Vikki A Rumph
Chester,VA
Summary
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Director, Quality Improvement & Risk Adjustment
Molina Healthcare
01.2022 - 05.2024
- Establish and refine quality strategies to drive monthly planning and performance tracking of goals for all enterprise priorities to identify new opportunities, reduce barriers, drive impact and exceed business goals to optimize and transform healthcare performance.
- Oversight of Health Plan NCQA and HEDIS activities and regulatory requirements to ensure meeting of accreditation standards; received Health Plan accreditation, Healthy Equity and LTSS Distinction in 2023.
- Lead development and cross functional collaboration to execute process mapping flows, tools and methodology to improve process and ensure efficient and effectiveness across Health Plan and UM operations.
- Researched and analyze data to identity areas of improvement and develop substantive collaborative partnerships to disseminate and optimize growth, meaningful content and community project development
- Implemented integrated priorities to drive and increase access to care, exceed target goal by 65% within 12 months of operation
- Develop and disseminated robust processes and technology resource for management of activities related to CMS, NCQA, Stars and HEDIS/CAHPS performance ensuring compliance with internal and external guidelines and goals were met; implemented Provider Wellness Incentive program targeting EPDST and health equity resulting in an increased utilization of service by 87% in completion of well child visits and exceeding state benchmark for the childhood immunization quality measure.
- Partner with the state to conduct compliance audits, create, track and monitor corrective action plans to ensure timely completion and regulatory requirements are met.
- Utilize, analyze, and interpret various data sources to identify trends, solve complex problems, monitor compliance and develop strategic plans to drive process improvement, efficiency and cost savings. .
- Report quarterly to health plan Board of Directors and Committees status of quality performance, activities, and compliance findings.
- Provider leadership and mentorship of a mixed team of clinical and non-clinical staff dedicated to QI activities: successfully created and deployed the Provide Quality Practice Transformation team, increased performance by 87% in data sharing agreement.
- Implemented innovative solutions to solve complex problems, resulting in increased productivity and streamlined operations.
Quality Program Manager
Blue Cross Blue Shield of Arkansas
05.2021 - 12.2021
- Conduct compliance audits in collaboration with department leads to ensure timely completion and compliance with regulatory requirements.
- Build and design targeted incentive programs with emphasis on HEDIS, STARs, Provider and Member Engagement.
- Monitor and manage full end-to-end vendor performance, compliance, quality and Valued-base care programs to ensure HEDIS/STARs exceed performance metrics and goals..
- Investigate, track and monitor suspected fraud and noncompliance activities to report outcome to health plan Boards and Committees.
- Manage a team of non-clinical staff dedicated to member experience activities and reporting
- Improved program efficiency by streamlining processes and implementing time-saving solutions.
Senior Quality Program Manager, Practice Performance Manager
United Healthcare / Optum
05.2017 - 05.2021
- Pioneered and managed the Clinical Quality Patient Navigator Program targeting NPS, HEDIS, STARS, CAHPS, HOS & SDOH to conduct effective initiatives to promote and improve health outcomes and experience.
- Boosted quality data performance and strategic partnerships nationwide with population health team, providers and Care Delivery Organizations leadership through collaborative research
- Track, monitor and manage full end-to-end program development and quality improvement initiatives with to proactively identify population health improvement opportunities through the use of data research and analysis
- Direct and support long-term and day-to-day work of direct reports, along with support of teams ongoing professional and personal development goals and perform performance reviews
- Support multistate markets in the development and execution of strategic performance improvement plans and VBP to improve overall Star Ratings for HEDIS, NPS, CAHPS and HOS survey results to achieve market and contract performance goals while improving patient satisfaction
- Work in partnership with provider practice to achieve benchmark requirements, develop and co brand on content and strategize to increase patient engagement and performance improvement.
