Director, Quality and Patient Safety (Ambulatory Clinician)

Sutter Health Plan | June 2015 - Present | 10 years 5 months | Sacramento CA

• NCQA® Accreditation
• HEDIS®
• CAHPS®
• AMP/IHA
• Quality Improvement Activities
• Case Management Oversight
• Credentialing Delegation Oversight
• Preventive Care
• Language Assistance Program
• Health Coaching Program Oversight
• Health and Wellness Portal
• DMHC Provider Surveys (PAAS, Provider Satisfaction, Provider After-Hours)
• DMHC Medical Record Provider Documentation Audits

Responsibilities

o Responsible for executing health plan accreditation and reaccreditation through NCQA
o Developed and implemented a fully functional HEDIS program
o Developed and implemented a fully functional IHA program
o Developed an accreditation-compliant Population Health Management program within the health plan and in conjunction with the Health System Care Management team
o Led change within the ICM team to build a Complex Case Management function that was consistent and compliant with health plan accreditation
o Rigorous data analysis for quality improvement strategies
o Delegation oversight of Credentialing
o Oversight of the Language Assistance Program for Sutter Health Plus (SHP)
o Vendor management of the SHP health coaching program
o Audits, reports, and analyzes data obtained from the Health and Wellness portal
o Provides oversight to clinical staff who perform annual medical record audits of provider documentation as mandated by the DMHC
o Vendor management of all required provider surveys, including PAAS, Provider Satisfaction, and Provider After-Hours survey

Blue Shield of CA (2001-2015)

Senior Director - Clinical Services/Operations - Utilization Management, Case Management, Transitions of Care, Transplant, Health Advocate, &
Federal Employee Program

Senior Manager - Case Management & Utilization Management

Senior Manager - Delegation Oversight and Program Development

Manager - Case Management & Utilization Management

Supervisor - Case Management & Utilization Management

Staff - Lead Care Manager

Optum (1999 - 2001)

Care Manager

Genesis Health System, Illinois (1989 -  1999)

Staff RN - ICCU

Lead Care Manager

EDUCATION

Bradley University - Master of Science in Nursing (Nursing Administration)

Brandman University - Master of Business Administration (Healthcare Administration)

Chapman University - Bachelor of Arts in Organizational Leadership

Black Hawk College - Registered Nursing

CERTIFICATIONS

CCMC - Board Certified Case Manager (CCM)