Tera Newman

Regulatory compliance professional with experience in managed care, healthcare quality, auditing, investigations, and regulatory oversight. Proven ability to analyze regulations, evaluate compliance risks, conduct audits and investigations, and support corrective action and quality improvement initiatives. Skilled in policy interpretation, documentation review, cross-functional collaboration, and ensuring adherence to state, federal, and organizational standards across healthcare and human services operations.

Program Specialist – Compliance & Quality Improvement at Westmoreland County Behavioral Health & Developmental Services (2024-02 – Present)

• Lead provider network compliance oversight for state, federal and CMS/HCBS requirements
• Conduct audits, monitoring reviews, and investigations to identify regulatory risks and operational gaps
• Develop, implement, and track Corrective Action Plans (CAPs/DCAPs) using compliance and incident data to identify trends, support reporting & address recurring findings
• Serve as SME on compliance and incident management
• Collaborate with cross-functional stakeholders to resolve compliance issues
• Work as part of a team to administer, plan, coordinate, implement, monitor and provide technical assistance for the intellectual disabilities program in Westmoreland County as per the Medicaid Waiver programs, ODP (Office of Developmental Programs) regulations and AE (Administrative Entity) operating agreement
• Review service authorization requests against Medicaid waiver program guidelines
• Perform incident management functions as a certified investigator and comply with ODP's incident management process by reviewing and approving provider filed incidents
• Review eligibility for Medicaid Waiver enrollment and complete the enrollment process
• Develop, implement and monitor quality management plan (QMP) through data analysis and conduct annual self-assessments to ensure program compliance
• Review and analyze data and performance over time, as well as any direction or feedback provided by the Department regarding priorities and/or opportunities to improve the AE's internal QM processes and/or plans
• Use routine data monitoring and data analysis to identify quality improvement (QI) initiatives and measuring progress consistent with Everyday Lives' recommendations, person-centered outcomes data, and ODP priorities in making decisions around QI initiatives
• Maintain documentation for improvement
• Identify risks and complete early identification of potential systemic issues
• Provide claims resolution and technical assistance to ODP service providers and supports coordinators
• Work with providers to complete the CAP process and approve submitted documents. Have knowledge with PA regulations including 6100 (services for individuals with an intellectual disability or autism) and 6400 residential (community homes for individuals with an intellectual disability or autism)
• Run and assess data from EIM prior to conducting onsite visits

Youth Counselor at Alternative Living Solutions (2023-02 – 2024-02)

• Monitored safety, behavior, and compliance with service plans
• Documented incidents and behavioral data

Business Manager at Newmans Transport LLC (2018-11 – 2022-11)

• Oversaw operations, compliance documentation, and employee supervision
• Managed client relationships and operational risk

Adult Residential Licensing Representative at Commonwealth of Pennsylvania (2010-02 – 2012-02)

• Conducted regulatory inspections and licensure evaluations, determined compliance with state regulations, complaint and incident investigations and prepared violation reports with corrective action recommendations
• Delivered compliance training

Foster Parent at Westmoreland County Children & Youth Services (2015-04 – 2022-02)

Providing a safe and comfortable family environment for the child, taking care of the child's physical and emotional needs, providing appropriate clothing; attending to the health and medical needs of the child, providing recreational and other enriching activities to promote healthy development of the child, and disciplining the child. Attending case management meetings and court appearance. Assisting with appropriate life skills and interventions as needed.

CEO/Owner at Keep It Classy Creation (2019-08 – 2021-12)

Owner of an e-commerce business where I sell handmade items. As an owner I complete my listings, do marketing and answer customer service.

Therapeutic Activities Services Worker at Commonwealth of Pennsylvania - Hiram G. Andrews Center (2008-02 – 2010-02)

• Designs, implements and evaluates therapeutic programming for Hiram G Andrews (a technical school for individuals with disabilities)
• Researches, develops and adapts techniques with reference to student's abilities
• Keeps accurate and up to date documentation of the student's progress

Dormitory Counselor at Commonwealth of Pennsylvania - Hiram G. Andrews Center (2004-08 – 2008-02)

• Counsels and advises student on as needed basis
• Make appropriate referrals and documentation for student's counselor
• Functions as part of the interdisciplinary team

Youth Development Aide Supervisor at Commonwealth of Pennsylvania - Loysville Secure Treatment Unit (2003-09 – 2004-08)

Supervision of Youth Development Aides. Make appropriate referrals and documentation for resident's counselors. Keep accurate and proper documentation of the residents and staff for court documentation.

Youth Development Aide at Commonwealth of Pennsylvania - Loysville Secure Treatment Unit (2002-08 – 2003-09)

Responsible for the care, custody, supervision and re-socialization of juvenile residents. Maintain order, discipline and safety during daily routines. Keep accurate and proper documentation of the residents and report to supervisor and counselors.

Youth Care Worker at Cresson Secure Treatment Unit (2000-06 – 2002-06)

Responsible for the care, custody, supervision and re-socialization of juvenile residents in a maximum secure unit. Maintain order, discipline and safety during daily routines. Keep accurate and proper documentation of the residents and report to supervisor and counselors.

Bachelor of Arts in Criminology – Mount Aloysius College