Deanna Talley Email & Phone Number

US

Albuquerque, NM, US

• Identified need for and helped build quality support across three Albuquerque metro hospitals, implementing matrix structure of program-based quality consultants
• Built and shared onboarding resources for new quality teammates
• With quality leaders, reviewed and revised the patient safety program, including root cause analysis process and tools, and reporting to regulators and hospital leaders.
• Supported standardization and spread of communication and project tools – SBAR, A3, 5 UP

Albuquerque, NM, US

• Supported Medical Staff Affairs (MSA) with improvement of meaningful OPPE/FPPE measures.
• Worked with physician leaders to develop Morbidity & Mortality, Quality Assurance/Improvement workgroups for physician specialty programs, e.g., heart and vascular, surgical service.

US

• Leader of delegated, contracted Utilization Management (UM), Case/Disease Management (CM/DM), and Population Health Management (PHM) functions for several managed care organizations.
• Successfully completed annual audits (NCQA/CMS).
• Ensured coverage determinations for healthcare services complied with CMS regulations, medical policies, and contractual obligations.

Canton, Massachusetts, US

• Responsible for all aspects of integrated care management activities and referral functions for medical, behavioral health, community health workers, clinical community outreach efforts, and contracted service providers.
• Provided hands on leadership for program management, clinical infrastructure, and service provision including Long Term Services and Supports (LTSS) and other community-based programs to best meet the needs of Rhode.
• Ensured compliance with the State of Rhode Island and NCQA requirements for care management, care coordination, and BH utilization management for Medicaid eligible beneficiaries.
• Collaboration with internal and external stakeholders in identifying, developing, and implementing innovative initiatives to improve HEDIS measures.
• Built relationships with provider groups to reduce non-urgent ED utilization and rehospitalizations.

Long Beach, California, US

• Senior leader for a large health plan (250K+ lives), delivering Medicaid, Medicare, Medicare/Medicaid, and Marketplace benefits, including behavioral health and LTSS.
• Targeted Population Care Management using epidemiologic analysis of membership and quality outcome to identify impactable and high-risk members.
• Downline of 500+ employees, including remote care coordination teams (nurses/social workers).
• Responsible for ensuring complex contract goals are met, developing collaborative teams, simplifying processes, and improving internal and external communication.
• Scope of services included maternal-child health, physical health, behavioral health/substance use disorder, disease management, and LTSS.
• Innovations included developing pre-release engagement at metropolitan detention center (jail), embedding transition coaches in high-volume facilities, peer recovery support.

Richmond, VA, US

• One of the writers resulting in winning RFP for Medicare/Medicaid Duals Demonstration project.
• Financial successes included 36% reduction in hospital readmissions and 9% reduction in ED visits overall using targeted case management and effective utilization management.
• Member Satisfaction successes included 97% overall satisfaction with case management program

Franklin, TN, US

• Innovative staff model redesign to ensure 24/7 case management coverage.
• Improved inpatient vs. observation designation, working with InterQual criteria and ED providers.

Charlotte, NC, US

• Clinical Transformation of Case Management program – developed effective staffing model
• Improved timely patient discharges and case management productivity measures

Franklin, TN, US

• On leadership team responsible for safe transfer of patients from old hospital building to new hospital.
• Leader of regulatory readiness of new hospital - successful CMS, State, and Joint Commission surveys.
• Responsibilities included: o medical staff affairs – credentialing, OPPE/FPPE, peer review o risk management o patient safety o quality management and performance improvement o infection prevention and control o.
• Member of hospital Ethics Board, which included internal and external providers and consumers

• Leader of regulatory readiness. Successful 2005 and 2008 Joint Commission surveys.
• Oversight of physician peer review, credentialing, and physician quality (OPPE/FPPE).
• Leader of patient safety and quality improvement work.
• Participated in Institute for Healthcare Improvement (IHI) 100K Lives and 5Million Lives
• Facilitator – Six Sigma Green Belt training for local health system.

Successful reworking of long-term disability unit for FedEx accountPrepared for NCQA Utilization Management (UM) accreditation reviewSupervised telephonic activities of 16 disability case managers

US

Workers' Compensation medical regulatory affairs with Florida Department of LaborContracting with Florida managed care organizations and DME companiesSupervised medical staff (nurses and physicians

San Francisco, California, US

Consultant in development of self-funded short-term disability case management departmentResponsible for staff hiring and developmentProcess mapped the programFacilitator of focus groups for the Buyers' Healthcare Action Group (BHCAG), a coalition of large self-insured corporationsWorked with programmer on development of software application for case.

Minneapolis, MN, US

Minneapolis, MN, US

Utilization review and case management. Assigned to cardiac medicine and surgical units.

Sioux Falls, SD, US

Master'S Of Science In Management And Healthcare Administration, Management And Healthcare Administration

Bachelors Health Services, Health Administration, Business

Diploma Rn, Nursing