David Widen
Anthem,USA
Summary
Quality Management and Quality Improvement Audit leader with extensive experience advancing healthcare compliance, provider performance, audit readiness, and continuous improvement across behavioral health and physical health provider networks. Skilled at leading audit teams, designing audit tools and review processes, coordinating cross-functional annual audit operations, facilitating formal exit interviews, and providing technical assistance and education that supports provider accountability and quality-of-care standards. Known for developing practical quality management approaches that reduce provider burden, strengthen contract deliverable oversight, and promote measurable performance improvement.
Overview
27
27
years of professional experience
Work History
Quality Improvement Audit Supervisor
Arizona Complete Health
Tempe, Arizona
10.2015 - Current
- Lead the Quality Improvement Audit Team in reviewing clinical records to assess compliance measures, quality-of-care standards, and contract deliverables.
- Direct annual behavioral health audit operations in partnership with internal departments, including audit calendar development, sampling, notifications, and final reporting.
- Develop, maintain, and strengthen quality management audit tools, focus review approaches, and provider readiness review processes to support consistent, defensible audit outcomes.
- Provide technical assistance, facilitate formal exit interviews, and coordinate with internal and external stakeholders to promote provider performance improvement and contract compliance.
- Represent quality management interests through active participation with the Arizona Association of Health Plans in monitoring physical health care providers.
- Advance process improvement by developing audit approaches designed to lessen provider burden while preserving regulatory rigor and accountability.
- Apply extensive knowledge of regulatory manuals and electronic health record platforms to support audit readiness, review accuracy, and operational continuity.
Quality Improvement Specialist
Arizona Complete Health
Tempe, Arizona
10.2008 - 10.2015
- Reviewed clinical records to evaluate compliance with quality measures, contract deliverables, and established care standards.
- Coordinated annual audit functions across departments, including calendar planning, sample coordination, audit notification, and final report development.
- Built and maintained quality management audit tools and focus review processes that supported consistent review practices and actionable findings.
- Delivered technical assistance and facilitated exit interviews to clarify expectations, reinforce compliance requirements, and support provider improvement.
- Conducted and helped develop provider readiness reviews while coordinating EHR access for scheduled reviews across varied electronic health record systems.
Senior Quality Improvement Specialist
Magellan Health Services
Phoenix, Arizona
05.2008 - 10.2008
- Partnered with clinical staff to interpret performance trends, develop improvement plans, and support quality-of-care standards.
- Participated in quality-focused workgroups and contributed to performance improvement initiatives that addressed identified trends and opportunities.
- Analyzed data and prepared performance improvement reports for internal and external audiences.
- Served as a certified reviewer for designated audits and provided technical assistance and educational training to behavioral health professionals.
Provider Relations Liaison
Magellan Health Services
Phoenix, Arizona
09.2007 - 05.2008
- Cultivated collaborative partnerships with behavioral health providers in Maricopa County to enhance service delivery.
- Provided technical assistance and educational training to improve provider understanding, strengthen relationships, and support positive outcomes.
- Monitored provider challenges, resolved issues, and conducted administrative site visits to ensure contract compliance.
- Reviewed audits and supported cross-departmental quality and operational projects to improve overall service standards.
Provider Monitoring Specialist
ValueOptions, Inc.
Phoenix, Arizona
01.2000 - 09.2007
- Monitored behavioral health provider contract compliance in Maricopa County, ensuring adherence through clinical record reviews, site inspections, and exit interviews.
- Identified performance trends and partnered with clinical staff to develop improvement plans aligned with quality-of-care expectations.
- Prepared performance reports for internal and external stakeholders, supporting development of policies, procedures, corrective action plans, and special programs.
- Participated as an independent reviewer in the Office of Monitor’s Community Audit.
Education
Bachelor of Science - Criminal Justice & Psychology
Northern Arizona University
Flagstaff, AZ05-1995
Skills
- Healthcare Quality Assurance
- Regulatory & Contract Compliance
- Clinical Record Review & Audit Methodology
- Quality Management & Continuous Improvement
- Corrective Action & Performance Improvement Support
- Audit Tool Development & Focus Reviews
- Annual Audit Planning & Final Reporting
- Provider Readiness Reviews
- Provider Education & Technical Assistance
- Performance Trend Analysis
- Electronic Health Record Navigation
- Cross-Functional Collaboration
Selected Quality Management Differentiators
- Deep experience leading quality improvement audits across behavioral health and physical health provider environments.
- History of translating audit findings into provider education, technical assistance, readiness support, and performance improvement opportunities.
- Practical working knowledge of audit sampling, notification workflows, final reporting, focus reviews, and EHR-based review coordination.
- Collaborative leadership style with experience engaging internal teams, external departments, health plan partners, and provider stakeholders.
Quality Management Value Proposition
Clinical record review, Audit tool development, Regulatory manual knowledge, Readiness reviews, Focus reviews, Technical assistance, Formal exit interviews, Provider education, Performance trend identification, Contract compliance support, Annual audit calendar management, Sampling, Notification workflows, Final reporting, Cross-functional coordination, EHR access coordination
Timeline
Quality Improvement Audit Supervisor
Arizona Complete Health
10.2015 - Current
Quality Improvement Specialist
Arizona Complete Health
10.2008 - 10.2015
Senior Quality Improvement Specialist
Magellan Health Services
05.2008 - 10.2008
Provider Relations Liaison
Magellan Health Services
09.2007 - 05.2008
Provider Monitoring Specialist
ValueOptions, Inc.
01.2000 - 09.2007
Bachelor of Science - Criminal Justice & Psychology
Northern Arizona University