Dawn Blake Email and Phone Number
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!
Centene Corporation
View- Website:
- centene.com
- Employees:
- 33823
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Sr. Manager And Director Of Quality Strategy And Plan Performance (Remote), Pa Health And WellnessCentene CorporationPlainfield, Il, Us -
Sr. Manager/Director Of Hedis Program & Quality Improvement, Pa Health And WellnessCentene Corporation Apr 2023 - PresentSaint Louis, Mo, UsStrategic 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. -
Senior Hedis Data Manager (Remote)Humana Oct 2021 - Apr 2023Louisville, Kentucky, UsDeveloped 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, Manager – Data Quality And Acquisitions (Interim Director)Amerihealth Caritas Jul 2018 - Oct 2021Philadelphia, Pa, UsManaged 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. -
Corporate New Business ImplementationAmerihealth Caritas Jun 2014 - Jul 2018Philadelphia, Pa, UsManaged 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. -
Corporate Implementation Administrator (Remote)Amerihealth Caritas Oct 2012 - Jun 2014Philadelphia, Pa, UsDeveloped 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. -
Principal/Health Care ConsultantRedeem Solutions, Inc Jan 2011 - Sep 2019Operated 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.
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Corporate Business & Network DevelopmentUniversal American Nov 2006 - Jan 2011White Plains, Ny, UsSpearheaded 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
Dawn Blake Education Details
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University Of PhoenixHealthcare Administration -
Cuyahoga Community CollegePractice 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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