Core Competencies and Background Areas:
Attorney and executive manager with a work history spanning all aspects of healthcare financing. Successful in administering public healthcare programs in complicated regulatory environments. Strong background in contract drafting, negotiation, and compliance. Additional areas of experience include:
- Managed Care
- Health insurance and healthcare financing
- Human resources and management
- Developing agency policy
- HIPAA
- Legal research and writing
- Building consensus with a diverse group of stakeholders
- Strong communication skills
- Administrative Hearings
Experience:
Director, Bureau of Managed Health Care ▪ January 2015 – Present
Utah Department of Health ▪ Division of Medicaid and Health Financing
Oversee the 1.2 billion dollar Medicaid and CHIP managed care programs
- Negotiate and draft amendments to the Medicaid and CHIP managed care contracts
- Ensure Compliance Reviews, HEDIS, and CAHPs data and other quality metrics are collected for all 22 contracted health plans
- Supervise 50 employees, directing their workloads and delegating assignments
- Responsible for hiring and conducting interviews for Bureau staff
- Manage a diverse group of public healthcare programs including School-Based Skills Development, Health Information Technology Electronic Health Records Incentives, Local Health Department Targeted Case Management, and the Restriction program
- Draft program policies, and procedures
- Ensure programs are compliant with state and federal law
Assistant Director, Bureau of Managed Health Care ▪ April 2012 – January 2015
Utah Department of Health ▪ Division of Medicaid and Health Financing
- Assisted in implementing the Utah Accountable Care Organization managed care program
- Drafted and negotiated the Medicaid and CHIP managed care contracts
- Appeared in administrative hearings
- Assisted in negotiations for a 72 million dollar Division IT contract
- Ensured appropriate benefit delivery to Medicaid and CHIP clients
- Monitored contractors for quality and contract compliance
- Directly supervised five employees, and indirectly supervised eight employees
Assistant Attorney General ▪ July 2007 – April 2012
Utah Attorney General’s Office ▪ Legal Counsel for University of Utah Health Care
- Represented the University of Utah, University Health Care
- Collected delinquent payments from government and commercial insurance payers through administrative proceedings, litigation, and settlement negotiations
- Provided training to hospital management, staff, and eligibility counselors regarding federal and state laws
- Appeared on behalf of University of Utah Healthcare in Utah Medicaid administrative hearings and Idaho County Assistance hearings
- Member of the Utah Attorney General’s Office HIPAA Task Force
Assistant Attorney General ▪ April 2006 – July 2007
Utah Attorney General’s Office ▪ Legal Counsel for three state agencies
- Represented the University of Utah Health Care, appearing in Idaho administrative hearings and collecting delinquent accounts from insurance companies
- Enforced state worker’s compensation requirements and collected wage claims as counsel for the Utah Labor Commission
- Co...
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