Position)

Departmental evaluation and implementation of processes to enhance functioning and interface with internal and external partners.

University of Arizona Health Network/Health Plan division, Phoenix, AZ – Special Needs Plan (SNP) Case Manager 2009 - 2012

Prior Authorization, Utilization Management and Case Management of behaviorally

complex members with and without co-morbid medical conditions for the Medicare

SNP plan in the Phoenix area

Inter- departmental and inter-agency coordination of services related to members

medical and behavioral health needs.

Consistent ability to assist members in obtaining behavioral/medical services

resulting in decreased admission/re-admission rates and appropriate utilization

of health care services.

Arizona Physicians, IPA, Phoenix, AZ – Director of Care Collaboration 2002 – 2008

Managed Care Coordination for 300,000 members throughout the State of

Arizona

Developed scorecards, setting metrics and monitoring the quality and efficacy of

the Disease Management, Chronic Care and Behavioral Health programs for the

Medicaid, Department of Developmental Disabilities and Special Needs

Plan/Medicare product lines

Program development focus on medical/behavioral integration

Achieved 100% score on CMS/Disease Management Audit

Achieved full compliance for Behavioral Health/Medical Management pieces of

Department of Developmental Disabilities Operational and Financial Review

Demonstrated consistent decrease in utilization averaging 43% and 1 million+ for

members receiving Case Management Services through Care Collaboration Department

Managerial/supervisory responsibility for up to 3 managers and 25 departmental

FTEs

CIGNA HealthCare, Phoenix, AZ 1993 - 2002

Formalized, developed and implemented positions to track, trend and analyze their

effectiveness.

Partnered with Quality Department regarding audits and program evaluations to

ensure compliance with HEDIS, NCQA, Medicaid and Medicare regulatory requirements.

Provided oversight for Medical/Behavioral Case Management services for membership

of 68,000 Medicaid members

Progressive professional and leadership development growth within CIGNA

HealthCare of Arizona.

Implemented Psychotropic Medication Initiative which resulted in increased

Compliance of Medicaid benefit

**Awarded five CIGNA HealthCare Circle of Excellence Awards for Results Achievement**

**Awarded a Service Star for exceptional Customer Service**

Boswell Memorial Hospital, Sun City, AZ

Ensured acute care bed days met regulatory compliance for Medicare length of

stay. Assisted with safe and appropriate discharge to contracted vendors.

Collaborated with medical staff in development of Critical Pathways related to

discharge.

EDUCATION/LICENCES /CERTIFICATIONS

PhD, Capella University, Minneapolis, MN – student

Master of Social Work, Arizona State University, Tempe, AZ

Foundation Year: Program Administration and Community Planning

Bachelor of Science; Northern Arizona University, Flagstaff, AZ Cum Laude

Licensed Master Level Social Worker

Trained as Certified Peer Panelist for CIGNA HealthCare of AZ Employee Resolution

Program

Academy of Health Care Management Certification

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