- Established a joint-venture Provider Champion Program with physicians throughout the state of South Carolina to improve Star Ratings by 3 points; moving practices from 2.5 to 4 in one year; instrumental in increasing overall health plan performance to a 4.5 Star rating
- Identified effective Data Optimization strategies to improve the ability to anticipate and timely address patient needs and proactively close gaps in care by leveraging AI data technologies
- Utilized data-driven decision-making approaches to inform strategy development and optimize outcomes.
- Ensured regulatory compliance by closely monitoring adherence to industry standards and guidelines throughout the program lifecycle.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
Program Manager, HCS and State Policy
South Carolina Dept. of HHS – Medicaid
12.2013 - 05.2017
- Serve as senior team lead for policy and process development and support federal quality research reviews, audits, special projects and serve as SME for policy and contract initiatives.
- Conduct quality reviews and audits of Medicaid published manuals, contracts and State Plan Amendments (SPAs) to provide recommendations and ensure compliance.
- Research to create and report content to state legislation and board on policy change and performance of activities, new and existing.
- Established strong relationships with key stakeholders, ensuring support for program initiatives.
- Met with project stakeholders on regular basis to assess progress and make adjustments.
Project Manager, Clinical Research
University of South Carolina
01.2009 - 01.2013
- Managed all operational aspects of multiple clinical trials from study start up to include; compliance audits, regulatory requirements management, Population Health, project and budget management.
Practice and Billing Manager
Lexington Internal Medicine and Pulmonary Care
01.2000 - 01.2009
- Provided leadership and management within physician practice operations, identification and monitoring of clinical research performance to ensure high-quality and efficient patient care, resulting in improved patient satisfaction and health outcomes
Education
Master’s Business Administration -
South University
South Carolina01.2010
Bachelor of Arts - Psychology
Limestone College
South Carolina01.2007
Skills
- Strategic Planning
- Verbal and written communication
- People Management
- Operations Management
- Creativity and Innovation
- Organizational Development
- Budget Management
- Hiring and Retention
- Government relations
- Contract Management
- Process Improvements
Certification
- Licensed Practical Nurse, 1997
- Professional, Academy Healthcare Management, 08/21
- Project Management
- NCQA/HEDIS, 2020
- Grant Administration & Budget Management
- Patient Quality & Safety – IHI, 2022
- Legislative & Regulatory Reporting
- Medicare & Retirement Certified
- Medicaid Certified
- Quality Data Analytics
- CPHQ, 09/20
- Health Equity, SDOH
- Improvement in Healthcare (IHI)
- CMS Risk Adjustment Modeling
Accomplishments
- Increased overall withhold earn by 75% within 2 quarters meeting
- Successfully implementation of several cost of care initiatives achieving significant organizational savings.
- Notable High-Performance Rating
Timeline
Director, Quality Improvement & Risk Adjustment
Molina Healthcare
01.2022 - 05.2024
Quality Program Manager
Blue Cross Blue Shield of Arkansas
05.2021 - 12.2021
Senior Quality Program Manager, Practice Performance Manager
United Healthcare / Optum
05.2017 - 05.2021
Program Manager, HCS and State Policy
South Carolina Dept. of HHS – Medicaid
12.2013 - 05.2017
Project Manager, Clinical Research
University of South Carolina
01.2009 - 01.2013
Practice and Billing Manager
Lexington Internal Medicine and Pulmonary Care
01.2000 - 01.2009
- Licensed Practical Nurse, 1997
- Professional, Academy Healthcare Management, 08/21
- Project Management
- NCQA/HEDIS, 2020
- Grant Administration & Budget Management
- Patient Quality & Safety – IHI, 2022
- Legislative & Regulatory Reporting
- Medicare & Retirement Certified
- Medicaid Certified
- Quality Data Analytics
- CPHQ, 09/20
- Health Equity, SDOH
- Improvement in Healthcare (IHI)
- CMS Risk Adjustment Modeling
Master’s Business Administration -
South University
Bachelor of Arts - Psychology
Limestone College
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