Beth Erwin Email & Phone Number

Attica, In, Us

Louisville, Kentucky, Us

Louisville, Kentucky, Us

•Managed team of 6-11 associates •Coordination of Compliance activities for NCQA and CMS providing instruction and guidance to team on data collection and reporting (HEDIS, CAHPS, AHRQ, Medical Record Review, Continuity of Care, Serious Reportable Adverse Events, Over/Underutilization of Frequent Selected Procedures)•Perform Inter-rater Reliability testing on HEDIS reviews, Quality case reviews, and Medical Record Review to ensure consistency and accuracy•Work with Corporate personnel and key market leadership to increase Continuity of Care results, HEDIS rates and CAHPS survey results•Work with team to increase physician awareness of preventive health guidelines enabling them to educate members.-Provide reports to physicians with members needing preventive health-Provide educational materials to physicians regarding preventive health guidelines•Increase Quality of Care provided to members-Review member complaints, request records and monitor for issues related to quality of care received-Review referrals received from Case Management, Risk Management, and other referral sources and monitor/research medical records for issues with quality of care-Work with Medical Director to determine Quality of Care Issues needing to go to Peer Review-Evaluate and trend all Quality complaints for trending by facility and provider•Create and present Quality Work Plan yearly, updating quarterly•Create and present Quality Improvement Evaluation yearly•Maintain Ohio and Indiana compliance to accreditation, state and federal regulations•Work with associates to create agenda and compile all documents needed for monthly Peer Review meeting•Ensure all staff understands HIPPA standards•Ensure all staff completes yearly ethics training•Oversee staff and guide in relation to Clinical Advisor role below

Louisville, Kentucky, Us

Visits to provider offices to share information on member needs to improve HEDIS measures and Medicare STARS Quality*Education of providers regarding Humana programs and HEDIS/CAHPS/HOS and communicates with members regarding HEDIS measures*HEDIS Coordinator 2010 season (2009 data)-Complete market paperwork in preparation for HEDIS and research physician demographic information-Managed overall collection in market-Collection and review of annual HEDIS data-Barrier analysis *Compliance to accreditation, state and federal regulations*Facilitate required medical record audits to meet all accreditation and regulatory requirements-Implemenation of corrective action plans -Medical Records alerts left behind for those members not having recommended preventive care*Investigation of quality issues from Case Management, Member Complaints and Grievance Department-Cases closed within 90 days*Participation in work groups and/or task forces -Readmissions research for PCP visit/home health utilization between admits-Indiana Immunization Coalition*Member outreach calls providing education/wellness messaging-Osteoporosis-Spirometry testing in COPD members-Breast Cancer Screening-Colorectal Cancer Screening*Physican messaging on members needing preventive care*NCQA Continuity of Care project for Dilated Retinal Eye Exam testing

Franklin, Tn, Us

2005-8/2007: Provider Services Manager, Healthways*Develop and implement disease specific initiatives with physicians and office staff -Dilated Retinal Exams -Hemoglobin A1c testing -Spirometry every year for members with COPD -Oral steroid use after an acute exacerbation for COPD -Spirometry every year for members over the age of 5 with asthma -Long-term medication use in members with persistent asthma*Established professional relationships with key physicians in Mid-Western Indiana*Provide physician and staff education centering on the use of National Clinical Practice Guidelines*Assist physicians with developing disease management strategies specific to their office practice *Develop and distribute risk stratified member reports to physicians*Consult with physicians regarding high risk patients, making referrals as indicated to disease specific programs and/or high risk case management *Collaborated on the development of informational brochures and support materials for physicians and their clinical staff to use in patient education*Provide educational training on patient clinical outcomes to physician and nursing staff relating to diabetes, cardiovascular, and respiratory disease*Coordinate quarterly health plan Physician Advisory Committee meetings *Prepare monthly reports of in-market overview for health plan and Healthways

*Development and implementation of Asthma Member Education Program for use by multi-specialty physician group practice*Risk stratified asthmatic members based on appropriate medication use and spirometry testing then provided education to asthmatic population by telephone, home visits, face to face encounters, or mail-only based on their stratification level*Helped implement on site employee health fairsEducational counseling with members-One-on-one education -Education by phone*Development of member health fairs in rural communities*Adopted diabetes program workload after previous health educator left*Conduct member education seminars for diabetes*Risk stratified diabetic members based on hemoglobin A1c level, presence of a lipid panel, microalbumin, and dilated retinal exam and provided education by telephone, home visits, face to face encounters, or mail-only based on their stratification level *Develop risk stratified member and physician outcome reports semi-annually*Adapted format of physician and member letters based on physician need and to incorporate members in their own care*Responsible for data management -Requests of needed administrative data -Member reports, -Physician reports -Education reports, -Year-end reports -Total members affected by disease state -Asthma, -Diabetes, -Hypertension*Consulted with practitioners regarding asthmatic and diabetic members*Perform smoking cessation and obesity management calls*Served as a resource for Arnett Clinic Respiratory, Allergy, and Asthma Department, Endocrinology, Family Medicine, Internal Medicine*Provide satellite offices with onsite comprehensive in-services on asthma management*Consulted with hospitalized asthmatic and/or diabetic members to develop education plan to prevent future hospitalizations. *Developed and provided work-site education class upon request by employer groups*Data abstraction for HEDIS measures

Master'S Degree, Health Leadership

Bsn, Registered Nurse, Disease Managment, Quality

Associate Degree, Nursing

Nursing Program

Bachelor Of Science, Nursing