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Russell H. Graves 11001 N. 7th St., Phoenix, AZ 85020 602-319-9391 rg15e8d74@westpost.

net Regulatory Compliance Professional: Managed Care Behavioral Health Licensing, Quality Assurance, Operational Management Regulatory Compliance Professional with 14+ years of experience in managing beh avioral health programs, coordinating quality assurance activities, licensing be havioral health facilities, coordinating policy development and providing regula tory oversight. Provide expertise to lower operating costs, increase operating e fficiency and lower risk for liability through implementation of an effective co mpliance program to achieve overall regulatory compliance. Surveying Behavioral Health Facilities Writing & Approving Plan of Corrections Writing Policies & Procedures Training Staff in Regulatory Compliance Standards Provide Risk Assessments in Mitigating Loss Associated With Adverse Outcomes Develop Monitoring Systems in Meeting Accreditation or Licensing Standards Experience in Facilitating Complaint Resolution & Mediation Professional Experience Ascend Corporation Valley Hospital, Phoenix, Arizona 2010-Present Director of Performance Improvement/Risk Management As a senior level director, responsible for the hospitals behavioral health and medical licensing, policy development, performance improvement, regulatory compl iance, accreditation, and hospitals risk management functions. Resolve patient c omplaints as the Patient Advocate. Lead the Performance Improvement Committee an d report to the Medical Executive Committee. Track and trend incident reporting, patient satisfaction and complaints. Responsible for ORYX reporting to The Join t Commission. Key Accomplishments: Revised operating policies and procedures to comply with Arizona Department of H ealth Services/ Office of Behavioral Health and Medical Licensing rules. Prepare d the start-up facility for expedited licensure and accreditation. People of Color Network (PCN), Magellan, and ValueOptions, Phoenix, Arizona 200 6-2010 PCN provides quality, culturally and linguistically appropriate services to high needs children and adults diagnosed with serious mental illness in Maricopa Cou nty. My compliance position with Magellan was transitioned to PCN in August 2009 to complete the divestiture of four outpatient clinics from Magellan to PCN. Magellan Health Services, Inc. provides behavioral health management, radiology benefits management, and specialty pharmacy services. Magellan is ranked 949 on the Fortune 1,000 list and services over 15 percent of the Fortune 500 companies . My compliance position with ValueOptions was transitioned to Magellan when the new state contract was awarded to Magellan in September 2007. ValueOptions, Inc. provides services to more than 23 million individuals through a variety of contracts with state and county agencies, as well as with health p lans and employers. ValueOptions managed the state contract to provide indigent mental health care for adults and children in Maricopa County for nine years pri

or to Magellan being awarded the contract in 2007. Compliance Manager Regulatory and Legal Analyst As Compliance Manager at PCN, led the regulatory compliance activities for the a gency and provided consultation to the board on compliance issues as needed. Com pleted behavioral health licensing for all outpatient clinics and monitored comp liance with the Office of Behavioral Health Licensing rules. Provided all regula tory oversight and ensured all HIPAA privacy standards were met as the Privacy O fficer. Investigated privacy complaints and grievances and responded to the appr opriate state or federal agency. Wrote and approved all operating policies and p rocedures to comply with contract, state, and federal statutes. Coordinated and approved all third party requests for medical records and ensured subpoenas were processed correctly within prescribed timelines. Provided regulatory and invest igative support to Human Resources. Responsible for establishing and monitoring fraud and abuse program. Ensured environmental, staff, and patient safety as the Safety/Compliance Manager. Provided risk assessment/consultation to physicians, nursing, clinical, and administrative staff in complying with applicable state and federal statutes. As chair of the Clinical Risk Review Committee, identified risk issues and facilitated changes to clinical practice for adverse/reportable incidents upon completing root cause analysis. Provided outside consultation in the aforementioned areas to the behavioral health providers comprised in the PC N Network. As Regulatory and Legal Analyst at Magellan and ValueOptions, provided oversight in a lead regulatory role for the agency. Licensed 25 behavioral health outpati ent clinics and a level I inpatient facility in Maricopa County. Conducted on-si te surveys of facilities to ensure compliance with environmental, personnel, and client record licensing standards. Trained staff members on regulatory complian ce standards at the licensed sites and wrote the Plans of Correction for any def iciencies noted during on-site inspections by the Office of Behavioral Health Li censing. Developed and wrote policies and procedures for the Direct Care Sites. Researched regulatory issues for corporate legal department to ensure agency com pliance with state and federal statutes. As HIPAA Privacy Officer for all licens ed sites, investigated all privacy complaints and breaches and provided regulato ry oversight for the medical records department. Provided consultation to the cl inical risk review department on investigating client deaths and other adverse i ncidents. Developed risk assessments with regard to complaints, privacy breaches , and regulatory issues. Key Accomplishments: At PCN, revised adult and children operating policies and procedures to comply w ith current licensing, state, and federal statutes. At PCN, implemented privacy program to ensure compliance with federal and state privacy rules, ensuring all patient health information, including substance abus e and HIV, is protected from unauthorized access. At PCN, established operating procedure to manage and process agency subpoenas t o comply with Third Party Requestors, Attorney Generals Office, and other state entities. At PCN, increased overall regulatory compliance by 75% reducing the risk for com plaints resulting in civil or criminal liability. At Magellan, oversaw the expedited licensing application process for all direct care facilities resulting in the licenses being issued within 30 days of change in ownership from ValueOptions.

