John Quigley Email & Phone Number

Responsible for planning and execution for Senior Health Services Clinical Value Portfolio. Emphasis on developing and maintaining a multi-year planning and capabilities matrix to guide and inform capital planning process and annual budgeting. Manages the value proposition, ensuring the portfolio creates, delivers and realizes projected benefits.

Southfield, Michigan

Lead strategic, operational, financial and administrative activities of the organization. Leads initiatives from ideation through development, approval and execution. Facilitator of annual and long-term planning and performance management. Health care, government programs, Medicare Advantage, non-profit, for-profit, benefit-cost reduction, Strategy, planning, critical-path, performance indicators, innovative solutions

Federal Business Division

Led all initiatives supporting NCQA accreditation, URAC accreditation, QI activities from Michigan dept. of Health and Human Services. Led and responsible for HEDIS/CAHPS initiatives/improvement.

Works closely with the Manager of Quality Management and the Quality Management Analyst to coordinate the development, implementation, documentation and evaluation of quality management initiatives. Assists and supports all quality management functions including QI projects, disease management programs, HEDIS, CAHPS and NCQA Accreditation efforts.

Responsible for coordination and submission of HEDIS and CAHPS as well as analysis of results, implementation and measurement of interventions for improvement as well as analysis of other survey materials. Responsible for monitoring and maintaining HEDIS and department work plans and providing analytical support to QM Analyst.

Created and implemented prospective review programEvaluated staff job roles and expectations, created new functions and responsibilitiesAnalyzed outpatient services expenditures to determine appropriate allocation of staff designated to review outpatient servicesConducted various Lean activities to optimize process flow within transitioning of work between staff roles resulting in additional available adjusted FTEs

Conducted value stream mapping activities using Lean principles to identify variation in authorization process and implemented new processes resulting in reduction of lead time for authorization completionMonitored staffing levels real time and retrospectively through software applicationSat on Department Redesign Committee to adjust job roles, policies and procedures and physical department designCreated training manuals for Care Management SpecialistsHandled calls from health care providers requesting authorization, resolution of problems, or other assistance

Conducted annual review of RxAmerica on site; audits of their customer service department to improve call handling, abandonment rates, and timeliness of call answeringConducted various training activities of new hiresResolved member and provider issues telephonically

Touring Pro on the Canadian Tour

Mhsa, Health Service Administration

Activities and Societies: Professional, Academy for Healthcare Management designation Student Associate MHEGADegree conferred May 9th

Bs, Marketing

Activities and Societies: Varisty Golf Team, 3rd place 2004 NCAA Championship; Student Athlete Advisory Committee; BLAST (Leadership.

Education record