NANCY D. DALE

360-***-**** acanan@r.postjobfree.com

Career Summary

Senior healthcare executive with 21 years' experience as both a medical

provider and manager / administrator. Extensive background in program and

policy development, quality / regulatory experience within major healthcare

institutions.

Relevant Experience / Skills

. Management / Leadership - advanced experience in all facets of

managerial functionality

. Program Development - developed and managed institutional programs

related to Medicare, Medicaid, MA-Special Needs Plan, and internal

reporting

. Medical Policy development, implementation, and management

. High-level financial, regulatory, and policy analysis

. NCQA management for Care Management, Review Services, Delegation

. Compliance management and oversight

. Reporting and data analysis

. Developing and managing teams and committees of medical directors and

supporting staff

. Federal and State onsite auditing and reporting

Employment History

Group Health Cooperative - 12/2004 to Present (Separate roles within

organization during this timeline delineated below)

Quality, Review, and Performance Manager - 3/2011 to Present

. Develop and manage Group Health's medical policies / clinical review

criteria while managing the Medical Director Policy Committee

. Monitor legislation, regulations, evidence, competitor positions,

data, and clinical trials to identify patient /organizational

interests / risks / needs, both clinically and financially

. Manage NCQA Delegation Oversight Committee

. Developed, managed, and led the organization's Medicare Advantage

Special Needs Plan across the health plan and delivery system, in a

Patient Centered Medical Home Model. Multiple 5-star elements, HEDIS

measures, and NCQA standards.

. Development of cross-functional systems for identifying and managing

"high-risk" members organizationally, while strategically leveraging

opportunities with Actuarial and Underwriting to improve HCC capture

and revenue

. 100% NCQA and "Superior" rating for CMS reviews, 100% on CMS Data

Validation, Best Practices for NCQA aggregate analyses, and Best

Practices for state submission of managing high-utilization members in

Medicaid population

Program Manager - 12/2008 to 3/2011

. Developed and managed the Medicare Advantage Special Needs Plan and

the Complex Case Management Program

. Created and implemented data tracking and reporting mechanisms

. Developed a departmental compliance reporting plan that included

document submission to state, Federal, and quality oversight

organizations

. Responsible for all of Care Management's State, Quality, and Federal

regulatory submissions

. Developed a new Medicaid high-utilization program involving multi-

discipline case management and integration into patients' homes

. Program utilization decreased by 50%, and was recognized by the State

of Washington as a Best Practice

. Group Health President's Award for successful program implementation

for SNP and reversal of compliance risk

Social Worker/Discharge Planner - 12/2004 to 12/2008

. Provided social work and discharge planning at St Joseph's hospital -

primarily in the Oncology Department

. Patient advocacy

. Medicare and Medicaid assistance

. Provided patient support in navigating internal processes and

resources

Sasquatch Farm

Owner and Manager - 12/1998 to Present

. Oversee the sustainable management of a sixty-acre organic farm

. Utilize 'green' forest practices that require managing multiple grants

and complying with multiple operational requirements

. Handle all sales and marketing aspects related to market delivery of

agricultural products

Education

. MBA

. Bachelor of Arts in Pre-Medicine

. Associates of Science degree, Paramedic Program

. University Studies in Public Administration

. Graduate Studies in Naturopathic Medicine

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