Accomplished, analytical, excellent communication and problem solving skills with more than 5 years of experience in the Quality Improvement field.
Planning and development
Quality improvement competency
Independent judgment and decision making
Experience with hospital discharge planning
Strong presentation skills
Quality Practice AdvisorOhana Health Plan Hawaii - 500 Ala Moana Blvd., 1 Waterfront Tower, Honolulu, HI 9681307/2015 - Current Essential Functions:
Advises and educates Provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements.
Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement.
Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).
Delivers provider specific metrics and coach providers on gap closing opportunities.
Identifies specific practice needs where WellCare can provide support.
Develops, enhances and maintains provider clinical relationship across product lines.
Defines gaps in WellCare's service relationship with providers and facilitate resolution.
Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations.
Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education.
Provides resources and educational opportunities to provider and staff.
Captures concerns/issues in action plans as agreed upon by Provider.
Clinical HEDIS Practice AdvisorUnited HealthCare Hawaii - 1132 Bishop Street, #400, Honolulu, HI 9681309/2009 - 07/2015
Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS / State Specific quality measures for provider and staff education during field visits
Materials additionally include information from local, state, and national departments of health on key health related issues (understanding, exploring, educating and facilitating on a local level)
Serves as subject matter expert (SME) for assigned HEDIS / State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS / State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS / State Measure rates
Participates, coordinates, and / or represents the Health Plan at community based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned
Identifies population - based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care
Associate of Science: NursingUniverisity of Hawaii - Maui College - 310 W Kaahumanu Ave, Kahului, HI 967322002
Bachelor of Arts: Computer ScienceChaminade Univerisity of Honolulu - 3140 Waialae Ave, Honolulu, HI 968161986