Chris Ann Uhler, RN, BSN

**** ****** ***** ****

New Kensington, PA 15068

Phone 724-***-****; Cell phone 724-***-****

Email: adu6gu@r.postjobfree.com

PROFESSIONAL PROFILE: Registered nurse with 35 years’ experience, in the quality management/improvement, who works independently to identify problems, efficient at root cause analysis and completion of performance improvement projects, oversight of million dollar pay-for-performance program related to physicians and managed care organizations. Preparation and presentation to Physician Advisory Committee and internal committees.

NCQA and CMS Regulatory Compliance and auditing

Program Management-large programs management of multidepartment projects to support regulatory requirements

Practice engagement, practice transformation

Quality Improvement, identify root cause and implementation of interventions,

Governance: chair and facilitate workgroups and committees

HEDIS/STARS experience, process, data collection,

Excellent writing skills, for example: comprehensive quality program evaluations

Development and management of clinical and non-clinical HEDIS® and Stars-related programs and interventions

Provider facing on-site visits for care gap closure, coding

Development of provider scorecards and training

Training and education to new staff

Independent worker with minimal direction needed to complete assignments. Experienced in leading and educating others in quality applications. Able to adapt to continuing change and apply new knowledge; capable of working independently, directing others or contributing to team productivity; able to build positive working relationships with individuals from diverse backgrounds. Ability to present to diverse audiences from staff level to senior management.

EDUCATION:

PENN STATE UNIVERSITY

Bachelor of Science in Nursing 2006

Current Active Pennsylvania License

RN-252384L

CITIZENS SCHOOL OF NURSING

Registered Nurse Diploma Graduate: 1982

Certification:

LEAN Yellow Belt Certificate 2014

Highmark Blue Cross Shield

Pittsburgh, PA

Dale Carnegie Leadership Course, 1993

COMPUTER:

Microsoft Office (PowerPoint, Word, Basic Excel)

PROFESSIONAL EXPERIENCE

GATEWAY HEALTHSM Pittsburgh, PA 2002 to August 2021 (RETIRED)

17 years in healthcare insurance industry-15 in quality and 2 in disease management 10 years as Program Manager of Gateway’s Pay-for-Performance Program

QI Regulatory: Senior Clinical Quality Management Analyst (2016-present)

State, CMS and NCQA regulatory experience

HEDIS process, medical record review, data abstraction

CMS Stars, barrier analysis, intervention

Identified trends with recommendations corrective action plans

Lead for mandated State quality improvement studies

Presentation to Senior Team, physician advisory boards

Provider Engagement Team: Senior Clinical Quality Management Analyst (2015-2016)

Practice transformation to assist office in meeting pay-for-performance goals

Coordination of meetings with physicians and office staff to improve clinical outcomes

Identify individual practice performance and create individual plan for performance improvement

Assist in development of PCP performance scorecards and standards

Practice presentations

Program Manager for Gateway's Medicaid and Medicare Provider Pay-for-Performance (P4P) Program summary of responsibilities (2005-2015)

oversight of a $3 million-dollar complex P4P programs

program and project resolution

workgroup lead, facilitation, multidepartment coordination

recommendations on practice improvement performance for maximum

reimbursement-data analytics

on-site office visits

presentations at Town Hall meetings and internal/external

physician workgroup meetings

identification of best practices, high and low performing practices

comprehensive annual program description and evaluation

vendor oversight

Operational Lead for Pay-for-Performance and Star Measures (2005-2015)

lead, facilitate Stars workgroup; assignment of measurers

request and analyze data analytics

trending and reporting of various QI work plan metrics

goal setting

identification of care gaps

reference/mentor to cross-departmental teams

Initiation and Completion of Quality Improvement Projects (2005-2015)

workgroup lead

staff resource, training and mentoring on root cause analysis

summarize performance data and identify opportunities for improvement

interpretation of state regulatory requirements

identification and implementation of interventions

GATEWAY HEALTH Pittsburgh, PA.

DISEASE MANAGEMENT SPECIALIST April 2003-2005

maintain regulatory standards

oversight of related HEDIS® measures

supervision of staff

benchmarking programs

identification of implementation of performance improvement initiatives to assure HEIDS and accreditation standards met.

Implementation and community network through AstraZeneca of three successful asthma basketball camps

Collaboration with external vendors to help meet program goals

GATEWAY HEALTH Pittsburgh, PA.

Quality Improvement Specialist April 2002 to April 2003

oversight of regulatory requirements for NCQA and DPW

resource on continuous quality improvement activities

member of Physician Portfolio Workgroup-duties included:

ooversight of portfolio measures

ocommunication to practitioners

opresentations to Workgroup

development of clinical guidelines and study criteria

West Penn Hospital Home Care, Pittsburgh, PA. December 1997 to April 2002

Quality and Home Care Coordinator/Reimbursement Specialist

oversight and compliance of JACHO, Medicare regulations

resource and training to staff on regulatory requirements

100% overturn of Medicare denials

home care referral intake, participation in discharge planning rounds

Hospital Home Health Services, Pittsburgh, PA. December 1997 to September 1987

Supervisor Quality Analysis August 1996 to December 1997

Co-chair Quality Care Committee

oversee compliance for Medicare reimbursement and regulatory documentation

liaison between Medicare intermediary and other third-party payors

Quality Assurance/Utilization Review Coordinator February 1995 to August 1996

trend quality assurance and utilization review trends

prepare recommendations for corrective action

Assistant Manager June 1993 to February 1995

supervise day to day operations of home care division

assist department manager in budget, strategic planning and corporate goals

assist in hiring and staff performance reviews

Home Care Coordinator January 1991 to June 1993

coordinate discharge planning

participation in multidisciplinary patient case conferences

intake of home care referrals, DME set up and authorization

Staff Nurse Reviewer February 1990 to January 1991

review clinical records for compliance with regulatory requirements

assess quality of care issues, KEPRO guidelines and third-party payor reimbursement

Staff Nurse October 1987 to February 1990

direct patient care

VNA of Western Pennsylvania, Tarentum, PA. August 1984 to October 1987

Visiting nurse

Allegheny Valley Hospital, Natrona Heights, PA. September 1982 to August 1984

staff RN

team lead

direct patient care

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