Apr 2019 – Dec 2021 · 2 yrs 8 mos

• Responsible for developing the strategies to drive quality ratings and performance improvement for both CMS Star Ratings and NCQA and population health management for ACA, Commercial, and Medicare members. Co-lead Clinical Integration and all Value-based Care Initiatives to ensure members receive high quality care and a rewarding customer experience. Oversees the Quality Health Integration (QHI), Member and Employer Wellness, and Condition/Disease Management, Credentialing/Delegation and Provider Informatics and Population Health Specialists Departments. Strategically develops innovative member and provider interventions and population health programs that support the success of Network Health’s CMS Star and NCQA programs, MLR initiatives, and value-based contracting. Oversight of quality rating regulations and results, peer review and credentialing, provider directory, and responsible for the integration of quality, performance improvement and member satisfaction initiatives into all aspects of Health Plan operations.

Jan 2016 – Mar 2019 · 3 yrs 2 mos

Mar 2014 – Dec 2015 · 1 yr 9 mos

• Provided project management and consulting expertise to clients transitioning to value-based care such as clinical integration and risk strategy development
• Provided operational support to clients through organizational and program and policy design and implementation
• Managed project teams
• Led marketing and sales growth efforts for the consulting team and company-wide
• Contributed to the growth of practice through key tasks such as enhancing and developing product offerings and deliverables

Aug 2013 – Mar 2014 · 7 mos

May 2008 – Aug 2013 · 5 yrs 3 mos

• Work with the Delaware DPH to reduce infant mortality and improve maternal and child healthcare through: surveys, public education, focus groups. cost-benefit analyses and engaging with key community and healthcare advocates. Assist with grant and needs assessment writing. Work independently and closely with team members, including senior management on developing new business, managing relationships and increasing APS’ market presence in both public and private sectors. Support and promote APS through publications, proposals, and presentations. Develop and implement project plans and marketing materials, stay current on market developments and social media, CMS and NCQA requirements and competitor programs.

Apr 2007 – May 2008 · 1 yr 1 mo

• Worked on and lead various quality projects such as HEDIS and SSI QI Indicator Reports as well as quarterly reports on diabetes and lead testing. Help WI design and implement new quality interventions and benchmarking. Performs county audits and financial analysis for the Comprehensive Community Services program. Assist with the development and writing of RFPs and other potential new business opportunities for APS Healthcare.

May 2005 – May 2006 · 1 yr