Manager Quality and Performance Improvement

• Feb 2022 - Present

Senior Manager, Quality Improvement

• Jun 2018 - Present

manage team of non-clinical staff review & analyze reports, records, and directivesconfer with staff to obtain data (new projects, status of work in progress, and problems encountered)manage the HEDIS and Risk Adjustment projects prepare reports and and present project status to senior leadership manage delegate vendor oversight monitor and analyze project costs and participate in the preparation of the budget

Manager, Quality Improvement

• Jun 2015 - Feb 2022

manage team of non-clinical staff review & analyze reports, records, and directivesconfer with staff to obtain data (new projects, status of work in progress, and problems encountered)manage the HEDIS and Risk Adjustment projects prepare reports and and present project status to senior leadership manage delegate vendor oversight monitor and analyze project costs and participate in the preparation of the budget

QI Project Manager

• Jul 2014 - Feb 2022

• Plans, organizes, monitors, and oversees projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives• Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives• Provide functional and technical knowledge across multiple business and technical areas• Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation• Create and communicate project milestone documents, dashboards, ROI tables, and departmental success metrics Show less

HEDIS coordinator

• Aug 2013 - Feb 2022

• Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results• Establish and maintain an action plan to improve HEDIS scores• Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities• Collaborate with providers and internal departments on rate investigation and validation activities, including maintain all evidences, documentations, and changes• Managed the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality• Conduct quality audit and maintain all data and process controls to ensure compliance Show less

Manager delegation oversight

• Jul 2010 - Aug 2013

• Act as primary liaison for the Managed Care Organization with all Delegated Subcontractors • Responsible for ensuring the timely receipt of accurate and complete reporting for all regulatory and contractual-required reports • Oversee compliance with the contract between the Managed Care Organization and the Subcontractor (including request, receipt and closure of corrective action plans, when necessary)• Act as a resource regarding contract and regulatory requirements• Responsible for annual audits to measure the performance of the Delegated Subcontractor• Participate in all quality management and improvement activities Show less

Program specialist

• Jun 2008 - Jul 2010

• Review & analyze reports to ensure compliance with contract standards and develop & monitor corrective action plans accordingly • Review & analyze legislative bills and proposed legislation for impact on Medicaid managed care programs and health plans • Identify & analyze complaint trends to find issues within Medicaid program policies or health plan operations • Review & provide feedback for marketing materials • Maintain database of current contract citations, amounts imposed, corrective action plans, and checks received Show less

Provider relations representative

• May 2006 - May 2008

• Maintain above satisfactory relationships with providers and provider office staff • Provide education, answer questions from provider offices, and conduct office orientations • Plan and present at provider workshops • Work closely with Government Programs to maintain compliance with Medicaid contract • Develop contract and negotiate contract rates • Understand claims issues including denials and educate providers when needed • Maintain above satisfactory relationships with providers and provider office staff • Provide education, answer questions from provider offices, and conduct office orientations • Plan and present at provider workshops • Work closely with Government Programs to maintain compliance with Medicaid contract • Develop contract and negotiate contract rates • Understand claims issues including denials and educate providers when needed