Quality Assurance Training Manager

Jennifer M. Whalen

**** #*** ******* ***. ********, NJ 08260

********@*****.*** 484-***-****

OBJECTIVE

Energetic professional in search of dynamic opportunity in the Healthcare field that calls forth my strong analytic, networking and negotiation skills.

EXPERIENCE

Quality Assurance and Training Manager, Liberty Community Connections (April 2021 to May 2022)

● Developed, implemented, and oversee quality improvement, Training and Critical Incident teams to ensure delivery of the highest quality LTSS care coordination.

● Established a conceptual framework for quality measurement and improvement activities.

● Oversaw all updates to training, policies and procedures, to a compliant Learning and data storage software program to ensure efficacy while switching to a more online friendly learning and training experience.

● Acted as subject matter expert for National Committee for Quality Assurance (NCQA) accreditation.

● Oversee the submission of all Employee fraud reports to Bureau of Provider Integrity (BPI) and the Office of the Attorney General (OAG)

● Develop and review policies and programs that encourage managers and employees to report suspected fraud or other improprieties.

● Created and maintained program to interact with the Managed Care Organizations (MCO) to reduce the number of reoccurring incidents to consumers through value added programs developed across all lines of business, often to the savings of the MCO. Senior Recruiter, Aesir Logistics, LLC (July 2020 – February 2021)

● Built the Recruiting program for sourcing and recruiting drivers which led to the successful Onboarding of 60 plus drivers.

● Lead the candidate through the hiring process to ensure a positive experience.

● Negotiate compensation and benefits packages.

● Develop strong relationships with candidates and all levels of staff to deliver a high level of engagement and professionalism.

● Ensure the recruitment process is in compliant with all State and Federal guidelines. Network Contract Manager, UnitedHealth Group (2016 – October 2019)

• Established and Maintained LTSS HCBS Services recruitment in the Virginia LTSS program.

• Established HCBS Networks within multiple states for the Veteran Affairs Community Care Network (VA CCN)

• Liaison for multiple States Medicaid and VA programs transitioning to Managed Care Organization.

• Collaborate with internal and external stakeholders to develop Virginia LTSS program including recruiting, sales of all lines of business and onboarding of assigned provider types.

• Facilitated the credentialing process.

• Ensure network availability for all services withing all deadlines and budgetary concerns.

• Developed network and market specific data modeling concerning utilization and spend. Southeastern Regional Program Specialist, P.A. Department of Human Services (2011-2016)

• Collaborated in the writing of the in Long Term Support Services RFP processes for the PA DHS transition to Managed Care model of care.

• Managed the Commonwealth’s Financial Management Service HCBS contract consolidation through Continuity of Care through to steady state.

• Coordinate with regional Program Specialists and QMET Statewide Coordinator to ensure consistent application of HCBS Qualified Provider Waiver standards and PA Regulation Title 55.

• Initiated and maintained OLTL’s Fraud and Financial Abuse program in conjunction with statewide Program Offices.

• Timely completion of CMS Evidentiary Based Reviews.

• Coordinated regional Quality Management Efficiency Team (QMET) team activities including scheduling on-site monitoring visits, completion of HCBS work plan activities and reviews and approved Provider Corrective Action Plans.

• Determined and managed statistical sampling methods to determine providers historic trends and tailor monitoring to target specific needs for each provide to achieve compliance with DPW Regulation and Waiver requirements.

• Responsible for regional budget.

• Manage a remote staff of twenty.

• Created and manage statewide OLTL’s ancillary billing practice metrics and analytics. Sr. Billing Coordinator Quest Diagnostics, Inc. (2004-2010)

• Communicate industry trends, new third party payer information and specific client requests between management and sales teams.

• Confer with cross-functional teams to develop programs uniquely tailored to meet client and customer needs.

• Collaborate with Insurance payers to determine appropriate denials and payment according to Medicare initiatives, predicted trends and demographical data.

• Develop best practice concepts and assist in creating progressive A/R recommendations, assist in training and piloting.

• Assist with Green Belt projects to resolve billing issues.

• Collaborated to accomplish Month End closing, P and L statement and Balance sheet preparation.

Hospitality Manager, St. Mary’s Catholic Church (2019 – Present) EDUCATION

B.B.A., Finance, Ursinus College, Collegeville, Pennsylvania

Contact this candidate