Dawn Blake

Dawn Blake Email and Phone Number

Sr. Manager and Director of Quality Strategy and Plan Performance (Remote), PA Health and Wellness @ Centene Corporation
Plainfield, IL, US
Dawn Blake's Location
Plainfield, Illinois, United States, United States
About Dawn Blake

I am a results-driven healthcare executive with over 15 years of experience in operational leadership, strategic program management, and vendor relationship optimization within complex healthcare environments. Throughout my career, I’ve specialized in streamlining operations, driving process improvements, and leveraging data-driven insights to enhance quality and efficiency. My expertise spans multiple facets of healthcare management, from team leadership and contract negotiations to regulatory compliance and performance metric analysis.In my most recent role as a HEDIS Operations Manager at Centene Corporation, I led cross-functional teams to optimize healthcare data retrieval methods, ensuring compliance and operational excellence. By focusing on key performance indicators and resource allocation, I achieved a significant boost in efficiency while supporting executive leadership with actionable insights and strategic recommendations.Previously, as Senior Manager at Humana, I managed HEDIS programs and data quality initiatives across high-stakes healthcare environments. I was instrumental in designing performance-driven workflows that aligned with organizational goals and fostered a culture of accountability and continuous improvement. My collaborative work with IT and product development led to the successful automation of several retrieval processes, which minimized manual effort and streamlined operations.At Amerihealth Caritas, I served as Interim Director and Manager of HEDIS Operations and Data Quality, where I enhanced data accuracy and operational efficiency through strategic program implementations and vendor management. My focus on vendor success metrics and contractual compliance contributed to a high standard of quality and performance across all retrieval and data quality initiatives.In each role, I bring a passion for fostering high-performance teams and optimizing every stage of operational workflows to support business growth and resilience. I thrive on building strong vendor relationships, introducing innovative solutions to drive performance, and creating sustainable, KPI-driven programs that deliver measurable results.I am always interested in connecting with like-minded professionals who are passionate about healthcare quality, operational excellence, and transformative growth strategies. Let’s connect!

