Brian Johnson, BHM’s President and Chief Executive Officer, has over sixteen years of executive-level experience in the healthcare field. His expansive body of knowledge includes financial analysis, budgeting, claims authorization, credentialing, and pharmacy workflows and processes. Brian has been responsible for the creation and implementation of numerous innovative data and IT systems for large healthcare organizations. This experience includes needs analysis, budget, bid requirements, selection, and implementation of enterprise-wide software solutions.
Brian’s experience also includes projects for multiple state and local governments, including the Department of Health and Mental Hygiene, the State Office of the Attorney General, the State Office of the Legislative Audits, and the Office of the Inspector General. His technical experience includes data mining and analytical services for a contract estimated at $500 million dollars. He also has implemented claims cost avoidance and Medicare eligibility reports (ASP/SWL/ACCESS) that enable internal auditors to analyze claims payment anomalies and Medicare eligibility validation.
Highly experienced in financial planning and reporting, Brian is an expert in cost-containment and ROI analysis for operational change initiatives. He also has developed of a full suite of reports and reporting metrics that enable forecasting of financials, organizational capacity, and requirements based on key population indicators.
CARLOS A. HERNANDEZ, MSW, LCSW
Carlos, Senior Vice President of Clinical Operations, began building his dynamic abilities through extension work with Goodwill Industries of South Florida. His foundation of community outreach developed while structuring client behavior in vocational training programs, effecting change on client behavior(s) via modification techniques, budget building, plan implementation, program evaluation, and institutional marketing. These skills dovetailed with stints with crisis assessment, intervention and follow-up of child abuse/neglect cases; providing individual, marital and family short-term outpatient psychotherapy to a broad population of clients with varied pathologies; and building to organizing, developing, and coordinating the entire scope of managed behavioral health services for company Medicaid project within Florida.
He saw the complexities of delivering behavioral health care while directing all operational/administrative aspects of the ValueOptions North Carolina Public Sector Division’s Medicaid behavioral health care service management operation; overseeing all levels of the Medicaid behavioral health care service array – including Community Support, Residential Treatment, Psychiatric Hospitalization, Psychotherapy, Substance Abuse Services, etc. for all age/disability designations; and providing executive level administrative leadership to key functional areas:
Clinical Operations, Provider/Network Operations, Service/Call Center and Community Operations – of the NCQA accredited, publicly managed behavioral health organization, with a budget of $356 million, serving fifteen counties across North Carolina with a total population of over 1 million lives.
Jean Neiner, Senior Vice President of Enterprise Sales with BHM, is a senior-level sales and marketing management professional with more than thirty years of healthcare expertise in strategic sales and marketing management, client services, account management, and customer service. Her experience includes selling solutions across the entire healthcare continuum of health plans, hospitals, health systems, providers, pharmaceutical companies, and retail/specialty pharmacies.
Jean is responsible for strategic planning, sales and marketing management, sales presentations, new client acquisition, sales forecasting, and achievement of described sales goals. Prior to working for BHM, Jean held sales and marketing executive positions with Avatar Solutions, Krames StayWell, and Mosby (Elsevier). At Krames StayWell, Jean was instrumental in transforming the sales team to proficiently sell software solutions to the C-Suite at health plans, hospitals and providers. She has a proven track record of achieving strategic objectives, driving double-digit sales growth, establishing key performance metrics, and retaining 95-98% of the organization’s existing client base.
RHONDA PIERSON, RN, MBA, CMCN
Rhonda, Director of Quality Management and Compliance, brings a diverse skillset to BHM Healthcare Solutions. She combines direct, ‘hands-on’ experiences of a clinical staff nurse and business analyst. She draws on a deep background that includes, representing FEP medical management on multiple committees (like Affordable Health Care, Medical Policy and Implementation, Communication Committee, the Central Quality Committee and FEPDO Town-Hall conference calls); the development and implementation business plans, and strategies to support FEPDO and corporate objectives for Anthem BlueCross BlueShield; conducting investigations and reviews of member and provider grievances and appeals; reviewing and summarizing all applicable medical information; preparing recommendations for medical director, consultants and other external reviewers; and performing the clinical duties of a staff nurse on Rehabilitation, Medical-Surgical, and Progressive Care Units. Best of all, Rhonda understands the business and patient care complexities of the entire care cycle from admissions through reimbursements.
