Barbara Toney
Punta Gorda,FL
Summary
Independent Travel Sales Leader and Agency Owner Over 10 years experience in leisure, luxury and group travel sales. Six years of agency owner with proven track record to drive leisure and business travel. Member of Travel Leaders Network, Nexion, CLIA and ASTA. Results-driven healthcare consultant with extensive experience in quality compliance, accreditation, medical management, and risk assessment. Adept in legal nurse consulting, healthcare program development, and strategic travel consulting. Proven track record in improving healthcare quality metrics, ensuring accreditation compliance, and driving business growth.
Goal-driven Agency Owner offering 11 years of experience generating business, acquiring customers and meeting demanding sales objectives. Knowledgeable about personal lines, commercial products and financial services.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Travel Agency Owner
Exclusive Travel Agency
03.2019 - Current
- Leisure Travel
- Cruise
- Resort
- Airlines and Transfer
- Hotel
- Luxury
- Group
- Destination Wedding
- Group Family
- Adventure
Health Care Consultant Owner
Long Toney Consultants
09.2020 - 05.2025
- Subcontractor Toney HealthCare
- Clients: Prominence Health Plan, Trillium, Denver Health Plan, Community Health Choice of Texas and Community Health Choice Plan Maine
- Clinical Quality Programs (Marketplace)
- NCQA & URAC Accreditation preparation
- Authored QI Program Description, Evaluation, and Work plans
- Led QOC investigations and reporting for QIC
- HEDIS hybrid chart review and validation
- Senior Consultant for UM audits and MCG training
- Population Health strategy development
Quality Consultant & Clinical Advisor
Ziphycare Technologies
05.2023 - 02.2025
- Business Development Contracting with Health Plans and Home Health Companies
- Developed clinical and quality programs, managed vendor relationships
- Audited billing, coding, and risk management
- Served as SME in medical product development
Healthcare Consultant
Subcontractor for Cope Health Partners
09.2020 - 01.2021
- Client: Christus First Health USFPS Tricare Plan
- Led NCQA Accreditation readiness for Tricare
- Developed CQMP and QI project documents
Director of Quality Assurance & Safety
Healthcare Network of SW Florida
04.2019 - 09.2020
- Improved STARS ratings from 2.17 to 4.63
- Oversaw QI, infection control, and patient safety programs
- Led population health efforts and chaired quality committees
Clinical Operations Manager
Evolent Healthcare
12.2018 - 04.2019
- Directed population health operations and clinical KPIs
- Oversaw chronic and maternity care initiatives
Director of Quality Management
AmeriHealth Caritas CHC
11.2017 - 08.2018
- Developed Medicaid LTSS QI programs
- Led NCQA and HEDIS initiatives; chaired QAPI committee
Front Line Leader
Humana Medicaid LTSS
06.2016 - 10.2017
- Oversaw case management for Medicaid LTSS
- Managed referrals and custodial prevention
HEDIS Quality Consultant
Humana – MSO Transcend MA Plan
05.2014 - 06.2016
- Improved STARS ratings from 2.7 to 4.25 in Florida Region 8
- Delivered provider education and performance improvement
Nurse Auditor & Case Manager
Lee Memorial Health Systems
04.2008 - 05.2014
- Conducted CMS audits and medical necessity appeals
- Managed provider relations and utilization reviews
RN, Cardiology & Med-Surg
McLaren (Bay) Regional Medical Center
05.2003 - 04.2008
- Delivered direct patient care in cardiology and med-surg units
Education
Master Law -
Nova Southeastern University
Davie, FL01.2015
Bachelor of Science in Nursing -
Rasmussen University Florida
Ocala, FL01.2012
Associate Degree in Nursing -
Delta College Michigan
University Center, MI01.2005
Skills
- Accreditation Preparedness
- Strategic travel planning
- Oversight of program initiatives
- Business development
- Business planning
- Customer relation
- Performance analysis
- Sales management
- Revenue generation
- Creative direction
Certification
- Travel Certifications: CLIA, ASTA
- Certifications: NCQA, URAC, AAAHC, JCHO, HEDIS, STARS, MCG Criteria
Accomplishments
- Elevated HEDIS/STARS ratings significantly across multiple health plans
- Successfully led NCQA, URAC, and AAAHC accreditation efforts
- Provided expert testimony and fraud consulting in legal nurse cases
- Built and scaled a successful travel consulting business
Affiliations
- Travel Leaders Network
- Nexion
Timeline
Quality Consultant & Clinical Advisor
Ziphycare Technologies
05.2023 - 02.2025
Health Care Consultant Owner
Long Toney Consultants
09.2020 - 05.2025
Healthcare Consultant
Subcontractor for Cope Health Partners
09.2020 - 01.2021
Director of Quality Assurance & Safety
Healthcare Network of SW Florida
04.2019 - 09.2020
Travel Agency Owner
Exclusive Travel Agency
03.2019 - Current
Clinical Operations Manager
Evolent Healthcare
12.2018 - 04.2019
Director of Quality Management
AmeriHealth Caritas CHC
11.2017 - 08.2018
Front Line Leader
Humana Medicaid LTSS
06.2016 - 10.2017
HEDIS Quality Consultant
Humana – MSO Transcend MA Plan
05.2014 - 06.2016
Nurse Auditor & Case Manager
Lee Memorial Health Systems
04.2008 - 05.2014
RN, Cardiology & Med-Surg
McLaren (Bay) Regional Medical Center
05.2003 - 04.2008
Master Law -
Nova Southeastern University
Bachelor of Science in Nursing -
Rasmussen University Florida
Associate Degree in Nursing -
Delta College Michigan
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