Provided executive oversight and direction of the Quality Improvement Department to improve processes, patient care and more efficient operations, overall satisfaction, and safety consistent with WellCare’s Mission, Vision, and Values. Led a team of 21 FTE consisting of clinical, analytic and Accreditation staff reporting to the State President and Medical Director. Supported quality strategeis for 16k Medicare members and 260k Medicaid members. Improved Health Plan outcomes by closing… Show more Provided executive oversight and direction of the Quality Improvement Department to improve processes, patient care and more efficient operations, overall satisfaction, and safety consistent with WellCare’s Mission, Vision, and Values. Led a team of 21 FTE consisting of clinical, analytic and Accreditation staff reporting to the State President and Medical Director. Supported quality strategeis for 16k Medicare members and 260k Medicaid members. Improved Health Plan outcomes by closing the HFS Corrective Action (CAP) within 8 months and earned $4.2M+ in quality bonus over a 2-year period. Managed all aspects of development, integration, and oversight of Quality Improvement Programs, including improved HEDIS scores, CAHPS result improvements, and State and CMS mandated quality measures for Medicaid/Medicare markets. Aligned care coordination and quality teams and developed key partnerships with vendors to improve quality outcomes. Track and present results of improvement efforts and ongoing measures of processes to executives and stakeholders. Collaborated with department heads to identify and mitigate potential issues and risks. Built and sustain lasting relationships with provider/community partners to improve quality and access to care. Managed IL State and Regulatory NCQA Accreditation and CMS reporting Reported outcomes at Joint Operating Committee (JOC) meetings with Provider Group leaders consisting of CEO, CFO, Medical Directors and key leaders Show less

Director of Network Programs (2014-2015)Sr. Manager of Accreditation (2013)Quality Initiatives / HEDIS reporting / UM/CM for HMO line of business (1998 – 2012)Responsible for the quality analysis/data of annual HEDIS/CAHPs reporting and strategies to improve outcomes for the HMO population of 800K+ members and the identification and implementation of programs, strategies, and initiatives designed to advance network strategy, minimize out-of-network cost exposures, quality… Show more Director of Network Programs (2014-2015)Sr. Manager of Accreditation (2013)Quality Initiatives / HEDIS reporting / UM/CM for HMO line of business (1998 – 2012)Responsible for the quality analysis/data of annual HEDIS/CAHPs reporting and strategies to improve outcomes for the HMO population of 800K+ members and the identification and implementation of programs, strategies, and initiatives designed to advance network strategy, minimize out-of-network cost exposures, quality outcomes, and improved patient access. Advance Network strategies to decrease healthcare costs, improve quality outcomes, and member experience. Oversight to all delegated providers/facilities in the HMO/Medicare Advantage Networks to assure compliance with state, regulatory, and business requirements. • Directed the UM/CM/DM, and wellness programs for members with chronic conditions/ reported key initiatives to Provider Group Executives at Managed Care Round Tables.Earned the 2013 Commendable Rating for leading the Health Plan for the URAC/NCQA surveys; produced profitable growth through improved customer satisfaction and quality scores due to strategic alliances with corporate and allied health providers/influencers at local and national levels. Show less