Kimberly Clarridge Email & Phone Number

Implemented Cityblock’s Delegated Case Management Program to complement Cityblock’s value based care model to provide personalized, community-based care to improve the health and well-being of underserved populations. Oversight of federal, state & contractual quality compliance requirements.Responsible for conducting end-to-end audits for CMS and state-led care management program audits to support Cityblock’s health plan clients. (e.g. MMPCC, D-SNP, EQR, ISCA, PMV, etc.)

Lead a cross-enterprise team to obtain and maintain medical, behavioral, physical health, Credentialing, and pharmacy accreditations with URAC, NCQA, ACHC, TJC, Legitscript, NABP, and Health on the Net. Participated on the NCQA Standards committee to develop the Stand-alone Case Management Program standards. Built a comprehensive delegation oversight program to support both client and vendor delegation.

Phoenix, Arizona Area

Responsibilities include resource expert for NCQA and/or URAC standards and their interpretation. Utilization of web-based accreditation platforms. Provide gap analysis; develop and manage a project plan designed to identify, track and close gaps. Conduct mock audits, identifying issues and communicating to business leads. Complete on-line applications, maintenance attestations, and organizational change notifications. Collect supportive evidence; evaluate evidence and submit relevant online documents to NCQA and/or URAC. Organize and support Clinical Operations staff for planned and unplanned site visits/audits. Develop and conduct employee training regarding the accreditation standards and their intention as needed. Communicate changes to standards to the accredited area in a timely manner and incorporate changes into the preparedness plan. Proactively identify and communicate accreditation risks and potential barriers to the accredited area; develop a plan of action to address risks and/or barriers. Interact collaboratively with Clinical Operations and Product Directors and staff to ensure continuous accreditation compliance. Interact collaboratively with other business segments as indicated. Demonstrate the ability to meet required timelines. Interact with accreditation agency and other regulatory and compliance bodies. Facilitate and attend the onsite accreditation survey and any onsite monitoring visits. Enter all issues identified during the accreditation survey into the issues database. Provide ad hoc consulting to functional areas, which may include analysis, reporting, recommendations for Quality Improvement Plans and any other accreditation related items. Take an active part in the development and documentation of Quality Improvement Projects (URAC)/Process Improvement Measures (NCQA). Provide guidance to Clinical Operations and Product and ensure completion of yearly program evaluations and program descriptions.

Phoenix, Arizona Area

Identified candidates for case management utilizing available resources. Identified problems or gaps in care requiring intervention; ability to identify if member is able and willing to accept intervention. Developed care plan in collaboration with member/family addressing gaps and focusing on areas for maximum impact. Consistently assessed plan of care for continued opportunity for impact and intervention. Promoted cost-effective health care consistent with value proposition. Coached and influenced members to take action. Promoted, coordinated, and facilitated collaboration amongst all parties to achieve stated goals and to insure informed decision making. Coordinated health care delivery to reduce fragmentation of health care and to maximize member outcomes. Supported and encouraged members to self-management. Facilitated partner and other referrals to meet consumer needs making best use of resources. Collaborated with medical directors to attain optimal outcomes and cost-effective services. Worked directly with physicians and ancillary providers to assist in the navigation of the complex health care delivery system. Arranged appropriate high-quality services when needed. Maximized the use of community services. Strived for continuity of care. Coached members through their use of health care products and services. Assessed the effectiveness and quality of services provided through clinical, functional, and financial impact and outcomes. Served as client advocate and maintained client's privacy, confidentiality and safety. Adhered to ethical, legal/regulatory and accreditation standards. Responsible for consumers with Diabetes, Coronary Artery Disease, Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure. Thoroughly versed in the policies of assigned accounts including Medicare Primary Cross Carrier; Member of the Health Advocate Initiative providing customer demonstrations; Successfully completed United Manager Program; Phoenix ISO representative.

Scottsdale, Arizona

Responsible for providing patient care in all critical care areas including: neuroscience, cardiothoracic surgery, medical, surgical and trauma; Preceptor to student nurses, new graduates, and new hire nurses during the orientation process; Member of the Rapid Response Team fostering collaboration between critical care nurses and medical-surgical nurses.

Mesa, Arizona

Responsible for assessing and completing nursing care plans for each resident. Over saw the organization, planning and coordination of care on a weekly basis for Medicare/Medicaid, Long Term Care and private pay residents. Evaluated and solved quality of care issues, ensuring individualized care for all residents. Responsible for the design and delivery of a variety of training courses and other interventions for employees. Creating pro-active and responsive solutions to business needs and seizing opportunities for continuous improvement in individual, team, business unit and organizational performance. Specific duties include preparation and facilitation of training courses and other interventions for employees to include the design of instructional materials for training and participant materials. Responsible for performing miscellaneous duties related to training and development.

Master Of Science In Nursing (M.S.N.), Registered Nursing/Registered Nurse

Master Of Business Administration (M.B.A.), Healthcare

Bachelor Of Science (B.S.), Registered Nursing/Registered Nurse

Activities and Societies: ASASU-Student Government, President of the College of Nursing, Alpha Delta Pi, Student Nurses Association