Lindsay Wallace

Program Manager, Behavioral Health @Medica

Middleton, WI, US

Primary responsibilities are to oversee quality performance and provide operational oversight of the Health Plan\'s internal and vended Behavioral Health (BH) QI Programs. Key duties include: •Establish, meet, and monitor program goals and objectives; prepare and deliver reports outlining progress toward goals, barriers/risks, and recommendations•Use data to identify improvement opportunities and implement interventions to improve member experience and health outcomes within an efficient cost structure•Provide matrix and/or direct leadership of the BH Utilization Management and Case Management staff; cultivate a positive work environment, identify staff development needs, and address performance•Lead and/or serve on internal and external committees to represent and coordinate activities of the BH Program and quality initiatives•Collaborate with Mental Health Parity team on NQTL data collection, validation, and analysis.•Ensure compliance with federal, state, and contractual requirementsKey Achievements•Developed and executed a multi-state behavioral health quality strategy for 1.5M+ members, resulting in 100% compliance with NCQA behavioral health standards and improved alignment with CMS and Medicaid contract requirements.•Identified cost-savings opportunities related to BH Utilization Management and worked collaboratively with stakeholders to implement interventions that resulted in $1.9 million savings in just 9 months•Used NCQA provider and member experience feedback to investigate BH claims denials; identified systemic trends and worked in partnership with functional areas on remediation and long-term solutioning to minimize risk.•Increased depression screening rates through integration of screening and follow-up protocols into case management workflows.•Achieved measurable improvements in BH HEDIS/withhold measures like FUH, FUM, and DSF.•Prepared internal and vendor data to support NQTL analysis and report submission.

University of Missouri-Columbia

Master of Arts (MA)

Missouri State University

Bachelor of Arts (BA)