Â· Over 15 years of management/ leadership experience, in a complex health system, FQHC, state hospital, and service organization. Ten years as a senior/executive director (Operations; Compliance, Performance/Quality Improvement)/ five years of social services & three years of home health experience. Â· Knowledge of the following software applications: Novell/ Windows NT, & Internet Explorer,
Intranet, HTML, Access, Microsoft Office, Word/Works, Power Point, Excel, MS Mail, Schedule, Oryx, Outlook, Merritt, Viaduct, i2i Tracks and Facilitator Quality Management System. (Facilitator-Starfinder)
Â· RESULTS ORIENTED: Demonstrated knowledge of delivering compliance results of over 90% with Regulatory Agencies such as; Joint Commission, CDPH, NCQA, NAHQ, CDC, HIPAA, HCFA, Title 22, DOJ, DHCS, DMHS, OBRA, URAC, CLIA, PCER, HEDIS, Cal-OSHA, OPR, CMS, Alameda Alliance for Health, Blue Cross, Knox-Keene Act, UDS, MHSA, & HRSA.
Â· Initiate, implement, chair and evaluate the Chronic Disease Management Teams (multi-sites) for La Clinica de La Raza, across the agency at all the medical sites (7) in three Counties with the support from the interdisciplinary teams of each site.
Â· Prepared Medical Center/ Mental Health Rehabilitation Facility for first JCAHO accreditation survey. Result: Received 91% rating, 7% above national average in 1999. Trained staff for 2002 JCAHO survey and prepared the physical building for an inspection which resulted in a 97% score.
Â· Outstanding Director: Direct the day to day operations of an agency and resolve organizational issues: Health Care Administrator at APS Healthcare Inc., in Sacramento, CA; La Clinica de La Raza, in Oakland, CA; The Mental Health Rehabilitation Facility(MHRF) on the campus of San Francisco General Hospital Medical Center (SFGHMC) in San Francisco, CA and Sonoma Developmental Center (SDC) in Eldridge, CA Â· Lead the APS Service Center in development and implementation of Member/Patient and Provider Satisfaction Surveys.
Â· Prepared APS Service Center (Call Center) for its first NCQA Mock Audit in 2011. Â· Member of the Solano County Mental Health Board; Chair of the Public Awareness & Education Committee 2000-2002
(2011 – Present) Legal Shield, Fairfield, CA
Insurance Consultant (Independent Associate)
Â· Provide pre-paid legal insurance and identity theft protection for my clients. Review insurance policy terms in order to determine whether a particular loss is covered by insurance. Â· Confer with customers by telephone or in person in order to provide information about products and services; to take orders or cancel accounts. Â· Provide clients with an opportunity to become an independent associate and start their home based business as they build toward becoming financially independent
(2009-2010) APS Healthcare Inc., Sacramento CA (Medi-Cal Coordination Program)
Quality Improvement Manager II/ Director
Â· Led the design and implemented two Medi-cal disease management (Department of Health Care Services (DHCS) contracts and utilized QI interventions that identified billable members/patients, decreased ER rates, hospitalization, hospital readmissions, which met the goals of DHCS, DMHS, URAC, NCQA and APS Healthcare Inc. (contracts: Seniors and Persons with Disabilities-SPD and SMI-Serious Mental Illness) (Contracts were $12,5000,000 each annually for 3 yrs) (ROI) Saved an estimate $800,000-$1,000,000 the first year. Â· Managed the local QI program and activities for the service center (Call Ctr.) which resulted in meeting and exceeding corporate and industry standards by decreased abandonment rates and average speed of answer.
Â· Increased customer service and used a member and provider satisfaction survey (DMAA/ CAHPS) to track and target areas for future improvement
Â· Worked collaboratively with the operational leadership to ensure measurable improvement in clinical outcomes, operational excellence, customer satisfaction, and economic health occurs Â· Compliance: Ensured the local QI program operates in accordance to corporate policies, accreditation standards, and QI processes.(URAC, HEDIS, NCQA) Â· Managed the local QI program at the Call Ctr. to ensure compliance with QI activities such as; complaints management, appeal and denial management, documentation audits, and telephone access which were enacted according to policy and accreditation standards as applicable Â· Ensured the service center maintained systems to establish standards relating to quality activities and measured performance against established standards. Â· Developed seven quality improvement projects (QIPs) even though only two were required for each contract Â· Assisted corporate QI department in accreditation and re-accreditation activities Â· Assisted with the development, implementation and training of corporate policies to ensure they meet URAC/NCQA/ HEDIS accreditation standards Â· Tracked and report all QI activities and outcomes to the Regional QI Mgr. quarterly and took necessary actions to ensure measurable improvement in clinical outcomes, operational excellence, customer satisfaction, and economic health occurs Â· Developed the 2010 QI Work Plan and participated in the development, tracking and evaluation of the annual corporate QI document such as the program description
(2004-2009) La Clinica de La Raza, Oakland, CA
Performance Improvement /Compliance Officer (Quality)/ Chronic (Disease) Care Team Chairman/ Emergency Preparedness Trainer/Liaison, & Safety Officer (Q.I. Specialist)
Â· Led and supported organizational QI projects which increased productivity, access, and patient’s positive health outcomes.
