Pamela J. Stanley, M.A., L.P.C.C.
EDUCATION
Master of Arts, Counseling, Webster University, August 2002
Bachelor of Arts, Health Policy Studies, University of Michigan-Dearborn, 1989
LICENSURE, CERTIFICATION & MEMBERSHIPS
Clinical Mental Health Counselor, New Mexico, August 30, 2006, #0096031
National Certified Counselor, National Board of Certified Counselors, December 2005, #79289
Academy of Cognitive Therapy, Certified Affiliate, May 2007
Association for Behavioral and Cognitive Therapies, Member, May 2007
CLINICAL/PROFESSIONAL EXPERIENCE
Cognitive Behavioral Institute of Albuquerque, LLC
Clinical Fellow August 2005 to Present
· Independently contracted to provide counseling services to adult and adolescent populations
· Specialize in treating women with peri-natal mood disorders
· Participate in clinical case conferences and supervision program
Presbyterian Medical Group
Behavioral Health Outpatient Department
Counselor March 2003 to August 2005
· Managed caseload of 60 patients, including collaboration with nursing and physician staff
· Participated in clinical case conferences and supervision program
· Completed psychosocial assessments within inpatient department for adults and adolescents
Emergency Room
Consult Liaison Department
Clinical Counselor Intern March-May 2004
· Completed psychosocial assessments in the emergency room
· Assessed patients for appropriate treatment plan, including admission and discharge plans
· Coordinated inpatient admissions with nursing and physician staff
Catholic Charities
Counseling Department
Clinical Counselor Intern November 2003-March 2004
· Completed psychosocial assessments for the Projecto La Luz program, for homeless women with children
· Provided counseling services to clients under supervision by program director
· Participated in treatment planning process and clinical case conferences
ADMINISTRATIVE/PROFESSIONAL EXPERIENCE
Presbyterian HealthCare Services
Director, Managed Care February 1999 to March 2003
Responsible for managed care operations for physician medical group of over 120 providers.
· Negotiated and implemented hospital, specialist and ancillary provider contracts to manage risk contract with Presbyterian Health Plan for over 50,000 members.
· Educated providers on managed care policies and procedures, including physician profiling.
· Assisted with development and implementation of Utilization Management guidelines.
Presbyterian Health Plan
Director, Provider Services May 1998 - January 1999
Developed and maintained provider networks for PHP in northern New Mexico region.
· Negotiate provider agreements, including primary care, group and global capitation contracts. Establish capitation payment arrangements with provider groups based on percent of premium or per member per month rates.
· Evaluated provider groups via PHP Risk Assessment Form for readiness of global capitation arrangements and delegation activities for utilization management, claims and credentialing.
· Assisted Physician Directed Teams (PDT) in successfully managing full risk contracts which included oversight of delegated activities, data transfer and retrieval, and general servicing issues for operations of PDT.
Mercy Health Plans
Manager, Provider Credentialing 1995 to 1998
Responsible for statewide credentialing program for all Mercy Health Plans’ products (175,000 member HMO, 75,000 member PPO) for over 5,000 physicians.
The National Committee for Quality Assurance (NCQA)
Led organization, as part of a team, in preparation for the 1997 NCQA revisit. Responsible for mock site survey. Coordinated NCQA revisit, including frequent contact with surveyors.
Achieved full NCQA compliance for Credentialing Program in 1995 and 1997 (perfect score).
Process Improvement
Developed key plan documents including Quality Improvement Program Description, Quality Improvement Workplan, Quality Improvement Program Evaluation, and Utilization Management Plan. Revised committee structure to meet the National Committee for Quality Assurance (NCQA) standards. Received substantial NCQA sponsored training.
Implemented self-evaluation for NCQA accreditation and led the Plan in significant improvements.
Credentialing Department
Developed, implemented, and monitored Credentialing Department’s quality indicators. Directed department through continuous quality improvement processes to measure and strengthen performance. This resulted in:
· a 78 percent reduction in medical director involvement
· a decrease in budget expenses of $250,000 annually
· an improved process for sanctioned/disciplined participating providers
· monitoring of credentialing turn around time
· improved board certification rates
The Detroit Medical Center (DMC)
Manager, Provider Services 1993 to 1994
Managed department of six FTE’s, provided physician credentialing, recruitment, and education for over 1600 DMC affiliated physicians for 15 managed care plans.
• Reorganized structure of department and set quality standards for provider recruitment, contracting, and credentialing.
• Monitored compliance of organization's contracting and credentialing procedures with NCQA and industry standards, and successfully secure delegated credentialing status with managed care plans.
• Involved with management leadership team's Continuous Improvement efforts.
The Detroit Medical Center
Network Development Coordinator 1992 to 1993
Developed specialty and ancillary provider networks for DMC System.
• Established standardized contracting parameters with the intent to negotiate consistent provisions on behalf of the hospital system and physicians with managed care plans in order to minimize business and financial risk exposure.
• Negotiated contract language for physician and ancillary agreements with successful modifications reducing contract liability.
• Renegotiated all DMC-Health Alliance Plan contracts and secured greater financial discounts for system.
• Developed ancillary credentialing criteria for DMC CARE (PPO) network.
The Detroit Medical Center
Program Administrator 1990 to 1992
Served as administrator to an Independent Practice Association (IPA) contracted with Blue Care Network overseeing all operational aspects of contract.
• Developed and implemented policies and procedures for IPA utilization committee.
• Created and implemented provider non-compliance and sanction criteria for IPA.
• Established ancillary and specialty care network.
• Educated providers on plan, IPA, and State HMO guidelines.
The Detroit Medical Center
Provider Services Representative 1989 to 1990
Provided DMC physicians with contracting and contract maintenance services for 15 managed care plans.
• Executed and maintained physician managed care contracts.
• Conducted provider orientations for managed care plans.
• Assigned to oversee 15 major university/faculty based physician groups and over 450 individual physician managed care contractual arrangements.
WAYNE COUNTY MEDICAL SOCIETY 1989
Administrative Intern
• Assisted in development of survey instrument for physicians.
• Organized panels for second annual Southeastern Michigan Health Care Expo.
• Compiled legislative health care update published in the April 1989 issue of The Detroit Medical News.
CONTINUING EDUCATION
Navigating Accreditation, NCQA, March 1997
Managed Behavioral Health Organizations, NCQA, March 1997
Diversity in the Workplace, Summer 1997
Continuous Quality Improvement, Accelerated Improvement Seminar, Fall 1997
VOLUNTEER ACTIVITIES
Chairperson of Outreach Committee, St. Michael’s All Angels & Episcopal Church
Officer, University of Michigan-Dearborn Alumni Society Board of Governors (1991 - 1995)
Instructor for Aquatic Exercise, Dearborn Fairlane Family YMCA (1994)
Fund raiser for United Way Campaign (1995-1998)