Malik Haynes, Cphq Email & Phone Number

Oversee all related activities for the Quality Improvement functions.

Camp Hill, PA, US

Responsible for the strategy of Quality Improvement programs/initiatives related to the Health Plan Rating System (HPRS) Scores, Star Measures, and Qualified Health Plan (QHP) Measures. Manage a team of 4 nurses and 6 operational staffEstablished the Provider Quality Liaison Department to improve provider engagement and increase CAHPS ScoresAchieved the.

Camp Hill, PA, US

Responsible for the oversight of health plan’s preparation for both the National Committee for Quality Assurance (NCQA) health plan accreditation and the Long Term Services & Supports (LTSS) distinction. Quality Improvement champion responsible for managing targeted activities to improve HEDIS, CAHPS, HOS, provider satisfaction, and other identified.

Newark, NJ, US

Responsible for managing the contractual relationship between the enterprise and its vendors and subcontractors. Accountabilities include coordinating, monitoring, and documenting operational issues associated with the business relationship.

Philadelphia, PA, US

• Provided operational support to the Healthcare Management (HCM) division to ensure that department goals and objectives were achieved.
• Managed a team of 8, including 2 nurses and 6 operations staff.
• Oversaw companywide compliance with NCQA Accreditation.
• Led all aspects of the delegated vendor management lifecycle including requests for proposal development, contract negotiations, and contract performance monitoring resulting in over $500K in savings.
• Developed and established full delegation oversight unit for the Healthcare Management Division.
• Negotiated medical management vendor contract, which resulted in over $500K savings.

Philadelphia, PA, US

• Responsible for supporting the clinical operations of the Healthcare Management (HCM) division through training, auditing, monitoring and project management.
• Managed a team of 15, including 7 nurses and 8 operations staff.
• Developed and implemented a quality monitoring, audit, and training unit bringing the division into overall compliance with state, federal, and accreditation requirements.
• Established call center reporting unit to monitor call center performance that improved overall compliance with regulatory reporting by requirements by 50%.
• Developed a mandatory companywide regulatory requirements training using video and Adobe Suite software. Administered through a Learning Management System.
• Conducted rapid process improvement for transitional case management that improved the partnership between care management and medical management, resulting in reducing the re-admissions rate.

Philadelphia, PA, US

• Responsible for the oversight and management of the organization’s delegated vendors.
• Managed a team of 3 administration staff.
• Developed Request for Proposal (RFP) and successfully negotiated behavioral health services vendor contract for the company’s new line of business.
• Negotiated dental vendor agreement, which resulted in savings of $750,000.
• Re-negotiated vision vendor contract, which resulted in savings of $100,000.

Philadelphia, PA, US

• Responsible for oversight and management of ancillary network including provider education, contract negotiation, and fee schedule development and pricing.
• Oversaw the development and execution of the provider network expansion for Skilled Nursing and Audiology providers, bringing the organization into compliance with geo-access standards.
• Identified and implemented operational efficiency opportunities that improved network access
• Standardized DME fee schedule process to ensure consistency with fee-for-service reimbursement and reducing spending by 10% for non-standard codes.

Philadelphia, PA, US

• Organization’s point of contact for dental, vision, behavioral health.
• Assisted in contract negotiations and multiple contracts for Specialty Programs.
• Conducted utilization analysis (including RFP) to reduce Vision Per Member Per Month rate.
• Performed weekly audits of pre-service denials, expedited organization determinations, and denied claims to ensure compliance with regulatory guidelines.

Philadelphia, PA, US

• Developed, implemented and trained Provider Services Team of 30 on a revised call tracking system.
• Worked with provider client services team to address issues and concerns.
• Educated callers regarding the plan’s benefits for the organization’s Medicaid and Medicare offerings.
• Investigated and resolved daily provider claims issues in accordance with the department’s policies and procedures.

Master Of Arts (M.A.), Organizational Management

Bachelor Of Science (Bs), Psychology