Qualifications

A hard-working, motivated leader who specializes in program oversight for NCQA Health Plan Accreditation. Extremely knowledgeable of the survey application and document submission process. Experience with successfully leading the on-site audit visit, ensuring an effortless and positive trip for the NCQA surveyors. Expertise in strategic and operational planning to guarantee ongoing accreditation readiness, including financial planning related to the accreditation program budget. Dedicated team player with strong ability to coach and educate multiple teams to achieve optimal efficiency and maximum productivity. Reliable and passionate innovator who effectively prioritizes program needs and objectives for continued success. Experience

Priority Health – Grand Rapids, MI (Formerly Total Health Care, Inc. – Acquired 1/1/2020)

Senior Improvement Specialist (August 2020 – Present; **Promoted 2020)

Subject matter expert on accreditation requirements outlined by National Committee for Quality Assurance

(NCQA), integrating requirements by Centers for Medicare and Medicaid Services (CMS) and State of Michigan

Conduct thorough department compliance readiness reviews; Identify strengths, gaps, and areas of improvement via evaluation of team operations, policies & procedures, and quarterly/annual reports

Create, implement, and maintain project plan for initiatives to improve health equity amongst members

Collaborate with department leaders to discuss audit findings, recommendations, and improvement plans

Execute deliverables for quality improvement, member experience, population health, network management

Create and conduct staff trainings on requirements to optimize effectiveness in customer experience, grievances/appeals, utilization review, and pharmacy operations, etc.

Quality Coordinator (2018 –2020)

Ensured continued regulatory audit readiness from detailed compliance reviews as required by NCQA, Centers for Medicare and Medicaid Services (CMS), and the State of Michigan

Conducted mock file audits and review of customer service, pharmacy, utilization review, and case management

Trained leadership on regulatory requirements and compliance review findings

Maintained and updated quality policies & procedures; Facilitated Quality Improvement Committee Behavioral Health Professionals, Inc. - Detroit, MI

Quality Assurance Specialist (2018)

Conducted evaluations of mental health facilities to ensure compliance according to state and federal guidelines

Identified deficiencies affecting patient health and safety; Provided recommendations for improvement Meridian Health Plan - Detroit, MI

Quality Improvement Coordinator (2016 – 2017)

Acted as project lead and subject matter expert on health plan accreditation and quality deliverables

Coordinated with other teams to establish project plan and execute identified strategies to meet program goals

Created and conducted quality trainings for new hires; Acted as resource for new team members

Team Lead – Nutrition Care Coordination (2014 – 2016; **Promoted 2014)

Led team of 12 telephonic outreach staff to consistently meet department answer/abandonment rate goals

Conducted team phone audits; Routinely coached individuals and provided feedback in weekly meetings

Created and conducted new hire trainings via comprehensive six-week overview; Interviewed potential candidates

Successfully maintained team schedule to continuously ensure adequate phone coverage was achieved

Care Coordinator (2012 – 2014)

Assisted members with scheduling medical appointments while ensuring transportation needs are met

Connected low-income members with food pantries, nutritional resources, and available member benefits Education

Master of Business Administration in Healthcare Management; Davenport University – Grand Rapids, Michigan

March 2022 – Present; Expected Graduation – 2024 Bachelor of Health Professions and Allied Health Sciences; Biology Minor; Grand Valley State University – Allendale, Michigan

Graduation: 2012

Certifications/Trainings

Project Management Training; Completion Date: March 2017 Lean Six Sigma Yellow Belt; Completion Date: April 2016 Fellow, Academy for Healthcare Management; Completion Date: July 2015 Professional, Academy for Healthcare Management; Completion Date: July 2013