Â· Prepared a Audit Ready System for the agency in Alameda, Contra Costa, and Solano Counties to ensure over 90% compliance rate when reviewed by regulatory agencies Â· Prepared a master compliance tool for the site managers to utilize for regulatory agency surveys, and audits. Â· Managed projects/programs (KP Diabetes Grant for La Clinica Vallejo, KP Quality Improvement Initiative Grant for the Chronic Disease Teams Agency Wide, Asthma Futures Grant (KP) for La Clinica Monument, Pediatric Obesity Grant for Transit Village) and activities, including activities of multi-disciplinary teams at multiple sites Â· Managed HEDIS (Preventive Screening) measures agency wide, collected and tracked data/metrics, provided trends, identified areas to improve, conducted chart and audit reviews annually. Â· Initiated, implemented and Chaired the Chronic Disease Management Teams (Agency-Wide), a multidisciplinary team of healthcare experts, and goals were to identify, prevent, and treat, chronic diseases, utilizing evidence based practices and guidelines. The teams (agency-wide) targeted these diseases; pre-diabetes, diabetes, asthma, HIV, pediatric obesity, cardiovascular disease, depression, and P.H.A.S.E., which is the acronym for preventing heart attacks and strokes everyday. Implemented PDSAs as a performance improvement tool with the chronic diseases agency wide. The continued effort of the teams resulted in positive health outcomes for patients
Â· Used Process Improvement Models such as; PDSAs, Juran’s Six Step Improvement Model, DMAIC etc, to improve targeted areas
Â· Represented the agency at Chronic Disease conferences such as PWC and annual Quality meetings Â· Conducted monthly Emergency Preparedness & Safety Training for new hires and provided annual trainings across the agency to medical sites. Introduced agency to Incident Command Systems training which help prepare the agency for table top drills.
(2004-2006) First Allmerica Financial Life Insurance Company
Â· Home Healthcare Recruiter/Provider: Researched, sourced, interviewed and hired staff for the quadriplegic patients in home health. Ensured the staff had the appropriate equipment to provide the best care. The nursing staff consisted of RN’s, LVN’s, and Psychiatric Technician’s. The staff worked twelve- hour shifts, per diem. Provided patient care and medication administration when there was a staff shortage.
(2003-2004) Fairfield/Suisun Community Action Council (CAC), 1545-B Webster St. Fairfield, CA Â· Director of Operations: Directed and managed the use of two homeless homes
(male/female) in Fairfield/Suisun which housed the chronically homeless residents/clients. Provided case management and job development for the residents/clients in the homes. Linked residents to Medi-Cal, dental, parole/probation officers, court appearances. Conducted alcohol breath test randomly and drug screening once a month. Provided a food pantry once a week, clothes from CAC and Mission Solano Thrift Store, information on how to receive a hot meal daily from one of the many Churches in Fairfield and clothes and stuffed animals for children at Christmas. Provided a program which paid the rent or mortgage once, if it could be justified financially (Seasons of Sharing)
(2002-2003) Napa Valley College, Napa CA
Â· Health Occupations Division- Clinical Instructor/ Consultant: for Napa valley students in the Psychiatric Technician/LVN FASTRAK Program. Â· Provided the environment which was conducive for learning and retaining knowledge in the class room. Provided behavioral health /mental illness history and theory in class with clinical follow-up and a comprehensive evaluation at the completion of each rotation. The clinic rotations took place at Sonoma Developmental Center, Napa State Hospital (Forensic), Sutter (Psych) Hospital in Santa Rosa, CA, St. Helena Hospital (Psych), specialty (Telecare) Hospital in Vallejo, CA, and California Medical Facility (CMF) at Solano County Prison.
(2/97-12/02) Mental Health Rehabilitation Facility (MHRF)/ San Francisco General Hospital Medical Center, City & County of San Francisco, California.
Â· As a member of the Executive Committee, we planned, organized, implemented, & evaluated Programs consistent with the mission statement, vision, goals, & the bio-psycho-social-medical-spiritual rehabilitation model, SFGHMC/MHRF, P & P. We also forecasted, reviewed, revised, and implemented our budget (upon approval), reviewed the staffing, overtime, holdovers, recruitment & retention, and upcoming surveys.
Â· Administrative Services Officer, managed the administrative support for all of the MHRF’s programs. Responsible for the day to day operations of the facility, which included; payroll, medical records, admissions, providers scheduling, nursing staffing, secretaries, material management, fire safety, emergency preparedness, storage room, front desk clerks, security, linen delivery & pick up. Implemented, managed, and evaluated various programs. Managed the medi-cal billing, medicare, managed care, and monitored the budget (budget management). Managed the personnel and provided annual evaluations. Developed M.O.U.s, and policies while marketing the program to stake holders and vendors in the city and County of San Francisco, CA. My experience included contracting with vendors, analyzing medical expenses, utilization, and profit & loss. The annual budget was $11,450,712. The organization was financially viable during my tenure in this position.
