Lisa L. Email & Phone Number

• Manages all aspects of quality improvement, health management and risk adjustment projects throughout the development project lifecycle including project scope, process workflows, resources, tracking, budget, data analysis and meeting regulatory deadline.• Collaborates with IT and other departments, track progress and effectiveness of projects.• Responsible for the organization & oversight of projects required for HEDIS and HEDIS Interventions including HEDIS files submission to QI Repository.• Develops and implements new ideas that support the business, cross-segment group facilitation and presentations, lead all program management tasks including monitoring, tracking and communicating progress of projects.• Manage audit, leads internal kick-off calls, tracks stakeholder submissions, timelines and submits to corresponding audit entities.

San Francisco, California, United States

• Develop and execute a comprehensive QI program for Healthcare Effectiveness and Data Information Set (HEDIS) Measures that delivers actionable information to the QI team, departments, and provider network.• Perform an evaluation of the QI program that assesses both progress in implementing the QI strategy and the extent to which the strategy is in fact promoting the development of an effective QI program on a regular basis.• Build, maintain, and interpret quality metrics and the analytical dashboard with vision and collaboration with the Clinical Informatics department. • Oversee the credentialing/re-credentialing process to ensure that credentialing activities are conducted in accordance to regulatory.• Oversee ongoing monitoring of sanction activities (i.e. disciplinary actions against licenses, sanctions activities by Medicare/Medi-Cal and grievance reports).• Evaluate, interpret and summarize accreditation guidelines on at least an annual basis and manage the process for accreditation activities, including communicating the changes in the standards from year to year and assist departments with updating policies, procedures, workflows, reports, etc., to comply with updated standards.• Facilitate survey distribution to collect and report measures of consumer satisfaction and health outcomes perceptions aligned with Medicare Health Outcomes Survey (HOS); Medicare Consumer Assessment of Health Plans Study (CAHPS).• Monitor, execute, and report on Medicare member incentive program that aligns with STAR measure completion, including member and provider communications and incentive fulfillment.

San Francisco, California, United States

• Manage all aspects of credentialing program operations and monitor for compliance.• Monitor the credentialing database, ensuring accuracy of data and reporting to downstream system.• Supports the Credentialing process with data collection, planning, and presenting pertinent data to physicians in credentialing meetings.• Collects data for quality interventions, studies and surveys including but not limited to provider and member satisfaction surveys, provider access survey, and provider wait time study.• Monitor critical data for extensive analysis and report generation.• Ensure all healthcare providers and facilities meet accrediting agency standards.• Performs Facility Site Reviews and maintenance for physicians and facilities.• Evaluates provider office Corrective Action Plans and conducts onsite inspection oversight as required.• Educates provider office staff about survey findings and areas of non-compliance with regulatory requirements.• Educates providers and office staff about new state and federal regulatory requirements.

San Francisco, California, United States

• Ensured quality assurance initiatives are coordinated and meeting targets for health maintenance, chronic care management, and HEDIS measures.• Identify, develop and implement HEDIS and medical data abstraction.• Assist Health Management Measurement and Improvement team in delivery necessary program documents, operations, and improvements for relevant accreditation, transparent, and community collaboratives.

San Francisco, California, United States

• Developed, implemented and delivered training programs for 900 volunteers for all UCSF Medical Center sites. • Responsible in research, strategy, design and creates course content and curriculum, training plans, audio/visual aids, test criteria, handouts, learning aids and evaluation/measurement tools; ensures the effectiveness of all related training materials, including procedures, manuals, handouts, etc. based on identified training needs.