Judy Conley Email and Phone Number

Re-engineering of the Quality Improvement area to meet State and Federal requirements. Business Contributions:• Responsible for oversight of the Quality area which included grievances and appeals, complaints, risk management, CMS reporting and the Quality Improvement Committee.• Assisted in completing all the deficiencies noted by CMS.

Led the re-engineering of current Health Services department to implement new care and disease management programs, outsourcing solutions which ensured ease of obtaining referrals/authorizations and significantly lowered administrative cost.Business Contributions:• Responsible for oversight and direction of the Utilization Management, Case/Disease Management and Quality Management/HEDIS departments, including budget and annual performance for 20 clinical and non-clinical staff.• Appointed Risk Manager with 100% compliance on all annual AHCA Risk Management Surveys• Initiated first Care Transition Coach and Care Management Programs where clinical and non-clinical staff visited members’ homes and conducted follow-up calls to ensure member compliance during transition phase of care.• Responsible for the education and Company wide training on URAC accreditation and Risk Management. Achieved full URAC three (3) year accreditation• Co-Chair of Quality Management Steering Committee, Medical Advisory and Peer Review Committees. Chair of Delegation Committee.• Trained internal department and providers on HEDIS and 5-star program.• Participated in several work groups to re-engineer the operational infrastructure of the plan in preparation for continued rapid growth in membership.• Developed performance improvement projects for Colorectal Cancer Screening which resulted in a 10% increase in those members obtaining Colorectal Cancer Screening.

Project lead and key contributor relating to design, implementation and RFP for the Florida Nursing Home Diversion program. Developed policies and procedures, hired and trained staff and met with the Department of Elder Affairs to maintain compliance with all requirements. Business Contributions:• Responsible for Florida Region Health Services activities, including review of daily census, UM Committee, Regional Market Action Meetings (MAP), UM Program Description and resolution of day-to-day issues with Corporate Health Services and corporate Risk Management.• Working with Regional leads, responsible for review of reports (financial/utilization/services), analyzing trends and developing/implementing Market Action Plans to assist in the reduction of the MBR. • Lead for MLTC on the EMMA project– new front-end computer system (CH MACK).• Responsible for Agency relationships/reporting (AHCA/DOEA) as it relates to Long Term Care.• Responsible for the successful implementation, readiness review and day-to-day operations of the Florida Nursing Home Diversion Program – WellCare Senior Partnership effective 9/1/07.• Responsible for completing the Healthy Kids re-bid including completing the Intent to Negotiate (RFP) resulting in award of 15 counties (10 existing and 5 new).Also Director, Plans & Programs (Health Services) April 2005 thru April 2007Also Director, Case Management & Special Projects May 2004 thru March 2005

Responsible for the implementation of the Medicaid product, including hiring and training of all employees, and maintaining compliance with AHCA. Instrumental in the transition of the Medicaid program to Amerigroup, including coordinating meetings, ensuring all compliance issues were addressed and all members were transitioned appropriately. Business Contributions:• Coordinated the Medicaid transition for Medical, Quality and Pharmacy to Amerigroup on June 2003.• Developed review tools to evaluate Medicaid compliance for all Medical, Quality, Pharmacy, and Risk Management within AvMed; reviewed departments, implemented training and corrective action plans.• Responsible for interpretation, application and training on the Agency for Health Care Administration (AHCA) Contract.• Redesigned Complex Case Management Program and processes; implemented P&Ps, training and developed databases for all product lines; Commercial, Medicare, Medicaid.• Provided leadership/oversight for the Oncology, Chronic Kidney Disease and Transplant Case Coordinators and Complex Case Managers approximately 30 clinical and non-clinical staff.• Instrumental in conversion of Amisys Infotrust to AvMed’s Amisy, including claims and authorization configuration requirements.• Reviewed reports (financial/utilization/services) analyzed trends and recommended, implemented corrective action plans when appropriate.• Instrumental in contract development, county expansion, system conversion, development and implementation of policies & procedures, and training for Commercial, Medicare & Medicaid.