Dawn Blake's Current Company Details
Centene Corporation

Centene Corporation

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Sr. Manager and Director of Quality Strategy and Plan Performance (Remote), PA Health and Wellness
Plainfield, IL, US
Website:
centene.com
Employees:
33823
Dawn Blake Work Experience Details
  • Centene Corporation
    Sr. Manager And Director Of Quality Strategy And Plan Performance (Remote), Pa Health And Wellness
    Centene Corporation
    Plainfield, Il, Us
  • Centene Corporation
    Sr. Manager/Director Of Hedis Program & Quality Improvement, Pa Health And Wellness
    Centene Corporation Apr 2023 - Present
    Saint Louis, Mo, Us
    Strategic Leadership and Collaboration: Partner with executive leadership to deliver operational insights, data-driven strategies, and actionable recommendations for optimizing HEDIS® measures, abstraction, retrieval processes, and vendor management.Quality Analytics and Performance Improvement: Oversee comprehensive HEDIS® operations, regulatory reporting, and population analytics, driving performance improvements across Medicaid, Medicare and Marketplace and CHIP programs. Achieved a star rating increase from 3.0 to 4.0 stars through targeted quality initiatives.Operational Excellence and Process Improvement: Led initiatives to streamline abstraction and documentation retrieval methods, leveraging KPIs to enhance team efficiency by 50% and close care gaps.Regulatory Compliance and Data Accuracy: Directed state Medicaid, Medicare, Exchange/Marketplace reporting efforts, ensuring audit readiness and precise data submission, contributing to high compliance standards.Business Development and RFP Support: Provided analytical expertise and program management support for RFP responses, aiding business growth and alignment with strategic goals.Innovative Solutions: Designed and implemented process enhancements, integrating data-driven approaches to improve operational efficiency and advance healthcare quality outcomes.
  • Humana
    Senior Hedis Data Manager (Remote)
    Humana Oct 2021 - Apr 2023
    Louisville, Kentucky, Us
    Developed comprehensive Medicaid program partnerships, fostering collaboration to meet state mandates, including reporting. Developed processes integrating new business, HEDIS Operations, and reporting to ensure seamless transitions and operational efficiency. Defined departmental structure and processes for the new Medicaid HEDIS department.Improved data collection and processing for supplemental data, enhancing operational efficiency.Oversaw the implementation of clinical measures and all related regulatory activities and reporting.Established partnerships with IT and HEDIS NCQA-certified vendor on tool and reporting enhancements.Enhanced data quality and accuracy through rigorous review processes, leading to a 20% improvement in reporting precision.Led a cross-functional team to implement new HEDIS measures, resulting in a 10% increase in overall compliance rates.
  • Amerihealth Caritas
    Amerihealth Caritas, Manager – Data Quality And Acquisitions (Interim Director)
    Amerihealth Caritas Jul 2018 - Oct 2021
    Philadelphia, Pa, Us
    Managed staff, including hiring, setting performance plans, coaching, and career development.Served as Interim Director, assuming full responsibilities of the Director role during the transition period.Created HEDIS supplemental data handbooks and collaborated on designing HEDIS and Supplemental Data Programs.Improved data collection and quality strategies, increasing HEDIS scores by closing measure gaps.Developed and implemented a data improvement model that increased provider participation and reduced submission templates.Supported data lake and Hadoop database design for data improvement initiatives.Managed the HEDIS audit season, including abstractions, overreads, and supplemental data audits.Conducted medical record abstractions and validation for data accuracy.Oversaw supplemental data audits, ensuring regulatory compliance.
  • Amerihealth Caritas
    Corporate New Business Implementation
    Amerihealth Caritas Jun 2014 - Jul 2018
    Philadelphia, Pa, Us
    Managed complex projects related to new business development and market expansions.Acted as a subject matter expert in new market implementations and system conversions.Conducted research and analysis to support project implementations and strategic alignment.Led project teams and implemented process improvements, increasing productivity by 15%.Involved in RFP processes for new markets and market expansion for Medicaid, Medicare, and Exchange products.Collaborated with RFP writers and ensured departmental compliance with RFP requirements. Participated in readiness reviews, ensuring market adherence to RFP and contract requirements and operational readiness by go-live date.
  • Amerihealth Caritas
    Corporate Implementation Administrator (Remote)
    Amerihealth Caritas Oct 2012 - Jun 2014
    Philadelphia, Pa, Us
    Developed project documentation for senior leadership and key clients.Managed integration and support for pioneering technology collaborations.Successfully implemented a 12-month pilot of a Centralized Data System project.
  • Redeem Solutions, Inc
    Principal/Health Care Consultant
    Redeem Solutions, Inc Jan 2011 - Sep 2019
    Operated an independent firm specializing in healthcare consulting services.Conducted collaborative engagement with client teams to manage goals and identify process improvements.Implemented a new process increasing efficiencies in quality programs, leading to significant cost savings.Participated in Medicaid and Medicare network development, leading to market penetration coverage of 60%.Developed and executed strategic business plans that resulted in a 35% increase in cost savings.
  • Universal American
    Corporate Business & Network Development
    Universal American Nov 2006 - Jan 2011
    White Plains, Ny, Us
    Spearheaded the development for the Medicare Advantage PPO, HMO, NPFFS and Medicaid Products in Illinois, Iowa, Wisconsin, Ohio, Indiana, Missouri, and Kansas by substantially increasing market share by filing with the CMS. Led development for Medicare Advantage PPO, HMO, NPFFS, and Medicaid Products, increasing market share.Negotiated provider contracts while adhering to CMS regulations.Managed CMS filings and strategic planning groups to meet compliance requirements.Facilitated innovative healthcare delivery models, reducing MLR and achieving quality measures.Exceeded company goals by 60% through strategic market expansion and provider engagement.Managed and motivated a team of business and development contractors and developed a successful growth strategy for expansion in new market areas throughout the Midwest territory and other territories as assigned. Trained staff on comprehension contracting information. Cultivates relationships from initial contact through implementation with partners, staff and management. Set project-related objectives with 5 team members and provide input to their annual performance evaluation.Facilitated Pay for Performance and innovative Gain Share Model with Physician Hospital Organizations (PHOs) and large community-based IPAs for improvement of healthcare delivery reducing MLR (Medical Loss Ratio) and achieving targeted Quality Incentive Model measures

Dawn Blake Skills

Managed Care Medicare Network Development Healthcare Information Technology Healthcare Consulting Ppo Contract Negotiation Provider Relations Hipaa Healthcare Management Credentialing Hmo Strategic Planning Project Management Accountable Care Account Management Crm Access Health Information Exchange Provider Network Development New Business Development Market Analysis Microsoft Excel Ms Project Healthcare Improvement Network Devices Presentations Closing Deals Staff Development Recruitments Sales And Marketing Leadership Relationship And Team Building Medicaid Managed Care Provider And Payor Operations Quality And Continuous Improvement Territory Management Territory Development Client Relations Development Accounts Management Operations Management Microsoft Word Microsoft Publisher Microsoft Office Powerpoint Cob Facets Citrix Crystal Reports Enterprise Content Management

Dawn Blake Education Details

  • University Of Phoenix
    University Of Phoenix
    Healthcare Administration
  • Cuyahoga Community College
    Cuyahoga Community College
    Practice Workflow And Redesign

Frequently Asked Questions about Dawn Blake

What company does Dawn Blake work for?

Dawn Blake works for Centene Corporation

What is Dawn Blake's role at the current company?

Dawn Blake's current role is Sr. Manager and Director of Quality Strategy and Plan Performance (Remote), PA Health and Wellness.

What schools did Dawn Blake attend?

Dawn Blake attended University Of Phoenix, Cuyahoga Community College.

What skills is Dawn Blake known for?

Dawn Blake has skills like Managed Care, Medicare, Network Development, Healthcare Information Technology, Healthcare Consulting, Ppo, Contract Negotiation, Provider Relations, Hipaa, Healthcare Management, Credentialing, Hmo.

Who are Dawn Blake's colleagues?

Dawn Blake's colleagues are Janice Lucas, Claudia Zanetti, Kenny R., Kevin Hudson, Liz Brandli, Desire Griffin, Jesus Puente.

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