Quality Improvement Project Manager (Company Acquired By Centene Corporation)
CurrentResponsible for creation of QI strategy for GA market; conduct quality improvement analysis / reporting and manage QI projects that impact over 1,000,000 Medicaid, Medicare and Ambetter members in the GA market• For 2019 and 2020, wrote the report: Quality Assessment Performance Improvement (QAPI), the QI strategy for the GA market; product received praise from the state regulator, the Department of Community Health, and is used to set priorities for interventions and activities • Perform data analysis and compose reports to meet GA market obligations to NCQA (National Committee for Quality Assurance) for plan accreditation and the Department of Community Health• Spearheaded collaboration with Community Relations department and created database that transformed workflow of 10 team members; final product reduced time spent performing administrative functions by 60% and optimized data collection • Created process efficiencies to lead team of 7 nurse reviewers to complete medical record audit (AMRR) 6 weeks ahead of schedule, outperforming teams nationally throughout the enterprise• Population Health Management: refined analysis to help care management and community engagement teams better manage members of disparate populations (with asthma or recurrent depressive disorder) whom have high utilization of ED / inpatient care o Results led to creation of additional community resources in areas where disparate populations reside (6 counties in GA market: Hall, Floyd, Camden, Fulton, DeKalb and Clayton) • Highly regarded influencer throughout the enterprise: lead education campaigns throughout the enterprise to create and drive strategy; produced positive member perception results that consistently exceeded the 90th percentile in CAHPS (Consumer Assessment of Healthcare Providers and Systems) for Medicare, Medicaid and Ambetter lines of business