Diane Pham, Md Email & Phone Number

Newport Beach, California, United States

DCE|MSSP ACO* Establish and maintain provider engagement/outreach for AWV, risk adjustment and quality measure training* Implement clinical programs and workflows, such as telehealth, home visits, remote patient monitoring, chronic care management, & transitions of care* Collaborate effectively with data team on data analysis and reporting* Leverage population health management platforms to risk stratify cohorts for disease management programs* Strong analytical skills with CMS claims data (CCLFs) and reports* Experience with Medicare billing to ensure HCCs are captured accurately and appropriatelyGolden State Medicare Health Plan* Collaborate with NCQA-certified vendor to submit & report HEDIS & STAR measures. Ensure all required reporting is accurate, timely, and complete.* Partner with licensed NCQA auditor/contractor to perform HEDIS audits & CMS data validation* Support and oversee the development of quality improvement initiatives, such as Chronic Care Improvement Projects (CCIP), Chronic-Special Needs Program (C-SNP) & Health Risk Assessment program with the Interdisciplinary Care Team (ICT)

Alhambra, California, United States

MSSP ACO|Next Generation ACO• Successfully submitted & reported for QPP/GPRO. Passed annual Quality Measure Validation Audit Review to be eligible for shared savings. Spearheaded & managed 3rd party vendor to extract clinical charts and abstract quality measures from providers.• Analyze expenditure and utilization reports for savings opportunities. Trend and interpret CMS quarterly performance benchmark reports.• Risk stratify beneficiaries for disease management programs based off the John Hopkins ACG Risk Methodology, CMS-HCC Model & AI Predictive Analytics software.• Coordinate with multiple hospital IT teams to configure and implement admission notifications.• Manage and design projects/programs, such as Annual Wellness/Home Visit, 24/7 Nurse Triage Call Center, Post-Discharge Care and Chronic Care Management.• Continuous updates with physicians to review performance report cards, HCC opportunities & provide recommendations for improvement.* Project Manager for contracted IT team to develop and enhance patient engagement platform* Create digital care plans with medical writer and clinical team using evidence-based medicine.

Livingston, New Jersey, United States

Doctor Of Medicine - Md

General Science