At Magellan, facilitated the initial development and implementation of all polic ies and procedures for the direct care sites within the first year of the contra ct with the Arizona Department of Health Services/Division of Behavioral Health Services. At Magellan and ValueOptions, increased regulatory compliance at all licensed si tes by 25%. Arizona Department of Health Services, Phoenix, Arizona 2000-2006 Office of Behavioral Health Licensing (OBHL), the state regulatory agency under the Arizona Department of Health Services that licenses over 900 behavioral heal th facilities in Arizona, certifies for AHCCCS under Title XIX/XXI, and investig ates complaints. Operating within the Division of Behavioral Health Services (DBHS), the Customer Service Unit tracks and facilitates the complaint resolution process for all st ate funded services within the state. Arizona State Hospital, the only publicly funded and operated hospital in Arizon a for treating civilly committed adults with serious mental illness and forensic patients requiring court ordered evaluation and treatment. State Licensing Team Leader Community Program Representative Forensic Unit Manager As a State Licensing Team Leader at OBHL, supervised and directed a team of surv eyors conducting inspections and evaluations of behavioral health facilities for state licensing and Title 19/21 certification. Led investigations into all comp laints of rule or statute violations including abuse, neglect, and exploitation of service recipients in behavioral health facilities. Provided training and tec hnical assistance to providers regarding state regulation requirements; particip ated in enforcement actions as necessary. Assisted in the promulgation of rules and five-year rule review. As a Community Program Representative at DBHS, coordinated and provided response s to customer inquiries and complaints received through the department. Research ed rules, regulations, laws, and policy and procedures; facilitated problem reso lution through coordination with the Regional Behavioral Health Authorities (RBH A), DBHS Bureaus, and other agencies. Member of the RBHA Monitoring and Complia nce Teams, including provision of training and technical assistance to the RBHA. Evaluated RBHA performance related to resolution of problem issues. Documented trending of inquiries/issues, and participated in related performance improvemen t activities. Engaged in the annual administrative reviews of RBHAs and TRBHAs r egarding contract compliance and submission of corrective action plans. As a Forensic Unit Manager at the Arizona State Hospital, identified all program and unit resource requirements and allocated resources through the procurement and budget request processes. Tracked inventory procurement and services for tre atment units within budget and tracked expenses through a customer relations dat abase. Submitted monthly productivity reports to Management Team for tracking ma naged patient funds. Directed all environmental functions including building mai ntenance, housekeeping, grounds, and facility renovations. Monitored all assigne d treatment units for physical plant compliance with JCAHO, Medicare and state l icensing standards. Key Accomplishments:

Increased customer service within OBHL by 50% at the provider level by focusing the department and mentoring staff. Improved efficiency 25% within OBHL by organizing workflow, streamlining paperwo rk and reducing timelines for processing license applications. Recognized by the Customer Service Department at ValueOptions, the Maricopa Coun ty RBHA, for providing outstanding customer service at DBHS in resolving custome r complaints with ValueOptions. At DBHS, established key working relationships within multiple state agencies an d played a prominent role in facilitating and resolving several high profile com plaints at the state level. As a Process Improvement Facilitator with the State Hospital, impacted patient t reatment goals, staff retention, and facility safety. Tracked submission data fo r hospital JCAHO accreditation. Arizona State Hospital Unit Managers nominated for Team of the Year in 2004. Education & Credentials Ottawa University, Bachelor of Arts Degree in Psychology - Phoenix, Arizona 1992 Training & Development Magellan Health Services, HIPAA Privacy and Security 2007 The Council on Licensure, Enforcement and Regulation National Certified Investigator/Inspector Training, Specialized Program, Advance d Investigative Analysis, Advanced Investigative Report Development, Advanced In terviewing 2006 The Office of the Arizona Attorney General The Civil Rights Division Compliance & Conflict Resolution Section Conflict Resolution/Mediation Training 2001 Professional Affiliations Society of Corporate Compliance and Ethics (SCCE)