Best Buy - Senior Consultant Resume Example

• Consultant to local specialty healthcare practices addressing growth opportunities, quality improvement, managed care contracting, risk management and general operations.

• Coordination of accreditation initiatives (NCQA/URAC), clinical quality management, process improvement and customer satisfaction for managed behavioral health organization
• Enhancement and implementation of quality improvement policies, goals, objectives, and procedures, conferring with board members, organization officials, and staff members as necessary.

• Management and development of clinical and medical review staff, ensuring compliance with state, federal and accrediting body regulations relating to utilization review and managed care.
• Coordination with department heads to facilitate integration with claims, provider development, customer service and financial operations and initiatives.

• Day to day management of  care management and utilization review and processes of managed behavioral healthcare organization.  

• Oversight of care management and utilization review staff and coordination with other departments to ensure efficient processes within the organization.

• Development and integration of behavioral health care services in facilities in Texas to address the needs of geriatric clients, their family members and the community at large. 

• Management of Partial Hospitalization Program, compliance with Medicare regulations, and facilitation of contractual obligations.

• Business development including managed care contracting, referral development, community relations, and account management
• Provision of clinical consultation for various programs throughout the facility and function as “Administrator–on-call
• Perform emergency room assessments and referrals as a member of the Psychiatric Assessment Team

Provision of developmental services to network members, development of additional network membership, and provision of assessments and direct clinical services through employee assistance program.