Betsy Simpson
Highlands Ranch,CO
Summary
Mission-driven healthcare professional specializing in Quality Compliance and Improvement. Experienced leader-doer with the enthusiasm grow teams while also thriving in day-to-day deliverables. Supportive educator with a deep passion to improve the healthcare experience. Motivated thought-partner for efficient and effective design while preserving integrity. Expert in long-term strategizing with the ability to translate into short-term goal planning. Skillful at gathering, analyzing and defining business and functional requirements; assessing improvement opportunities; implementing interventions, creating and translating global metrics for optimal transparency; and designing/re-engineering processes, workflows and technology solutions for business systems and process. Operational Excellence professional with more than 25 years of experience in Program Strategy, Development and Effectiveness Analysis, Project Management, Process Development, Process Efficiency, People Management at the local, regional and national level for both start-up and established corporations.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Vice President, Quality
Strive Health
Denver , CO
2022.04 - 2024.04
- Developed and executed strategic plans to support the vision of the organization.
- Provided oversight of all departments in order to ensure smooth operation of daily activities.
- Quality Compliance - NCQA CM and PHP accreditations, delegation of Strive services to health plans,complaints & grievances oversight, policy and documentation management; Quality Improvement and Performance - CMS, HEDIS, and contractual Quality measure performance, QIPs; Patient Safety and Experience - Quality of Care Concerns, patient safety; Auditing - centralized audits for all patient-facing staff.
- Established performance standards for team in order to drive productivity levels up.
- Reviewed reports from functional areas to assess progress towards organizational goals.
- Determined performance goals and offered tactics for achieving milestones.
Senior Director, Quality
Strive Health
Denver , CO
2021.04 - 2022.03
- Build and implement the Strive Quality program to identify, measure, analyze and integrate quality and performance improvement throughout all aspects of the organization
- Translate technical and anecdotal data into operational initiatives to achieve improved health outcomes for CKD and ESRD patients while aligning clinical programs with the care model design
- Strategize with executive leadership to tailor the care model for compliance with internal initiatives and compliance requirements
- Operationalizing design into functional workflows for staff while allowing for tracking and trending of program effectiveness
- Direct all Quality and Performance Improvement activities as they apply to the annual program to identify business needs, subject matter expertise, remove silos and collaborative initiatives to drive interventions from a global perspective for greatest impact utilizing existing resources.
Director, Quality
Strive Health
Denver , CO
2020.08 - 2021.03
- Build and implement the Strive Quality program to identify, measure, analyze and integrate quality and performance improvement throughout all aspects of the organization
- Translate technical and anecdotal data into operational initiatives to achieve improved health outcomes for CKD and ESRD patients while aligning clinical programs with the care model design
- Strategize with executive leadership to tailor the care model for compliance with internal initiatives and compliance requirements
- Operationalizing design into functional workflows for staff while allowing for tracking and trending of program effectiveness
- Direct all Quality and Performance Improvement activities as they apply to the annual program to identify business needs, subject matter expertise, remove silos and collaborative initiatives to drive interventions from a global perspective for greatest impact utilizing existing resources.
Director, Quality Strategy and Performance Improvement: Medicaid and Medicare Advantage DSNP
Evolent Health
Arlington , VA
2016.01 - 2020.07
- Oversee the Quality program to implement quality and performance improvement across the organization as it applies to multiple lines of business
- Strategize with team members and executive leadership to execute existing and new quality interventions to impact HEDIS, Stars and Risk Adjustment
- Direct Quality team in all areas to support the organization with innovation and best practice.
NCQA Accreditation and Project Management Consultant
Managed Healthcare Resources
Detroit , MI
2016.01 - 2019.05
- Provide NCQA accreditation consulting services for health plan and care management clients
- Project management, documentation creation and support for managed healthcare resources clientele
- Create tools and templates for accurate compliance with NCQA accreditation standards supporting health plan, case management, population health management and utilization management accreditations.
QI Strategy Program Manager/Accreditation Manager: Case Management, Disease Management, Medicaid Health Plan
Evolent Health
Arlington , VA
2016.01 - 2019.04
- Program Manager for all quality initiatives across the organization
- Develop work plans and interventions to support improvement in quality and performance
- Create and manage member and provider engagement to impact HEDIS and Stars performance
- Collaborate with all departments to create a culture of quality in all member interactions
- Analyze data to interpret performance and determine outreach strategies
- Ensure the centralized Clinical Operations Care Management and Disease Management services adhere and shape programs to align with NCQA accreditation standards
- Identify process and outcome measures and annual analysis for internal programs
- Collaborate with clinical operations to define and implement quality improvement interventions to measure effectiveness of the program.
Director of Quality Improvement and Credentialing
Colorado HealthOP
2013.09 - 2015.11
Quality Program Manager
New Mexico Health Connections
Albuquerque , NM
2013.04 - 2013.09
Patient Placement and Transfer Center, Operations
Presbyterian Hospital
Albuquerque , NM
2012.06 - 2013.03
Operations Manager
SDS Solutions, Inc.
