Penny Bartelt

Project Specialist on Behavioral Health Connect Project. BH Connect is a no-cost resource available to Wisconsin Medicaid-enrolled behavioral health organizations and providers to improve patient outcomes and safety through the use of technology.

Conduct quality compliance audits for Medicaid Long Term Care Programs, CMS Protocol 2 measures for performance improvement projects, and additional programs. Prepare audit reports presenting findings and recommendations for organizations and state oversight teams. Support appeal and grievance hotline and reviews.

• Supervise team of case managers and nurses providing case management within Medicaid long term support program. • Evaluate ongoing compliance with quality standards and expectations, performed via case file audits and data analysis to identify trends, measure performance, and identify opportunities for improvement. • Co-lead organization wide effort to improve compliance with contract requirements. • Developed and project managed a quality improvement program with my team that received organization wide recognition. • Area project lead for new collaborative opportunity with an external partner.

• Provide case management services in compliance with WI Medicaid children’s waiver regulations and organizational policies and procedures. • Engage in process improvement efforts including developing new hire educational materials and procedural documents.

• Responsible for collecting, reporting, and analyzing organizational quality measures primarily based on internal audits to identify trends, measure performance and identify quality improvement opportunities. • Internal expert on program requirements, contract language, and statutes to ensure compliance and develop best practices. • State oversight liaison for incident reporting and incident response including root cause analysis completion. • Project manager and state liaison for external compliance audit.

• Department leader responsible for monitoring staff resources, hiring, coaching, prioritizing, monitoring workloads, and work completion. • Demonstrate leadership in developing, participating in, and monitoring operational work plan initiatives that align with board end statements and overall organizational strategic plan. • Organizational liaison for functional assessment as well as organization representative in numerous state level workgroups related to quality and performance improvement, member satisfaction, contract negotiations, and additional projects. • Responsible for data collection, state required reporting, analyzing and validating data as well as developing performance improvement interventions across departments and monitoring improvement efforts. • Develop policy and procedural documents and educational materials along with developing and providing trainings/presentations to internal and external stakeholders. • Collaborate and partner with internal and external stakeholders as an active participant and/or leader of various committees, workgroups, and projects. • Internal resource on reviewing and interpreting program requirements, contract language, and statutes to ensure compliance and provide technical assistance. • Direct staff completing eligibility determinations in accordance with written instructions and contract expectations as well as organizational liaison for state audits and appeals related to functional eligibility. • Develop, implement, and evaluate quality improvement action plans around organizational quality as well as targeted quality areas. • Coordinate and respond to external quality compliance audits as well as develop internal compliance plans.