Call Center Quality Manager

Susan Vermette, RNC

Hampton, NH ***** 603-***-**** *****@*******.***

Summary

Impactful Quality Manager with natural talents in process improvement, cost management and quality control. Safety- focused and forward-thinking with excellent time management and problem-solving abilities. Skills

Performance Improvement Monitoring

Critical Thinking

Attention to Detail

Preventive Healthcare

Microsoft Office

Work Process Analysis

Team Management

Data Management

Experience

QUALITY IMPROVEMENT MANAGER (REMOTE) 08/2014 - 12/2021 WellSense-Boston Medical Center HealthNet Plan - Manchester, NH The health plan's Quality Improvement Manager serves as the plan's New Hampshire Quality Improvement Director. Responsible for programmatic development of the plan's Quality Department by developing departmental policy, clinical practice guidelines and clinical quality improvement initiatives. Assured compliance with the contractual obligations of the quality components of the health plan's State Medicaid contract, Federal Regulatory Requirements and NCQA accreditation standards. Utilized process improvement methodology to develop, lead and implement the organizations annual Quality Assessment and Performance Improvement (QAPI) plan. Responsible for the plan's Quality Performance Improvement Projects (PIPs) and External Quality Review Organizations (EQRO) communications and reporting activities. Served as the liaison to the plan's contracted providers, health systems, local care agencies and DHHS to develop partnership opportunities and QI initiatives for behavioral health, women's healthcare, management of chronic care and emergency department utilization.

Worked collaboratively with stakeholders across the enterprise to develop and provide clinical oversight for the plan's Pay for Performance and Provider Incentive Programs. Responsible for the review, investigation and reporting of the plan's adverse events, provider preventable conditions and providers and and member clinical grievances.

Provide data and reporting to achieve the quality components of the NCQA accreditation standards for the plan's New Hampshire and Massachusetts Medicaid product lines. Lead the NH Quality Improvement Committee and presented data and reporting to the plan's multi-state Quality Improvement Committee.

DIRECTOR, QUALITY PERFORMANCE IMPROVEMENT 03/2014 - 09/2014 Meridian Health Plan - Manchester, NH

Lead, coordinate and ensure documentation of quality improvement, accreditation and regulatory activities in the implementation of the quality functions of the health plan's New Hampshire State Medicaid contract. Foster partnerships with the plan's contracted healthsystems, providers, statewide community service agencies, Federally Qualified Health Centers (FQHCs) to enhance quality and coordination of care for our members. Serve as the the organization's lead for HEDIS and CAHPS reporting and improvement initiatives including developing strategy and action plans for all key HEDIS measures, monitoring HEDIS data collection, medical review and analysis of data to identify opportunities for improvement. Lead and direct accreditation survey processes and performance improvement projects (PIPs) with the EQRO. Lead the New Hampshire Quality Committee and present data for the plan's multistate Quality Improvement Committee.

September 2014, Meridian Health Plan withdrew from the New Hampshire market, hence my 6 month tenure. PROJECT MANAGER, PERFORMANCE IMPROVEMENT DEPT 11/2009 - 09/2013 Elliot Health System - Manchester, NH

Responsible for an assignment of clinical project improvement projects within the inpatient and outpatient sectors of the health system.

Provided oversight for quality improvement projects with regards to collaborating, supervising, educating, developing and implementing operations for assigned HEDIS metrics, CMS Core Measures, Accountable Care Organization and Joint Commission related indicators. Promote quality in clinical practice by collaborating in the development of guidelines, best practices, and criteria for measuring quality and appropriateness of care related NCQA, HEDIS, CMS Core Measures, ACO and Pay for Performance initiatives.

Collaborated with departments across the health system (ie: nurse managers, department Chiefs & Chairs) to develop, implement, assess and track PDSA processes, performance improvement measures and operational objectives.

Performed clinical data abstraction and validation for assigned inpatient core measures required by CMS and TJC. September 2013, the health system restructured the Performance Improvement Department and eliminated the positions of all 3 nurse project managers within the Performance Improvement Department. DIRECTOR, MEDICAL TRIAGE CALL CENTER 04/2008 - 09/2009 Alicare Medical Management - Salem, NH

Program and clinical accountability for large nationwide 24/7 medical triage call center representing hundreds of hospitals, primary & specialty care physician practices and insurance companies for after hours triage and nurse advice line services.

Managed, mentored and developed a call center staff of 25-30 Registered Nurses. Responsible for accreditation compliance with URAC (Utilization Review Accreditation Commission) and AACN

(American Ambulatory Care Nursing) standards.

Implemented and titrated telephonic applications, decision support tools and EMR reporting to track and analyze staff performance and service metrics, patient outcomes and cost containment objectives. DIRECTOR, ASK A NURSE PROGRAM 03/1999 - 11/2008

Catholic Medical Center - Manchester, NH

Responsible for all aspects of a statewide 24/7 medical triage call center with a staff of 15-20 Registered Nurses. Prepared and implemented a sizeable departmental budget and managed the effectiveness of the departments marketing and customer service initiatives.

Implemented and modified software applications to meet the departmental needs and perform routine analysis of call center quality, safety and effectiveness against goals. GERO-PSYCHIATIRC UNIT NURSE 11/1997 - 03/1999

Elliot Health System - Manchester, NH

Performed in the capacity of Clinical Nurse and Weekend Charge Nurse. Performed comprehensive psychiatric & physical nursing assessments. Collaborated with multidisciplinary teams to evaluate the patient's response to treatment modalities. Assisted with ECT treatment preparation and processes. Education and Training

Catholic Medical Center School of Nursing - Manchester, New Hampshire Diploma in Nursing (RN) Nursing Practice, 05/1982

University of New Hampshire - Manchester, New Hampshire Nursing Undergraduate Studies Coursework Nursing

Southern New Hampshire University - Hooksett, NH RN To MSN Program Quality & Safety (2012 to 2015) Certifications

RN Licensure: New Hampshire and Massachusetts, Expires 12/2022 Lean Six Sigma - Yellow Belt Certification

Telehealth Nursing Practice Certification, National Certification Corp, (NCC)

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