Annette Ainsleigh, Director of Internal Operations with BHM, is an operations professional with over twenty years of experience. Prior to joining BHM, she worked as an executive assistant at Health Integrated, where she provided operational support to key executive staff, directors, managers, and supervisors of the company’s customer delivery team. Her expertise includes human resources, training, and optimization of all internal operations activities.
She is also skilled in heavy analysis, writing, and report preparation in support of management decision-making, and is highly adept in managing operational metrics and measures, including status reports and cost analyses. Annette’s judgment, decision-making capabilities, negotiating, and expediting skills make her a valuable member of the BHM team.
Linda Ross, a Senior Consultant with BHM, has administrative and clinical experience both in the managed care setting as well as acute hospital. She has extensive expertise with regulatory compliance for state licensures and required certifications. Linda is a subject matter expert with URAC applications for Case Management, Utilization Management, Network Operations and Specialty Pharmacy. With a proven track record of successfully instituting utilization management programs in two managed care companies and an acute care hospital case management program, Linda increased profitability while maintaining compliance with URAC standards in Pre-certification/Case Management.
Linda’s knowledge in the URAC accreditation arena, with Case Management and Specialty Pharmacy, has been integral in creating policies and procedures, patient education, quality management, and outcome reporting with performance improvement recommendations. She is a subject matter expert in the areas of Managed Care, Quality Management, Compliance, Clinical Services, Utilization Management, and Case Management. She has designed, executed and evaluated all aspects of a compliance and quality management program with a major managed care organization. Linda has expertise with application submission, policy and procedure development, on-site review, and ensuring compliance for all standards related to URAC accreditation for Health Network, Health Utilization Management, and Case Management. Linda also has experience with the New Jersey Organization Certification, Connecticut Workers Compensation Managed Care Organization Certification, and New Jersey PIP Pre-Certification Plan compliance.
IRMA MOREIRA, RN, MSN, MHSA, CPHQ
Irma Moreira, Senior Consultant with BHM, is a seasoned, licensed nurse and healthcare administrator from a myriad of healthcare field settings to include Medicare Advantage, Medicaid, and behavioral managed care organizations, psychiatric and general hospitals, outpatient services and consultation services for private organizations, and the federal government. She held the positions of Vice President of Clinical Services, Chief Clinical Officer, Chief Executive Officer, Director of Quality Improvement, and Registered Nurse.
Irma’s over 35 years of healthcare experience covers the areas of Credentialing, Accreditation Process, Managed Care, Medicare Advantage, Utilization Management, Quality Improvement, Case Management, Customer Call Center, and Disease Management. Irma has licensures and certifications as Healthcare Services Executive Licensure in Puerto Rico; Professional Nurse Licensure in NY, NJ, OK, TN, and PR; and Certified Healthcare Quality Professional. She speaks fluent English and Spanish.
DIANA LEE DOUGLASS
Diana Lee Douglass, R.N., a Senior Consultant with BHM, has more than 30 years working in complex clinical healthcare environments. She is accomplished in both the clinical and executive aspects of healthcare and has worked with health insurance organizations, managed care organizations, Medicare and Medicaid. She has worked for many years in the behavioral health industry as both a direct care professional and an executive-level clinical director. She has extensive management capability with a proven record of successful results in instituting utilization management programs. As an NCQA and URAC accreditation and certification expert, she has led and participated in successful accreditations and certifications for multiple healthcare organizations. She has developed and implemented HEDIS and QI studies and achieved successful turn-around of ACD call center statistics to regulatory compliance within 30 days of accepting management responsibility. In 1991 – 1999, she was honored for excellence in nursing by Who’s Who in American Nursing.