Feb. 21, 2014. Smoky Mountain Center (SMC), Western North Carolina’s largest managed care organization for publicly funded mental health, substance abuse and developmental disability services, is pleased to announce three major new appointments that elevate its capabilities as an organization dedicated to ensuring quality community-based care for consumers.
The new leaders are: A nationally recognized executive for provider relations, a general counsel with deep experience in North Carolina Medicaid law and a director for clinical operations with a record of care and business innovation at SMC. With their hiring, SMC continues to refine its community care model to optimally balance the perspectives and interests of consumers, providers and regulators.
Joining SMC are:
- Sean Jones as Senior Director-Provider Network. Jones starts March 3 and will be in charge of SMC’s partnerships with 800+ providers across the 23-county service region. He brings executive experience with national best practices in integrated care at a time when SMC and providers together are driving quality of care initiatives to ensure consumer access to a full continuum of services based on their needs.
- Tracy Hayes as General Counsel. Hayes, who started Dec. 2, is a recognized expert in Medicaid and behavioral health law and brings significant regulatory and public policy experience to SMC. Her previous career included representing and advising the NC Department of Health and Human Services and serving as chief legal officer at Alliance Behavioral Healthcare.
- Toni Shelow as Senior Director-Clinical Operations. Shelow is a licensed psychologist with more than twenty years’ experience in the behavioral health field in all three disability areas and with multiple stakeholder groups. She joined SMC in February 2012 and was promoted to her new role on the Management Team effective February 1, 2014.
“Individually and together, these three leaders bring us an even greater level of professionalism and provide the deeper base of skill and experience required in an evolving field that is critical to our citizens,” said Smoky Mountain Center CEO Brian Ingraham.
Jones is currently a consultant based in Waukesha, Wis., and has more than 22 years of experience in the behavioral health field as a leader, including as National Director of Network Operations and Contracting for Humana and as Director, Network Operations, with FEI Behavioral Health.
“Providers across the country have opportunities to apply their quality services within an integrated care model and expand their business. I would like to get our providers excited about those opportunities,” Jones said.
SMC’s CEO said “bringing Jones on board underscores SMC’s commitment to continued improvement in the strength of its provider network. Jones’ experience at the national level over more than two decades with all facets of managed care and behavioral health will reinforce SMC’s existing commitments to integrated care for its consumers and active involvement with providers, including ongoing education and consulting.”
“As an organization, we need to maintain a very high level of engagement with our provider partners if we want to craft a complete network of services that provides a continuum of care for our consumers’ needs,” Ingraham said.
Hayes was previously General Counsel at Alliance, where her responsibilities included overseeing all legal aspects of contracts related to operation of an organization with a $400+ million budget and analyzing the impact of county, state and federal legislative and policy mandates on the organization. Before that, she was a Special Deputy Attorney General at the NC Department of Justice, where she represented the DHHS in litigation and transactional matters.
“Medicaid managed care is a very complex area of overlapping federal and state regulations, and it continues to evolve as Medicaid reforms are considered,” Hayes said. “What we want to achieve at SMC is a healthy regulatory stance for the organization while at the same time maintaining our strong community-based quality of care.”
Shelow’s wide-ranging experience as a licensed psychologist has included five years working with brain injuries, spinal cord injuries and stroke patients. She has also worked with school systems, hospitals, the juvenile justice system and in private practice. Since joining SMC, she has played a key role in multiple initiatives including preparation for the 1915 b/c Waiver in 2012 and the development of new business processes now in use in our Clinical Operations Department.
“At SMC, we are very focused on quality of care, and a big part of what I’m doing now is establishing measurements and metrics for defining that quality,” Shelow said. ”When we have objective, evidence-based standards, it helps consumers and providers by ensuring transparency and clinical best practices.”
Smoky Mountain Center manages mental health, substance abuse, and intellectual/developmental disability services in Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey Counties in North Carolina. Access to services is available 24 hours a day, 7 days a week by calling 1-800-849-6127.