Deborah White, Md, Mba Email & Phone Number

Washington, Dc

• Conduct quality assurance surveys of managed care entities.• Reviewer for Special Needs Plan Model of Care (SNP MOC) program submissions since 2011; Executive Reviewer 2015.• Physician Surveyor Trainer since 2013.• Member of the Review Oversight Committee since December 2013.• Executive Reviewer for QIS (QIS = Quality Improvement Strategies required of Qualified Health Plans participating in the Marketplace for two or more consecutive years in accordance with section 1311(g) of the Affordable Care Act entitled “Rewarding Quality Through Market-Based Incentives.)

Tarrytown, Ny

Medicaid Population Health Management• Medical Director for General Medicine, Health and Recovery Plan (HARP).• Wrote the HARP section of the 2016 MVP QI Program Description.• Member, interdisciplinary team that reviewed HARP care plans and approved levels of service.• Led the workgroup that developed risk stratification of HARP members to prioritize outreach to those not in Health Homes.• Helped develop and implement Medicaid performance improvement projects required by NY State DOH for HARP and mainstream Medicaid.• Wrote the addendum to the 2019 QI Program Description required for the transition of medically fragile children into Medicaid Managed Care.• Wrote articles for the HARP and mainstream Medicaid newsletters.• Initiated project to actively transition adolescent members to adult care to facilitate closing gaps in care.Clinical Operations Support• Consultative resource to Case Management and Utilization Management for Medicaid.• Adjudicated first level appeals for Mid-Hudson region for all lines of business.• Consultative resource to Patient Safety-Restricted Recipient Committee.Contracting & Reimbursement• Supported value-based contracting implementation in Mid-Hudson region. • Led initiative to identify and implement strategies to contain lab costs for all lines of business. Committee Leadership:• Credentialing Committee Chair.• Clinical Operations Committee (formerly the UM Committee) Co-chair.Committee/workgroup membership:• Social Determinants of Health Committee.• Children’s Physical Health/Behavioral Health Transformation to Medicaid Managed Care Committee and Steering Committee • The Total Medical Expense Committee. • The Medical Management Committee.• The Medical Policy Task Force.• The Quality Improvement Committee.• The Quality Improvement Steering Committee.• The Value-based Payment Steering Committee.• The Behavioral Health Steering Committee.• The Delegation Oversight Committee.

New York, Ny

Provided clinical leadership for Care Management, Quality Improvement and Utilization Management.Organized priorities into the following categories:• Clinical Operational Excellence.• Administrative Operational Excellence.• Revenue Optimization.• Compliance.For each priority category, formulated tactics to accomplish:• Improved population health.• Enhanced consumer experience.• Cost containment.• Market readiness.Assured compliance with CMS and all applicable New York State regulations as they pertained to medical quality and utilization review components of care.• Provided support and guidance to primary care physicians and clinical leadership for the nurse practitioners and the pharmacy manager. • Represented ArchCare as liaison to physician groups, specialists, hospitals and nursing homes. Led clinical staff in achieving performance and financial goals. • Slashed $70,000 of unnecessary pharmaco-genetic testing.• Identified over $300,000 of out-of-network imaging, DME and lab work that occurred during the first six months of 2014 that could have been redirected to participating vendors.• Created a primer on Hierarchical Condition Categories for the nurse practitioners to facilitate robust clinical documentation to maximize RAF scores.Chaired the: • QI Committee.• UM Committee.• Credentialing Committee.

Garden City, Ny

Special Needs Plan Program• Wrote SNP Model of Care for 2 clients; received 3-yr approval for each.• Led prep for CMS SNP MOC audits; policies & procedures I wrote were cited as best practice.• Tracked SNP population health improvement with PQIs.• With IT developed registries to manage SNP population.• Prepared annual SNP MOC training materials.• Wrote SNP Structure & Process reports.• Sept 2013 to Feb 2014, led weekly SNP Interdisciplinary Care Team meetings.• Implemented SNP MOC Manual.• Obtained member-centric care plan templates from corporate HQ; increased care plan completion efficiency.• Implemented process to send care plans to members and PCPs for first time ever at HCP.Case Management• Taught Care Plan 101 to CM staff. • Updated CM Policies & Procedures to match NCQA standards.• Wrote and updated CM Program Description.CMS Initiatives• 2012 CCIP reports for 2 clients.• 2013 CCIP for Dual-Eligible and Medicare members for 2 clients.• 2013 update of CCIP Policies & Procedures; last updated 2011.• 2013 CMS-mandated QIP for 2 clients.Credentialing• Dec 27, 2012, assigned to lead the Cred Dept. • Set Audit-Ready & Error-Free tone yielding flawless audits by all 3 client health plans 2013-2014. • Jan 2013, started and chaired monthly Credentialing Operations Committee to foster joint problem solving between Credentialing Dept., Provider Services/ Contracting Dept. and Database Management; committee was QI engine for cred/recred process.• By Feb 2013, cleared 1-yr backlog of initial cred applications while stopping overtime and improving staff morale.• By June 2013, shortened recred cycle from 36 to 32 months to permit audit prep without overtime.QM• Chaired Clinical Services QI Committee from May 2013; on hiatus since May 2011. • Wrote QI documents for MSO and ACO with SMART objectives.• Developed and implemented the Inter-rater Reliability Policy & Procedure.• Brought current 63 UM policies over 1 year overdue for update.

