Due to a health issue I resigned my FL Blue position slightly ahead of my contract ending. The issue resolved, but other family member's health concerns developed; I was asked to provide assistants with daily activities of living and health care responsibilities. I continue to manage a number of these duties still, but are more stable and will allow me to assume a remote or hybrid role.

Initially responsible for 26 provider groups to manage Medicare Advantage quality measures both on site and remote, address concerns/issues, maintain accurate reports regarding quality measures, Fl Blue news, staff education and trouble shooting activities. Manage campaigns hosted by the health plan including chart chase, vision screening, incentive program and more.

Contract position

MAIN FOCUS: Management of the team in review of Veteran disability claims for clarity prior to submitting the claim packets to the VA for review. New program being developed from the ground up. TO INCLUDE THE online programs to review and deliver the cases, training of staff, development of policies and procedures, and other activities related to bringing a business up to activation.

Developed a program for the management of six (6) health plans with a focus on HEDIS (quality) measures for the Medicare Advantage Plans, with eventual spill over into Medicaid and Commercial products. Responsible for over sixty (60) Primary Care Offices. Primary goal to improve both CMS STAR ratings and patient care through improve health.Significant Contributions:-Development of a positive partnership with the insurance representatives -Improvement in communications between the representatives and the providers/office staff-Education of providers/staff on the requirements/expectations of the different health plans-Development of a process for managing incentive funds as they came into the Medical Group, assuring accurate information was disseminated to the Finance Staff, Medical Group Administration, and providers-Focusing on improving the quality measure STAR ratings - [currently STAR rating stands at 3.5 across most plans, with one plan's rating reaching 4.0 for both 2015 and 2016 - resulting in large bonus incentive payouts]-Incentive returns to date are in excess of $200,000 for 2015 and $500,000 for 2016-Expanding role includes improvement in office staff education to improve accurate coding, documentation, and completion of quality measures for thousands of patients over six (6) counties between Alabama and Florida panhandle. -Identifying barriers to measure completions and development of actions to over come them.

Temporary contracted role: Evaluate and assess all clinical grant funded activities for compliance with the grant goals. Increasing awareness of possible areas of opportunities for improvement. Program set in rural, low income, and low literacy community in partnership with several other local agencies.Significant Contributions:-Advanced policy/procedure reviews, updates, revisions, additional policies-Increased understanding & identify health education needs and development of literacy materials (5)- Institute required "client perception of care" survey process-data collection, upload to Excel spreadsheets, provide data reports, and recommend process improvements. Utilizing a telephonic process in obtaining survey results.-Assist in care management activities, developing refinements, marketing opportunities and process changes for improved time management, utilization of resources, and identify staffing needs/changes-Research: Health incentives for improving client self-management activities; telephonic apps for healthy choices/improvements in blood glucose/blood pressure; and assurance that the program is utilizing best practice care in self-management among others.

Expanding and utilization of my professional experience, vision, and program development acumen to design two new and retool one outreach program(s): 1) Mobile Health Unit - Covering 7 counties providing health screenings for adults/children including limited care management based on outcomes with follow up contacts, educational information, and community resources appropriate to the patient's needs. 2) Faith Community Nursing- Developed the program - providing care management, population health through healthcare support, appropriate referrals, screenings, and education in church setting. 3) CHIPRA Florida KidCare Health Insurance Enrollment - Grant awarded for enrollment assistance for children meeting the criteria. Responsible for the hiring and management of representatives reaching and enrolling eligible children, day to day operations, and grant data reporting.Significant Contributions:-Designed the replacement mobile health vehicle with more versatility, safer access, fuel economy, increased storage, and visual appeal. -Designed a limited nursing navigation/care management service for follow up on clients w/abnormal screening results - resulting in an increase of 25% more clients seeking medical intervention. -Actively sought out and obtained screening equipment through grants ranging from $500-21,000.Reduced cost of educational material by more than $7,000 over four years as an expert reviewing for Chaning-Betes-Focus health screenings/education to the low income population.-Challenged to manage all requirements to develop & implement a joint venture to assist a sister hospital in AL to increase their health outreach programing. -Applied erudition necessary to develop & implement Faith Community Nursing Programs from inception. Providing guidance, education, resources, and promotion/growth of the programs over three counties one in AL. Many marketing activities.