Patrick Mackey Email & Phone Number

•Develop and coordinate delegation oversight mechanisms and act as liaison for the Plan with Corporate Delegation Oversight.•Develop and maintain accreditation readiness schedule.•Creates policy and procedures to support accreditation activities.•Conduct training and education programs for Plan, provider network, delegated vendors to support NCQA and HEDIS activities.•Develop QI, NCQA and HEDIS projects with delegated vendors to support accreditation maintenance and HEDIS reporting.•Coordinate assigned NCQA and HEDIS work plan activities.•Assist with delegation oversight audits and coordinate corrective action plans to ensure compliance with all state, federal, contract and accreditation requirements.

Greater San Diego Area

•Perform accreditation and quality management related audits and activities with an emphasis on obtaining or maintaining NCQA accreditation and state Utilization Review (UR) licensure.•Participate in onsite audits/reviews, agency inquiries, and training employees, as needed. •Perform ongoing monitoring to ensure the organization is meeting accreditation standards.•Analyze data, workflows, policies and procedures to assess program effectiveness. Interprets significance of routine-intermediate findings to identify areas of improvement, make and implement recommendations for improvement.•Define and document accreditation and compliance process steps (i.e., policy and procedures) in accordance with current state, federal, and independent accreditation and UR licensing requirements.•Communicate and consult with internal partners to assist with the implementation of accreditation and compliance recommendations for assigned area(s).•Serve as accreditation subject-matter expert for all or specific program sections, to consult and update internal partners on accreditation efforts and requirements. Recommend and provide training to employees regarding accreditation and compliance requirements and procedures.•Stay current with accreditation and regulatory requirements, as well as PA/UM programs in an effort to consult and provide a mutually beneficial resolution.•Coordinates and facilitates quality and oversight meetings such as, but not limited to Utilization Management Oversight Committee (UMOC) and Quality Improvement Committee (QIC).

San Diego

•Served as a technical subject matter expert for all Part D audits by CMS•Lead assigned audits as the primary participant for the PA & UM department•Project managed to ensure departmental goals and initiatives are achieved; When not in audits, learned all aspects of the current PA program for assigned clients, MedImpact internal processes, and applicable regulations•Provided QC to, audit related reports and all supporting documentation•Trained staff in audit requirements as needed•Worked with the Audit Support Pharmacist(s) and Audit Support Technician(s) the PA & UM QA Department, Government Programs, and clients to design and implement Quality Improvement projects related to audit findings, potential audit findings, and process improvements•Understands techniques of CQI and High Reliability Organizations (HROs) and teaches them to others•Worked closely with other departments to design and execute systems changes and enhancements to assist in quality improvement•Audited established guidelines for CMS required measurements•Researched, analyzed, and recommended QA and QA training programs•Served as the client facing client manager for all audit issues and client oversight, collaborating with other members of the audit support team•Assisted the Audit Support team with the initiation, performance in, progression, completion, and follow up of CMS client audits and other audits as needed•Assisted the Appeals & Grievance Team, Prior Authorization Team, , PA Implementation Team, and Drug Information Team as needed

Temecula, Ca

•Data entry•Manage working inventory for departmental needs, various nursing units, and operating rooms•Prepared medications for topical, enteral and intravenous use. •Delivered medications to patient rooms, nursing stations, and operating rooms

Rancho Mirage, Ca

•Data entry•Manage working inventory for departmental needs, various nursing units, and operating rooms•Prepared medications for topical, enteral and intravenous use. •Delivered medications to patient rooms, nursing stations, and operating rooms

•Prepared pharmaceuticals for dispensing to patients by packaging bulk products into unit-of-use packaging•Compounding products by combining several ingredients after review of calculations and measures by a licensed pharmacist.•Maintained working inventory within established department guidelines by reviewing stock levels and recording for order, removing stock from storage areas and replenishing active use areas.•Assist pharmacist in provision of pharmaceutical care by reviewing and collecting data used by pharmacists in pharmaceutical care•Collecting and entering data into the pharmacy information system as directed•Answering telephone calls and greeting staff and responding appropriately if qualified or authorized to do so.•Train new hires on workflow techniques as well as day-to-day operations.•Traveled to Delaware for the company to assist in acquisition and training of new employees of small drug chain.

Bachelor Of Arts (B.A.), Non-Profit/Public/Organizational Management

BA in Organizational Management with a Minor in Information Systems

Associates Degree, Business / Technology

AA in Business Foundations