New York, Ny

Responsible for oversight of the Clinical Services and the Care Management departments of Royal Health Care (an MSO) and Neighborhood Health Providers (a PHSP). • Performed all pre-service, concurrent and post-service reviews requiring physician input.• Conducted weekly conference call rounds with the case management staff to facilitate clinically appropriate and cost-effective care. • Participated in weekly conference call case review rounds with the behavioral health vendor to facilitate clinically appropriate and cost-effective care.Responsible for oversight of the Quality Management departments of Royal Health Care (an MSO) and Neighborhood Health Providers (a PHSP). • Coordinated an ongoing and systematic Quality Improvement Program.• Ensured operational and regulatory compliance with all Federal, New York State and New York City regulations related to Managed Medicaid, Child Health Plus, Family Health Plus and Medicare+Choice products.

New York, Ny

Managed the clinical and administrative functions of a freestanding, Article 28, federally-qualified diagnostic and treatment center in the heart of West Harlem with over 19,000 patient visits during calendar year 2007.• Responsible for oversight of adult and pediatric primary care, dentistry, podiatry, gynecology, HIV comprehensive care, social work and substance abuse counseling programs.• Responsible for the health of the 611 consumers who were residents in the housing component of the agency.• Administered a school-based health center serving approximately 1,000 children from pre-K to sixth grade.• Strengthened the skills of the management staff by instituting an “Administrator of the Day” program with the goal of equipping clinical and non-clinical management staff to adeptly handle unexpected administrative issues that might arise when I was out of the office.• Monthly reported treatment center status and outcomes to the Board of Directors.

New York, Ny

Provided oversight, management, clinical leadership and guidance for the Quality Management Department.• Achieved Excellent accreditation status for Commercial, Medicare and Medicaid product lines.• Implemented SMART objectives to restructure and quantitatively evaluate the Quality Improvement Program.• Implemented SMART objectives to manage and evaluate staff performance.• Responsible for HEDIS & QARR data collection and performance improvement.• Implemented processes that resulted in obtaining over 95% of medical records each year for all hybrid measures. (Prior to my arrival, approximately 60% of medical records had been obtained for some hybrid measures.)Implemented a multilingual telephonic outreach program to improve HEDIS & QARR results:• Collaborated with Medical Informatics to create a registry that identified non-compliant members by household.• Multilingual outreach team members contacted the head of each household and facilitated completion of appropriate screening and testing for each non-compliant member in the household.• Established a women’s wellness program made available to over 400,000 female members 18 years of age and older. .Chaired the: • Clinical Quality Improvement Committee.• Preventive Health/Disease Management Subcommittee.• Served as a member of the:• Quality Improvement Committee.• Credentialing/Recredentialing Committee.• Peer Review Committee.• Technology & Bioethics Subcommittee.• Quarterly reported Quality Management updates to the Quality Improvement Committee of the Board of Directors.• Did concurrent review and provider appeals of UM denials.• Served as liaison to the community by presenting wellness seminars.

New York, Ny

Senior Medical Director, Quality (2000 - 2002)Medical Director, Quality (1998 - 2000)Medical Director (1997 - 1998)Associate Medical Director (1996 - 1997)Progressively expanded my responsibilities within the Quality Department; ultimately provided clinical leadership and guidance for all functions in the Quality Department.Achieved Excellent accreditation status at Empire BlueCross BlueShield for Commercial and Medicare product lines.Implemented SMART objectives to restructure and quantitatively evaluate the Quality Improvement Program.Managed staff performance using SMART objectives.Chaired the:• Credentialing Committee.• Physician Review Committee.• Provider Appeals Committee.• Performance Monitoring Committee.• Practice Guidelines Sub-committee.Chaired and co-chaired the Continuous Quality Improvement Committee.Semi-annually reported Quality Improvement Program updates to the Board of Directors.Provided clinical consultation and support to:• The Health Education Department.• The Credentialing Department.• The Utilization Management Department• The Fraud and Abuse Division.Led the project to implement the initial disease management program for congestive heart failure.Led the clinical/quality indicator sub-team of the physician profiling project.

New York, Ny

Responsible for providing and improving obstetrical and gynecological outpatient care.• Chaired the OB/GYN Patient Retention Task Force at the request of the Chief Operating Officer.• Developed and implemented patient education and marketing tools to enhance the OB/GYN and pediatric care continuum. • Over a six-month period, initiatives increased delivery within network from 20% to 70%; postpartum and pediatric visits within network increased 60%.• Collaborated with the Chief Operating Officer, the Medical Director and the Associate Medical Director to resolve a service quality and cost effectiveness challenge created by primary care physicians who were not doing Pap smears and pelvic exams:Women who were seen in the primary care clinic for chronic medical conditions were routinely referred to GYN clinic for Pap smear and pelvic exam; two thirds of the women thusly referred to GYN clinic did not keep their GYN referral appointments. By blocking GYN clinic appointment slots, these referrals created a two to three-month appointment availability delay for women who received all their care in the GYN clinic. By missing their GYN referral appointments, the women with chronic conditions failed to obtain a vital component of their primary care.I implemented a project to retrain the primary care clinic physicians to do Pap smears and pelvic exams. This initiative made Pap smears and pelvic exams more accessible and available to women with chronic medical conditions and markedly improved GYN clinic appointment availability.

New York, Ny

Responsible for providing inpatient and outpatient care in an academic medical center.• Trained and supervised resident physicians, medical students, midwifery students, physician assistant students, and nursing students.Chief of Education for OB/GYN Residents (1986-1992)Responsible for the didactic education of OB/GYN residents.• Formulated departmental educational objectives.• Developed and implemented a didactic curriculum using problem-based learning.

Mba, Finance

Obstetrics & Gynecology Residency At St. Luke'S-Roosevelt Hospital Center

Md, Medicine

Ba, Biology

Activities and Societies: Graduated Magna Cum Laude

Education record