Beth Foley Email & Phone Number

Worcester Ma.

• Responsible for Clinical Quality programs across all FCHP products, Senior Plan (Medicare) HMO, PPO, Commercial, HMO, PPO, Navicare (SCO/SNP, Commonwealth Care,• Design and implement strategic direction for the Wellness Programs and communicate the value proposition of clinical programs at FCHP in supporting the health and decreased total medical expense for employer groups.• Support the development and ongoing preparation of reports and act as resource to the Sales organization for clinical programs implemented for the Advantage Plan groups and large accounts.• Lead the enterprise-wide wellness strategy, design medical clinics on site with key employers, and develop programs that will promote innovative health solutions and web-based self-service health sites.• Maximize annual Star Rating for the Medicare Advantage products to continually achieve 4-5 Star rating to keep FCHP eligible for the Quality Bonus Payment.• Achieve national rankings through clinical quality improvement activities and high quality HEDIS® data collection and results for all commercial, Medicare and Medicaid products. • Achieve "Best in Class” health management programs, compliance with CMS QI requirements, value based wellness programs and compliance with NCQA HP and Deeming standards. • Design, organize, and coordinate the implementation, reporting, follow up, and re-evaluation of all disease and population management.

Provide overall direction for all corporate-wide clinical quality activities with direct responsibility for three departments within the health plan.Quality Services Directs all clinical quality activities for all product lines. Responsible for health plan’s accreditation with National Committee for Quality Assurance (NCQA). Responsible for Healthcare Effectiveness Data information Set (HEDIS®) submission that results in health plan’s national ranking. Health Promotions Directs Health Promotions department that includes general health and wellness programming, worksite wellness, and population management. Develops programs and outreach strategies to encourage members to adopt healthy lifestyles and evidence based preventive care.Government Services Directs all clinical quality activities for Government Services, including national NCQA accreditation, Massachusetts MassHealth (Medicaid) requirements, Centers for Medicare and Medicaid regulations, annual audits, and outcomes measurements related to Quality Improvement Projects. Provides oversight on behalf of the health plan to vendors that are delegated with managed care functions to ensure that all downstream entities comply with NCQA and other regulatory requirements related to quality.

Responsible for the supervision, management and leadership of nursing practice within an adult acute rehabilitation facility. Responsibilities including program development, performance improvement, patient satisfaction, nursing practice and patient care outcomes.