• Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher and meet all requirements of the National Committee for Quality Assurance (NCQA).• Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups.• Be the primary resource person for all STARS related activities and CAHPS/HOS within their assigned market(s) working within a matrix relationship which includes United Healthcare's Regional Vice President, Administrative Call Center Team, Health Plan Medical Directors, and other Health Plan and Optum team members to assure that all STARS activities are planned and executed.• Collaborate with the Compliance, Legal and Regulatory team across UHC and Optum• Assist OPTUM and United Healthcare in development of training and analytical materials for Stars and HEDIS• Facilitate Weekly, Monthly, Bi-monthly, Quarterly and / or Annual business review meetings related to STAR activities which summarize provider group performance and market performance as requested or required by the Health Plan and the Director of Market Consultation.• Analyze and evaluate provider group structure and characteristics, provider group/ provider office operations and personnel to identify the most effective approaches and strategies.• Identify and assess decision makers and other key provider group personal with a focus on identifying barriers to achieving targeted outcomes. Focus communication and efforts accordingly• Develop solution-based, user friendly initiatives to support practice success.• Track and maintain inventories and processes related to data transmission through secure transactions• Build and develop strong and lasting relationships with internal and external partners

• Assisted with quality improvement initiatives in the service and clinical areas.• Achieved a 4.38 STAR rating with Humana.• Coordinated and updated proper departments on clinical quality metrics, CAHPS/HOS and HEDIS processes and results.• Established and maintained an action plan to improve HEDIS and CAHPS scores.• Implemented processes to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities.• Managed and ensured HEDIS medical records data abstraction was accurate per NCQA and HEDIS specifications• Collaborated with insurance companies, external providers, internal providers and internal departments on training, documentation and ways to improve processes in obtaining compliance for each HEDIS measure/goal for every patient.• Managed HEDIS projects: (including but not limited to) scheduling external "mobile" vendors to administer HEDIS screenings for patients internally, schedule management in EMR system, schedule patients for HEDIS screenings externally, report generation to check non-compliance.•Conducted quality audit and maintain all data and process controls to ensure compliance.•Provided subject matter expertise in the calculation of rates for HEDIS Medicare CMS Guidelines.•Be a reference and leader in data structures for HEDIS operational team.•Interacted with the technology team to produce accurate and timely reports.•Led and grew a team in analyzing quality opportunities and diagnosing quality issues.

• Coordinated and maintained all functions for Peer Review Consultant Credentialing.• Supported the organization by maintaining accurate and organized documentation of the Alliant peerroster and the peer consultant database.• Assembled highly confidential and sensitive correspondence and information.• Edited, composed and proofed memorandums and presentation materials.• Prepared weekly, monthly and quarterly statistical data reports as part of contract deliverables andmaintained meeting minutes.• Tracked and managed compliance of all contracts with operational and business requirements andensured all deliverables and deadlines were maintained and met.• Maintained current documentation and data as required for all continual accreditation programs.• Supported and assisted the Chief Operations Officer and the Chief Compliance Officer with projectmanagement tasks.• Applied departmental policies, practices and procedures to function effectively.• Trained and instructed new employees on Utilization Compliance Review and administrative tasks.• Served as a liaison between the company and the contractual peer consultants.• Planned, developed, maintained and operated a variety of health record indexes or storage andretrieval systems to collect, classify, store, and analyze information.• Organized and maintained health information both in paper files and in electronic systems.• Checked data for accuracy, record information and kept file folders and electronic databases up todate.• Protected the security of medical records to ensure that confidentiality was maintained.

• Provided health advice and promoted healthy living practices for Army personnel• Assessed patient's nutritional needs, developed and implemented nutrition programs and evaluatedand reported the results• Conferred with doctors and healthcare professionals to coordinate medical and nutritional needs