Â· Admissions Manager, reviewed all referral packets of patient/residents sent to me from referring organizations, usually from an acute setting. (PES). Assessed the financial viability, risk level to the staff and facility. The MHRF maintained over 90% census ratio at all times, and 72 hour admission turn around process without compromising the integrity of policies or procedures. Result: Reduced potential revenue loss $400,000 annually. Managed all admission & billing submission processes for long term care patients. Result: Effective procedures ensured $3,000,000 to $5,000,000 Medi-Cal revenue collection annually.
Â· Employee Health & Safety Officer (Environment of Care), addressed any issues related to employee health & safety (EOC), the physical building, cleanliness, security, hazardous materials, needle sticks, emergency preparedness (fire, earthquakes, pandemic, bio-terrorist etc), fire/life safety, ergonomics, medical equipment, and all utilities @ the MHRF. Conducted mock surveys, & building inspections, and identified areas that were deficient. This role was significant in the MHRF getting a 97% JCAHO score in 2002.
Â· Asst. Director of Continuous Quality Improvement/Risk Management, prepared, coordinated, and trained the staff for Joint Commission accreditation. Implemented the Unit Based CQI-Performance Improvement meetings, projects, and utilized the FOCUS-PDCA format/model for the units to complete their CQI/PI projects. Investigated any unusual occurrences at the MHRF. Developed tools/ indicators, to track the pertinent areas targeted for improvement at the facility. Prepared Plans of Correction for citations our organization received by reviewing agencies. Conducted risk management assessments which encompassed patient safety, medicolegal issues, rules and laws in malpractice, patient safety and patient satisfaction, quality improvement/ making decisions, suicide/ confidentiality, quality metrics/malpractice and medical errors.
Â· Facilitated the weekly Discharge Planning & Utilization Review meeting. The meeting goals were to place the patient/resident in an appropriate community setting, so they have the best chance to succeed, in their on-going rehabilitation process. The meeting was a weekly functional status, of where each patient/resident were on the rehabilitation continuum. There were local vendors who attended the weekly meetings to evaluate if the clients had the necessary decorum to continue their rehabilitation process in their treatment facilities based on the criteria they set forth.
Â· Public Health Team Leader, managed the day to day operations of the unit (geriatric Psych) & my staff which included; an RN, LCSW, LPTs, LVNs, MHWs, Rehab Worker, & Unit Clerk), and arranged appointments for patients/residents on a Geriatric Psych/ MI unit @ the MHRF. Utilized progressive/positive discipline techniques. Conducted performance evaluations annually on my staff.
(9/85-1/97) Sonoma Developmental Center (SDC), in Eldridge, CA
Â· Assistant Program Director, CQI Coordinator, Unit Mgr., Qualified Mental Retardation Professional (QMRP), Individual Planning Coordinator (IPC), Community Placement Specialist, EEO Representative on the Hiring Panel, Supervisor
Â· In the role of Program Assistant, planned, organized, and managed mental health services in the program. Monitored the delivery of mental health services including clinic management and monitored regional services (North Bay); conducted program
planning and development, evaluation, and performance outcome studies. Developed and implemented operational policies in the program. Ensured all units in the program had the resources, and staffing needed to run an effective program. Ensured the unit leadership was current on all operational policies and procedure of the Developmental Center, and regulatory agencies. Monitored the budgets of all the units in the program and sought ways to run more effective and efficient programs.
Â· In the role of the CQI Coordinator, prepared and trained Unit Managers on review preparation. The surveys/reviews such as Title 22, DOJ, DDS, DMH, DHS, and other regulatory agencies. The training included how to prepare policies & procedures, staff, medical records, and the physical building for any upcoming survey. Mock surveys were conducted to identify deficient areas and there was an on-going quarterly CQI in-service for unit managers
Â· Prepared a case study for the placement of developmentally disabled residents in the community, by identifying barriers, conducting town hall meetings & resolved issues, which streamlined the process and led to more successful placements in Alameda, Marin, and San Francisco Counties.
(1982-1988) US NAVY /USNR- Great Lakes, Illinois/ Balboa Hospital, San Diego, CA/ Mare Island Branch Clinic, Vallejo, CA (Oaknoll Naval Hospital, Oakland, CA)
Â· Hospital Corpsman, Ocular Tech, Office Manager, Trainer and EMT Â· Led 86 sailors(As Recruit Chief Petty Officer (RCPO) in boot camp excelling and winning flags in academic, marching and sporting competition Â· Named SAILOR OF THE QUARTER (JAN-MAR 85) for exemplary customer service, and patient care at the clinic. I received an HONORABLE discharge with Commendations & Recommendations, upon my departure. I served as a USNR until 1998.
Â· Master of Science in Health Services Administration, from St. Mary’s College of California Â· Bachelor of Arts in History (Political Science/ Pre-Law) Talladega College, Talladega, AL Â· Napa Valley College, Napa, California (Psych) Â· Glendale Career College, Glendale, CA (Principles of Teaching Adults Learners) Â· I am prepared to take the CPHQ exam in 2013.
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