Community Care Quality Improvement
Resume:
Coral Springs, FL
*******@*********.***
Jo Ann Ferro
Experience April 2018 - September 29 2021 Community Care Plan Sunrise, FL Credentialing Manager
Responsible for the credentialing of providers for Medicaid and Children’s Medical Services
Manage a staff of 14 credentialing specialist
Track and trend department cost
Initiated changes to timelines and saved Community Care Plan 400,000 per year
JuJune 2017 – March 2018 - Prestige Health Choice Doral, FL Accreditation Specialist
Interfaces with all departments to ensure process compliance and execution of required processes; influences design of processes and related documentation to ensure compliance with new standards and changes to existing standards
Serves as a Line of Business SME for accreditation.
Tracks performance against requirements and ensures compliance through continual review, audit and monitoring
JuJune 2014–June 2017- Sunshine Health Sunrise, FL Manager, Quality Improvement
Works to ensure all QI compliance related activities are successfully accomplished each year, including NCQA Accreditation
Works with Sr. Management to organize efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory and accrediting body’s standard requirements.
Responsible for the successful development and evaluation of an annual QI work plan, program description and QI evaluation by facilitating QI throughout the organization.
Responsible for oversight of delegated entities, including transportation, radiology, contract compliance, NCQA compliance, facilitate quarterly Joint Operation Committees.
Work with all contracted vendors to ensure monthly reports are submitted timely and within contracted goals.
Participates in the development, implementation and contract accuracy for vendors.
Conducts pre-delegation audits and annual audits of all vendors to ensure all contract compliance.
Implements corrective action plans and monitors gaps.
Reports to Sr. Management outcomes of all monthly meetings.
Participates on QI committees structured to achieve outcomes success and completes committee documentation that is consistent in meeting state agency and accrediting body requirements
Maintains interrelationships with partner organizations
Manages field and office staff.
2009 – 2014– Sunshine Health Sunrise, FL
Manager, Pharmacy Services
Implement new process for pharmacy department including new specialty vendor (savings for the company)
Review clinical criteria to support approval/denial of all pharmacy requests – for all products, Medicare, Medicaid, Long Term Care, Ambetter
Analyze pmpm and recommend saving areas
Implemented processes to meet deadlines for members and providers
Prioritize work for staff members for a more efficient process
Acts as the liaison to all inter-departments and corporate levels
Trouble shoot all discrepancies within the Pharmacy Department
Review criteria from the Preferred Drug List to ensure compliance
Work directly with the Medical Director and CEO on questionable decisions
Manage the Pharmacy Coordinators within the department
Present to Ad Hoc Committees
Present at the Therapeutic and Pharmacy Committee
Prepare all monthly financials for the pharmacy department; present to Corporate Senior Management
2007-2009 - Omnicomm Systems Ft. Lauderdale, FL
COMPLIANCE SPECIALIST
Conducts external & vendor audits with potential and existing clients
Conducts internal audits and performs due diligence, recommending process improvements
Ensure 21 CFR Part 11 compliance with regulatory documents in regards to EDC and paper clinical studies
Audits existing processes and procedures and composes recommendations for more effective methods.
Analyses past audits and perspective corrective actions to determine corrective action effectiveness to ensure elimination of repeat observations.
Creates internal audit reports and files associated with the audit performed
Reviews existing and new client contracts – discussing changes, payments, NDA’s (non-disclosure amendments)
Reviews mid-study changes in existing contracts
Responds to client audit reports
Design ecrf’s to protocol specifications
Design data dictionaries according to protocol
Assign user groups in Trial Master 3.0 and 4.0
Creates Standard Operating Procedures (SOP’s), working instructions, and Corporate Policies
2006- 2007 – KOS Pharmaceuticals Weston, FL
Clinical Quality Assurance Administrator
Conducts clinical site audits to ensure regulatory compliance
Audits SOPs for process compliance
Reviewing protocols to compile and analyze clinical site study reports to ensure compliance with FDA regulations
Trouble shoot discrepancies with study data – trending reports for problem study sites- analyzing data with problem sites
Implement reporting tools for FDA audits
Creates and reviews standard operating procedures for accuracy of clinical studies
Execute training reports – preparing monthly reports for directors and above to ensure compliance and timelines are met 2004-2006 – KOS Pharmaceuticals Weston, FL
Clinical Data Coordinator
Responsible for overall quality of data in-house
Data review of electronic and paper CRFs for accuracy
Generates, reviews and tracks electronic and paper queries issued to investigative sites
Responsible for Serious Adverse Event reconciliation
Responsible for management of multiple ongoing projects and timelines
Manages and trains CRO staff, and serves as a resource for all external contractors, including site monitors
Writes, edits and reviews standard operating procedures and guidelines
Provides pertinent input for the Data Management Plan by defining the data validation rules and the data flow
Ensured compliance with established SOPs and regulatory requirements.
Produced bi-weekly management reports detailing study progress and developments.
Assist in selection of external vendors to ensure contact compliance and adherence.
Responsible for collection and validation of clinical trial data; created and implemented data validation plans, clinical report forms and edits and query management.
2003-2004 – Vista Healthcare Sunrise, FL
Grievance and Appeals Administrator
Research grievance and appeal cases, recommend and coordinate services/payment
Present cases to Medical Director
Communicate orally and written, to physicians, ancillary facilities, and members
Prepare reports, documentation regarding state compliance and regulations
2002-2003 InPhyNet Hospital Services Sunrise, FL Regional Coordinator
Administrative support for South Dade hospitals, -credentialing, payroll, scheduling shifts
Assisted Head of Risk Management- prepared risk management reports in, generated bonus reports and prepared training documents
Calculate hours needed for each facility for accurate coverage
Schedule regional medical director meetings/workshops
1996 - 2002 Aetna US Healthcare Plantation, FL
Southeast Regional Pharmacy Project Coordinator
Process pharmacy claims from vendors including assistant living facilities, hospitals and hospice.
Coordinators of new clinical programs for the southeast region, prepared utilization reports in excel and transferred to PowerPoint for presentations.
Liaison for healthcare providers –troubleshooting claim discrepancies, researching patient history, recommending to Medical Director approval/denial of claims.
Presenter for Quality Assurance Forums – presenting to Medical Directors located throughout the east coast.
Report developer for drug track and trending reports – utilization of brand drugs vs. generic
Worked independently – Pharmacy Director located in Alpharetta, GA Education AS Business Management - In Progress
Broward Community College
EDC Systems: Inform (PhaseForward), TrialMaster (Omnicomm) and Rave (Medidata) IVRS/IWRS: ClinPhone, Clarix
Paper Data
Capture:
ClinTrial
Other
Technical
Proficiencies:
Microsoft Outlook
Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Blueprint Requirement Center
Mercury Quality Center
CCMS
True Care
Professional
Organizations
ASQ
Contact this candidate