- Collaborate with multiple departments to strategize, plan, and execute projects aimed at improving HEDIS scores from the provider front- Transformed clinical insights into actionable strategies, bridging clinical expertise with data analytics to drive continuous quality improvement across healthcare practices.- Led cross-functional teams in quality improvement projects, effectively coordinating efforts to achieve measurable results and optimize patient outcomes.- Championed a culture of data-driven decision-making, fostering collaboration between clinicians, nurses, and administrators to align practices with evidence-based strategies.- Designed and executed performance measurement systems, facilitating ongoing evaluation and refinement of healthcare practices for maximum efficiency.- Streamlined processes and workflows, identifying inefficiencies and implementing solutions that positively impacted patient care delivery.- Collaborated with IT teams to integrate data sources, enabling seamless access to real-time insights for informed decision-making at all levels of healthcare operations.- Monitored industry trends and best practices, continuously adapting strategies to ensure the organization remains at the forefront of quality and practice transformation.

• Increased Pay for Performance withhold at least 18% in one year in conjunction with the team• Leads interdisciplinary workgroups, with senior leadership for behavioral health related HEDIS measures and follow up with summary of key takeaways, action items and next follow up dates• Integrate Risk Adjustment by designing interventions to mitigate risk to overall business process• Adhere to quality strategy roadmap consistently communicating timelines, barriers, and escalating needs for immediate attention• High-level understanding of risk adjustment models and diagnosis related groups as they relate to CMS• Spearheading data validation of WI state pharmacy file, investigating the process of intake, rate calculation and confirming compliance with pharmacies, IT, and DHS• Report results for Value Based Contracting HEDIS measures for provider-based improvement• Operates as clinical quality SME for all HEDIS measures educating staff, developing internal resources• Project manage, designs, and implements behavioral health quality improvement projects and initiatives • Provide strategic direction for case managers, population health, and transitions of care coaches• Develops, analyzes, and monitors new and routine ad hoc reports using multiple data sources and systems• Writes narrative reports to interpret regulatory specifications, analyze, and record results/limitations • Analyzes key plan and intervention metrics to provide recommendations for quality improvement• Created and updates SharePoint for plan visibility on KPI, metrics and performance for all learning styles

• Assisted staff in obtaining and utilizing pro-predictive modeling tool for emergency room use, clinical indicators for intervention, high-cost medical condition compliance gaps, and more• Personalized care based on patient goals, resources, and barriers according to Medicaid SSI Contract• Consistently exceeded productivity goals with high number of touches to members in need of interventions, while increasing reimbursement payments from the state• Made vital contribution during SSI expansion where ~2,500 new members required healthcare assessments within first 60 days of membership • Provided resources to covered plan members including transportation and socioeconomic needs through telephonic health risk assessments and other outreach attempts• Collaborated with Utilization Management Team in reviewing medical records for prior authorizations

• Complete monthly audits on Healthcare Services staff based on positions, and requirements of governing agencies• Prepare and conduct national audits for NCQA, Metastar SSI, CMS and CLA for the MHWI plan• Analyze and report trends to assist supervisors with remediation and staff training• Update all processes for each contract change for all lines of business, attended Medicare CMS Remediation training• Manage statewide excel database housing employee scorecards and audit scoresPosition has been eliminated due to nationwide restructuring

• Manage companywide excel database housing employee performance scores with utmost confidentiality• Educate members on appropriate and effective use of health care system• Provide resources to members for management of chronic disease(s)• Collaborate with other Health Care Services team members to deliver quality care• Serve as member of employee wellness commission

Primary Job Duties and Responsibilities:·Manages all programs in accordance with QuadMed’s operational, quality, safety, and service standards. ·Contributes to the planning and health promotion/wellness intervention process for their site(s). ·Coordinates the planning and delivery of wellness programs including health awareness (bulletin boards, newsletters), educational campaigns (lunch n learns, workshops), behavior change programs (Choose to Lose, Maintain Don’t Gain), health assessments/screenings (biometric screenings, incentive program), smoking cessation, and more. ·Provide appropriate health outreach and Wellness Counseling/Coaching using motivational interviewing techniques·Proactively contributes to wellness team meetings. ·Effectively promotes and markets the wellness programs to target populations by utilizing existing resources. ·Integrates/collaborates effectively and seamlessly with health partners such as QuadMed, Fitness, Safety, EAP, or those in the community. ·Performs research on relevant topics in health promotion and disease prevention, as required. ·Collects and evaluates program data.Accomplishments:•Researched and designed worksite wellness culture report as a marketing tool for account managers, sales, and senior leadership to improve employee health.•Developed companywide needs assessment, implementation strategy to assess areas of weakness for appropriate wellness programming to increase participation and ensure success.•Responsible for designing, collecting, analyzing and reporting wellness program assessments nationwide to improve program offerings, content and efficiency.•Practice motivational interviewing techniques as a medical provider for one-on-one coaching and program facilitation. Continuously improving as various client goals and challenges are presented.

Fitness center management and oversee pool and spa facility. Specializing in physical and mental wellness of individuals with physical limitations, dementia, Parkinson's disease and other disorders.Enforce rules and regulations of aquatic and fitness facility to maintain discipline and ensure safety. • Organize, lead, and promote interest in recreational activities such as group exercise offered on land and water and personal training sessions on land and water• Meet with staff to discuss rules, regulations, and work-related problems. • Greet new arrivals to activities, introducing them to other participants, explaining facility rules, and encouraging participation. • Explain principles, techniques, and safety procedures to participants in recreational activities, and demonstrate use of materials and equipment.*Work closely with Physical therapists and continuing patient specialized theraputic exercise routinesAccomplishments:Selected "Staff Champion" as Masterpiece Living lifestyle coach

Observe, analyze, and record patients' participation, reactions, and progress during treatment sessions, modifying treatment programs as needed.Develop treatment plan to meet needs of patient, based on needs assessment, patient interests and objectives of therapy.Encourage clients with special needs and circumstances to acquire new skills and get involved in health-promoting leisure activities, such as sports, games, arts and crafts, and gardening.Counsel and encourage patients to develop leisure activities.Confer with members of treatment team to plan and evaluate therapy programs.Conduct therapy sessions to improve patients' mental and physical well-being.Instruct patient in activities and techniques, such as sports, dance, music, art or relaxation techniques, designed to meet their specific physical or psychological needs.Obtain information from medical records, medical staff, family members and the patients themselves to assess patients' capabilities, needs and interests.Plan, organize, direct and participate in treatment programs and activities to facilitate patients' rehabilitation, help them integrate into the community and prevent further medical problems.Prepare and submit reports and charts to treatment team to reflect patients' reactions and evidence of progress or regression.Accomplishments:•Designed and implemented individualized care plans alongside medial staff and family for wellbeing and best interest of their loved one.•Prepare and submit reports to treatment team to reflect patients' evidence of progress or regression.•Responsible for facilitating group or one-on-one activities on three units, skilled nursing, memory support and rehabilitation, which taught me how to be flexible and accommodate to the needs of each participant. Also to supervise and schedule volunteers necessary for scheduled activities.