NCQA Market Lead for Colorado

Manager of 4 teams: care navigators, RN care coordinators, population health, and the 'All of Us' research program that aims to increase ethnic diversity in medical research. Managed 72 staff in a complex matrixed environment.• Responsible for hiring, creation & departmental operations of the 4 teams in ambulatory care services primarily focusing on health/behavioral health programs & health equity• Performed accountability-based performance reviews and performance improvement plans• Established and monitored KPI, metrics, & data analyses to evaluate effectiveness of programs• Facilitated team meetings & teaching opportunities for staff• Implemented quality improvement programs for care management operations• Responsible for CMS & NCQA regulations of all regulatory compliance and accreditation standards• Managed incentive-based programs for managed care payers (DHMP, UnitedHealthcare, Aetna, Cigna, Anthem)• Targeted interventions to increase STARS ratings and Hedis measures• Developed clinic-wide implementations of health disparity projects• Managed the strategic planning for all teams• Owned project management responsibilities for all teams• Implemented LEAN methodologies for process improvement• Closed gaps in care for patients, Commercial, Medicare, and Medicaid members• Worked cross functional collaboration for MDs, RNs, LCSWs, MAs, care navigators, and pharmacists• Implemented standard work for all teams to be in compliant with State requirements on building care plans for the highest acuity of utilization and costly complex patients• Provided virtual care solutions to patients having issues accessing healthcare services• Partnered with care management team to address social determinants of health (SDOH) of patients

• Responsible for hiring, creation & departmental operations of the healthcare management department in managed care• Managed programs such as complex case management, care management, disease management, population health, quality improvement and behavioral health programs for Commercial, Medicare, and Medicaid members• Oversaw efforts to meet STARS & HEDIS measures for members• Collaborated with departmental Directors for strategic planning of health plan operations• Oversaw and managed the departmental budget• Led team through implementation of virtual care opportunities for health plan members• Implemented digital health solutions to members for compliance in health related programs• Guided staff on NCQA and CMS regulations for implementations into daily workflow• Successfully led staff through a full CMS audit on the Medicare Advantage D-SNP members with no findings or no penalties• Incorporated LEAN methodologies for process improvement• Co-developed the Data Analyst Workgroup• Co-Chairs of Medical Management Committee, STARS workgroups, Strategic Planning for Employee Engagement, and Quality Management Committee• Chair of Care Management Steering Committee

• Responsible for the implementation and evaluation of behavioral health, disease management, population health programs along with quality improvement projects• Managed Chronic Care Improvement Program & Quality Improvement Project evaluated by CMS• Partnered with STARS workgroup to meet metrics• Owned the departmental NCQA accreditation requirements for Commercial and Medicare Members• Developed outcome measures based on data analytics from Tableau• Secured funding to implement virtual health programs for plan members • Implemented numerous grant funded projects related to disease management & behavioral health• Calculated departmental budget and all expenditures for health and wellness incentives• Worked with senior health plan leaders to implement strategic planning initiatives• Collaborated cross functionally with all managed care departments to meet contractual obligations

• Served as validation and approval lead for groups of hospitals to ensure timely access to healthcare systems and applications• Trained staff on new workflows to support groups of physicians, nurses, and other clinic staff• Performed quality assurance protocols• Problem solved any issues that arose regarding access and setup of staff within the Catholic Health network hospitals• Collaborated with all major hospitals to implement and establish programs, accesses, and qualifications for user access to medical and professional applications• Assisted with hiring and onboarding of new staff• Measured productivity and performance improvement plans

• Managed product development and implementation for client’s preferences of health promotion programs, both self-paced and health coach assisted• Implemented and designed global behavioral health programs, disease management, and risk reduction programs for major clients such as Halliburton, Chevron, Nestle, Exxon, Campbells and US Express• Responsible for post implementation quality assurance protocols• Assisted with research initiatives to update programs• Provided data for national publication in medical journals on population health• Conducted global health and national seminars on topics such as health promotion devices, risk reduction programs, disease management, and stress management programs• Trained global clients on setup and implementation of products selected for employee engagement and incentive based programs• Developed new strategic plans for enterprise applications• Strengthened client relationships through client satisfaction surveys and post-implementation teleconferences• Collaborated with data analytics team to ensure program delivery executed successfully and business strategic goals were met