Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm Email and Phone Number
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HEALTHCARE QUALITY, ACCREDITATION, COMPLIANCE, AND REGULATIONSeasoned healthcare quality professional known for 13+ years’ direct experience in managed care health plans plus 15+ years’ regulatory/appropriations experience in state government, specializing in healthcare agencies and Medicaid managed care. Comprehensive, detailed knowledge and skills in:- NCQA and URAC accreditation oversight and leadership- Medicaid, Medicare, Exchange/Marketplace, and Commercial Lines of Business, PPO, HMO, POS- HEDIS and Quality Rating System (QRS), including CAHPS Member Satisfaction Survey- Regulatory compliance with state and federal government, including CMS and ACA regulations, plus EQRO audit experience- Management of multiple quality and related committees- Continuous quality improvement, both clinical and service, including oversight of Quality Improvement Projects (QIP)- Supervision and leadership of successful department of 60+ employees- Delegation and vendor oversight, including contracting and ongoing monitoring and audit- Expert legislation tracking, specializing in appropriations- Diplomacy, tact, persuasion, and negotiation- Interdepartmental and intercompany project management - Critical thinking and problem-solving- Proficiency in Microsoft Word, Excel, PowerPoint, Outlook, Adobe Professional
Absolute Total Care
View- Website:
- absolutetotalcare.com
- Employees:
- 53
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Vice President, Quality ImprovementAbsolute Total Care Mar 2020 - Present
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Director, Division Of Quality And Healthcare OutcomesSouth Carolina Department Of Health And Human Services Apr 2016 - Mar 2020
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Director Of Quality ManagementConsumers' Choice Health Plan Aug 2014 - Nov 2015Directed the Quality Management department of the South Carolina and Tennessee nonprofit co-op health plans and ensured compliance with all related accreditation and regulatory requirements. Achieved full three-year NCQA Health Plan Accreditation under the First Survey option for both health plans within the plans’ first full year of operation. Oversaw creation of the plans’ first HEDIS program, as well as the plans’ first Enrollee Experience Survey (EES) for submission to CMS. Responsible for accreditation and quality aspects of the Affordable Care Act (ACA). Facilitated the Quality Improvement Committee (QIC) and the Delegation Oversight Committee (DOC) for both plans. Represented Quality Management department in CMS audits. Directed QM until health plan closed.
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Quality DirectorBluechoice Healthplan & Bluecross Blueshield Of South Carolina Aug 2012 - Aug 2014Columbia, South Carolina, UsDirected the corporate Quality Management unit, including all aspects of NCQA and URAC accreditations and annual HEDIS clinical measurement and CAHPS member satisfaction measurements. Directed continuous clinical improvement and ongoing compliance with accreditation requirements. Directed credentialing for all private commercial, Medicare, and Medicaid lines of business of BlueCross BlueShield of South Carolina, including BlueChoice HealthPlan, Companion Benefits Alternative, and Companion Property and Casualty. Oversaw accreditation and quality aspects of healthcare reform legislation. Represented corporate Quality Management unit in audits and ensured compliance with all quality-related regulatory requirements. Oversaw quality improvement committees and related committees. -
Accreditation Compliance ManagerBluechoice, A Subsidiary Of Blue Cross Blue Shield Of South Carolina Sep 2007 - Aug 2012Led three consecutive NCQA accreditation surveys, achieving highest possible accreditation level in each, including two renewals at Excellent level and one New Health Plan. Personally handled completion of the ISS tools, as well as preparation of hundreds of documents loaded into the tools. Oversaw accreditation compliance with healthcare reform legislation and regulatory requirements. Oversaw CAHPS member satisfaction and HEDIS clinical measurement for two and three lines of business, respectively, showing steady continuous improvement in critical rates in each of last three successive seasons. Directed quality management for two lines of business. Represented Quality Management unit for compliance in multiple Medicaid and Medicare audits. Oversaw four quality-related committees. -
Accounting/Fiscal Manager IiSc Department Of Mental Health Jan 2004 - Sep 2007Directed development of $375 million annual budget, including requests from multiple funding sources and budget provisos. Assessed fiscal impact of and tracked pending legislation. Wrote budget-relevant sections of annual accountability report. Analyzed budget and expenditure data for national and state surveys.
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Accounting/Fiscal Manager ISc Budget And Control Board, Office Of State Budget 1999 - Dec 2003Regulated state budgets of ten health/insurance agencies. Applied laws and policies to budget procedures. Collected and analyzed statewide data and made budget recommendations. Evaluated fiscal impact of legislation. Developed accountability report guidelines around Malcolm Baldrige award criteria.
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Research AnalystSc General Assembly, House Ways And Means Committee 1998 - 1999Coordinated budget request information. Provided the central legislation tracking for the Committee and coordinated legislative actions. Researched and resolved constituent issues for legislators. Staffed subcommittee meetings. Wrote budget provisos.
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Research AnalystSc General Assembly, State Reorganization Commission 1996 - 1998Audited agencies for efficiency and effectiveness in accordance with the standards of the General Accounting Office. Planned fieldwork. Collected and evaluated testimony, documentation, and statistical data. Wrote and presented findings to the members of the Senate, House of Representatives, and Commission members.
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Special Projects AssistantSouth Carolina Continuum Of Care 1995 - 1996Designed, implemented, analyzed and presented research project into time and effort spent by care coordinators for children for severe emotional disturbance.
Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm Skills
Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm Education Details
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University Of South CarolinaPublic Administration -
Francis Marion UniversityHistory
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Senior Executive Institute
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The Leadership Institute, Columbia College
Frequently Asked Questions about Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm
What company does Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm work for?
Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm works for Absolute Total Care
What is Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm's role at the current company?
Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm's current role is Vice President, Quality Improvement at Absolute Total Care.
What is Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm's email address?
Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm's email address is sh****@****esc.com
What schools did Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm attend?
Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm attended University Of South Carolina, Francis Marion University, Senior Executive Institute, The Leadership Institute, Columbia College.
What skills is Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm known for?
Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm has skills like Managed Care, Ncqa, Medicaid, Medicare, Quality Improvement, Healthcare, Health Insurance, Credentialing, Process Improvement, Hedis, Hipaa, Accreditation.
Who are Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm's colleagues?
Sharon Mancuso Mpa Cphq Cpc Pcmh-Cce Cpm Pahm's colleagues are Dashel Wiggins, Jennifer Frederick, Harriet Sirmons, Mary Jeffers, Anna Eddy, Jennifer Helms, Chandlyn Ferguson.
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