Tampa , FL
2007.02 - 2011.04
Asset Management Analyst/ Work Flow Coordinator/It Support
Capital One
Tampa , FL
1998.11 - 2004.04
Education
Master of Healthcare Administration - Project Management
Colorado State University - Global Campus
01.2015
Bachelor of Science in Business Management -
Colorado State University - Pueblo
01.2012
Skills
- Quality Leadership, Coaching, and Mentoring
- NCQA Accreditation and Delegation
- HEDIS
- Process Improvement
- Innovation management
- Documentation And Reporting
- Performance data analysis
- Complex Problem-Solving
- Strategic Planning
- Policy and procedure development
- OKRs and KPIs
- Performance monitoring and evaluation
Certification
Certified Professional of Healthcare Quality (CPHQ), 2022
Quality Improvement strategy: Centers for Medicare and medicaid
Technical Expertise Panel: 2014-2016
· National panel for developing policy to meet the ACA Quality Improvement Strategy
· Collaborate with NCQA, CMS and Booz Allen Hamilton
NATIONAL ALLIANCE OF STATE HEALTH co-OPS (NASHCO)
Quality and Accreditation Work group, Chair: 2013-2016
· Coordinate vendor collaboration activities
· Coordinate educational opportunities: CMS, QHP, NCQA
· Administer shared resource pool for policies and documentation
· Lead bi-weekly information sharing conference calls
NATIONAL COMMITTEE FOR QUALITY ASSURANCE
NASHCO representative for Health Plan Advisory Council: 2015
· Communicate between health plans and NCQA regarding standards for accreditation
· Create understanding and collaboration for accrediting bodies
National Experience
- Quality Improvement Strategy: Centers for Medicare and Medicaid, Technical Expertise Panel, 2014, 2016
- National Alliance of State Health Co-ops (NASHCO), Quality and Accreditation Work group, Chair, 2013, 2016
- National Committee for Quality Assurance, NASHCO representative for Health Plan Advisory Council, 2015
Expertise Highlights
- Healthcare Program Strategy
- Process Improvement and Logistics Management
- Data Analysis and Interpretation for Executive Leadership
- Relationship Management for Cross-departmental collaboration and design
- NCQA Health Plan Accreditation: Medicaid, Commercial, Marketplace, Medicare Advantage D-SNP
- NCQA Case Management Accreditation, Disease Management Accreditation
- HEDIS, CAHPS, Stars, QRS, QHP Surveys and Requirements
- People Management and Professional Development
- CMS Quality Improvement Activities (QIP), Performance Improvement Projects (PIPS)
- Health Plan Quality Improvement Development
- Credentialing Management
- Delegation Oversight
- Vendor Contracting and Management Team Management (Remote and local)
- Technical Writing (Policy/Procedures/SOPs/Manuals/System Specifications)
- Business Development
- Budget Maintenance and Control
- Data Flow & Process Mapping
- Intervention Development
- Program/Project Manager
- Database Design & Management
- Major Software/Systems Implementations
- Application Support, Quality Assurance and Training
Personal Information
Title: MHA, CPHQ
References
References available upon request.
Timeline
Vice President, Quality
Strive Health
2022.04 - 2024.04
Senior Director, Quality
Strive Health
2021.04 - 2022.03
Director, Quality
Strive Health
2020.08 - 2021.03
Director, Quality Strategy and Performance Improvement: Medicaid and Medicare Advantage DSNP
Evolent Health
2016.01 - 2020.07
NCQA Accreditation and Project Management Consultant
Managed Healthcare Resources
2016.01 - 2019.05
QI Strategy Program Manager/Accreditation Manager: Case Management, Disease Management, Medicaid Health Plan
Evolent Health
2016.01 - 2019.04
Director of Quality Improvement and Credentialing
Colorado HealthOP
2013.09 - 2015.11
Quality Program Manager
New Mexico Health Connections
2013.04 - 2013.09
Patient Placement and Transfer Center, Operations
Presbyterian Hospital
2012.06 - 2013.03
Operations Manager
SDS Solutions, Inc.
2007.02 - 2011.04
Asset Management Analyst/ Work Flow Coordinator/It Support
Capital One
1998.11 - 2004.04
Master of Healthcare Administration - Project Management
Colorado State University - Global Campus
Bachelor of Science in Business Management -
Colorado State University - Pueblo
Certified Professional of Healthcare Quality (CPHQ), 2022
Quality Improvement strategy: Centers for Medicare and medicaid
Technical Expertise Panel: 2014-2016
· National panel for developing policy to meet the ACA Quality Improvement Strategy
· Collaborate with NCQA, CMS and Booz Allen Hamilton
NATIONAL ALLIANCE OF STATE HEALTH co-OPS (NASHCO)
Quality and Accreditation Work group, Chair: 2013-2016
· Coordinate vendor collaboration activities
· Coordinate educational opportunities: CMS, QHP, NCQA
· Administer shared resource pool for policies and documentation
· Lead bi-weekly information sharing conference calls
NATIONAL COMMITTEE FOR QUALITY ASSURANCE
NASHCO representative for Health Plan Advisory Council: 2015
· Communicate between health plans and NCQA regarding standards for accreditation
· Create understanding and collaboration for accrediting bodies
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