Ana Mercado

adjzfu@r.postjobfree.com

347-***-****

Objective: Strategic and seasoned healthcare professional with proven success in merging clinical expertise, proactive leadership, and technological resource knowledge to improve patient outcomes and achieve cost savings.

MVP Health Care 2019 – Present

Quality Improvement Manager

Perform computer-based statistical analysis of data related to the Quality Improvement (QI) program;

Collect data from one or more sources including encounter, claims and other data sources;

Utilize data systems to generate, manipulate and analyze data;

Evaluate reports for accuracy of data;

Perform analysis to determine statistically significant trends in the data compared to industry standards and recognized benchmarks;

Provide technical expertise in statistical analysis to staff of Health Services and external agencies as necessary;

Create process documentation for QI/HEDIS activities; and

Collaborate with practices to integrate their electronic medical record data into vendor software.

Westchester Medical Center PPS 2016 – 2019

Sr. Program Manager, Performance Measures & Care Coordination

●Establish working relationships and collaborate with Leadership staff in executing contracts and adhering to performance factors within the contract

●Leading Westchester Medical Center’s multiple efforts to accomplish the goals of healthcare transformation under the New York State Delivery System Reform Incentive Payment (DSRIP) program

●Work closely with the Medical Center’s executive leadership to advance the 5-year DSRIP implementation plan

●Guide practices in delivery system transformation initiatives including Patient Centered Medical Home and connectivity to Health Information Exchanges

●Develop and implement the quality assurance and performance improvement strategy for cross-functional partners

●Help enable practices to change workflows to incorporate clinical paradigms such as behavioral health integration

●Perform site visits to conduct outreach, education, training and orientation sessions for providers and key administrative staff

●In conjunction with the data analyst, monitor practice performance to ensure compliance with all DSRIP metrics, identify any barriers and make recommendations for corrective action plans and other interventions as required via a Performance Improvement model

●Extract relevant data and reporting material from EMR systems of partner organizations

●Follow all applicable federal/state regulations with respect to Confidentiality and HIPAA, among others

●Provide project management support to both CRHI Hub Project Management office and PPS' Project Management Offices including but not limited to, tracking DSRIP deliverables, update narratives and documentation logging, present at local and PPS work-group meetings, etc.

EmblemHealth 2012 – 2015

Transformation Coach of Shared Savings Program and ACO’s

•Implemented population health initiatives across Commercial, Medicare, and Medicaid programs, with many provider types such as large health systems, multi-specialty physician groups, IPAs, academic health systems, and FQHCs

•Responsible for leadership of Shared Savings Program and quality reporting for 4 major health groups

•Led aspects of ACO and population health management programs

•Collaborated with clinical operations leadership to develop disease-specific clinical pathways and best practice care guidelines for members undergoing transitions in care settings

•Created a TOC best practice workflow tool for EH and stakeholders

•Developed Care Models for Care Management, Care Coordination, and Transitions of Care

•Drive ACO readiness, Disease Management Programs and enterprise workflow tools, portals, including chat and text

Complex Care Solution

Director of End of Life Program 2010-2013

•Conduct in-home, high-risk patient visits in order to assess physiological, psycho-social, environmental, financial, and health-related behavior domains

•Enhanced communication and collaborative relationships with multidisciplinary healthcare team

•Coordinate with physicians regarding implementation of medication and treatment plans

•Educated patients regarding preventive care and health management

•Participated in case reviews with Physicians & Care Managers

•Use of predictive modeling tools and Nursing assessments tools to create individualized care plans

SKILLS & ABILITIES

•Change management experience in the areas of communications, stakeholder engagement, training, adoption/change measurement, leadership engagement and development

•Large strategic health transformations inclusive of HEDIS/ Quality Improvement

•Workflow analysis and design

•Asthma Educator

•Diabetes Educator

•PMP Certified

•NCQA PCMH Content Expert

•Service innovation & operationalizing complicated partnerships

•Developing educational modules to improve complex case management and fiscal responsibility in healthcare

•Insightful innovative ability to Vet meaningful / business performance data to identify opportunities for clinical and operational improvements aimed at achieving quality and financial targets

EDUCATION

Baruch College, New York, NY Bachelor of Science

Sanford Brown Ultrasound Technician Certification

Peace Corps Health Extension Volunteer

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