Emilie Castro, Mph Email & Phone Number

Responsible for all reporting needs associated with the Health Plan’s Quality Improvement, Accreditation, and Chronic Care Improvement Programs. Including:- monitoring performance and progress against all quality improvement goals- reporting metrics to assure the Health Plan meets CMS, accreditation, and other regulatory agencies’ standards for quality.

Rochester, New York Area

Assessed health plan compliance with NCQA, CMS, state and federal regulations for commercial and Medicare Advantage business. Worked with internal and external colleagues on various cross-functional projects including: mock audits, risk assessments, delegated vendor audits, regulatory and accreditation documentation.

Responsible for researching, developing, and implementing clinical policies to manage medical expense and quality through the instantiation of evidence-based medical content and maintenance of the existing policy portfolio. Works in collaboration with internal and external stakeholders to operationalize content and provide clinical support.

Wellesley, MA

Authored medical policies for external publications, monitored professional journals to uncover relevant emerging and updated topics, and analyzed information from peer-reviewed clinical literature, professional organizations, government agencies, and competitive intelligence. Oversaw implementation/communication of medical policies and review.

Quincy, MA

Partnered with internal and external sources to address issues in health product sales and Internal Business Unit. Researched policies and authored resource documents for Compass plans that were used by sales team; also drafted documents on MA Health Reform and updated company’s product training materials. Consulted with sales trainers on certification.