Microsoft 365 Suite
Hi, I’m
Denise Baxter-Still
Franklinville,New Jersey
"To see into the future, one must be mindful of the present"
Kouzes, J. M., & Posner, B. Z.
Summary
•Extensive experience managing quality assurance systems across various healthcare settings, including hospitals, public health agencies, healthcare companies, and managed care organizations.
•Proven track record in developing and implementing quality assurance and health policy frameworks for public health agencies, programs, and facilities.
•Strong background in defining patient care and service delivery standards and continuously assessing and improving quality to ensure compliance with established standards.
•Skilled in managing and making decisions related to health promotion data, research and evaluation, and assessment.
•Proficient in the development and maintenance of electronic database management and auditing.
•Proficient in reviewing, auditing, and developing Medicaid, Medicare, and Behavioral Health Services contracts and system providers.
•In-depth Quality Assurance Specialist with success in prioritization and multitasking. Exceptional communication and organizational skills. Committed to paying impeccable attention to reviews and auditing procedures.
Overview
11
years of professional experience
4
Certificate
Work History
Department of Health, State of New Jersey
Quality Assurance Specialist - Health Services
04.2021 - Current
Job overview
- Currently responsible for project management of over 48 active submissions.
- Manage various aspects of healthcare settings, including management, licensure, strategic planning, and implementation of new regulations.
- Conduct thorough research and analysis of healthcare settings’ current ownership structure, financial health, legal obligation, and operational processes to identify potential risks and opportunities.
- Provide input and support for Department of Health quality improvement initiatives to enhance efficiency and effectiveness in service delivery.
- Identify and mitigate potential risks associated with any transfer of ownership, such as legal disputes, financial instability, reputational damage, or regulatory non-compliance; develop strategies and contingency plans to address these risks.
- Collaborate with statewide program managers and performance management to develop licensure measures and strategies and ensure compliance with state and federal policies.
- Experience providing insight on N.J.A.C. 8:43A regulatory process, including relationship all healthcare regulations, healthcare operation specifications, notices, updates and memos issued.
- Lead, plan, and manage licensure process for assigned projects, providing education, technical advice, and expert guidance to ensure compliance with federal, state, and Department of Health policies.
- Establish and maintain effective relationships with key stakeholders to foster collaboration, address concerns, and provide updates to facilitate decision-making among individuals with diverse interests.
- To drive successful completion, develop and monitor project plans, including activities, milestones, timelines, and metrics.
- Ensure compliance with applicable laws, regulations, and industry standards related to healthcare systems.
- Provide guidance and support to healthcare systems, providers, and staff on process improvements and best practices.
- Prepare complex documents, reports, and letters to contribute to process improvement and project management.
- Ensured product compliance with industry regulations by staying up-to-date on relevant standards and guidelines, implementing necessary changes to maintain conformance.
- Completed deviation forms and recorded findings of inspection process, collaborating with quality team members and department managers to implement procedural remedies.
Division of Medical Assistance and Health Services, State of New Jersey
Quality Assurance Health Specialist
08.2018 - 04.2021
Job overview
- Developed and implemented strategies to optimize healthcare delivery, improve patient outcomes, and enhance overall performance of managed care organized and associated healthcare systems.
- Analyzer of healthcare systems, processes, and workflows to identify areas for improvement and inefficiencies to include all of 5 major health plans offered within Medicaid / NJ Family Care system in New Jersey.
- Knowledge of regulatory guidance materials such as healthcare advisories, and other regulatory guidance publications.
- Knowledge of Section 6102(c) of Affordable Care Act to develop, design, implement, monitor and analyze data from all required quality assurance and performance improvement (QAPI) plans as required.
- Conduct research and data analysis to evaluate impact and effectiveness of healthcare programs and interventions within state-offered managed care organizations.
- Review Medicaid contracts and related documents to ensure accuracy and completeness.
- Analyze State Medicaid contract terms and conditions to identify potential risks or compliance issues.
- Assist in development and implementation of contract review protocols and procedures.
- Provide professional, evidence-based, and ethical advice on delivering Medicaid services to improve their quality clinical safety and promote wellness while reducing health inequalities.
- Offer expert public health support and leadership to ensure evidence-based approaches in developing high-quality and equitable services within Medicaid / NJ Family Care, including mandated core services.
- Collected, reviewed, and analyzed data to enhance utilization of health resources, including risk management, program evaluation, infection control measures, health policy, and staff development.
- Analyzed and evaluated research evidence from various sources to make informed recommendations and support decision-making related to Medicaid recipients and Lead Intervention Team.
- Assigned as Team lead for New Jersey Lead Intervention, ensuring managed care organizations remained compliant with Medicaid Contract, relevant regulations, industry standards, and other Division policies.
Division of Developmental Disabilities, State of New Jersey
Habilitation Plan Coordinator
03.2013 - 08.2018
Job overview
- Monitor and evaluate compliance issues and concerns within assigned care-managed organizations and refer them for investigation and resolution as necessary.
- Analyzing trends in purchases and financial reporting compliance, according to Medicaid and Community Care Waiver and Community Care Residences serving persons with Intellectual Disabilities.
- Providing coaching and mentoring to over 42 Community Care Residences for problem-solving related to Medicaid compliance, fiscal compliance, and healthcare compliance/reporting; monitoring and coordinating compliance activities such as scheduling additional training for assigned agencies to stay current in their knowledge base.
- Furthermore, this body is responsible for reporting progress or lack thereof in compliance efforts on monthly and quarterly basis, as well as responding to alleged violations of rules, regulations, policies, and procedures mandated by State of New Jersey.
- Collaborate with state-contracted agencies to direct compliance issues to appropriate channels for investigation and resolution and ensure proper reporting of violations or potential.
Education
University of PhoenixTempe, AZ
Master of Education from Education of Individuals With Multiple Disabilities
01.2009
Xavier University of LouisianaNew Orleans, LA
Bachelor's Degree from Clinical Psychology
05.2003
University Overview
- Awarded Honors in English
- Awarded Concentration in Biology
- Awarded Concentration in English
Skills
- Detail Oriented
- Quality Assurance
- Problem-solving skills
- Analytical Thinking
- Team Collaboration
- Quality Management Systems
- Data Analysis
- Documentation And Reporting
- Correction action planning
- Establishing and Enforcing Policy
- Regulatory Compliance
- Project Management
- Technical reporting
- Technical Documentation
- Performance monitoring
- Relationship Building
Accomplishments
· Receiver of consistent positive feedback from hospital system project managers, risk operation managers, and attorneys, resulting in increased transactional values due to a decrease in the timeline of the project managed by 5%.
· Receiver various accolades from stakeholders, noting increased favorable outcomes and a reduction in holding costs by 3% due to completion times of projects.
· Assigned as the team lead of four (4) co-workers tasked to update the State of New Jersey Medicaid Contract regarding managed care organizations and their obligations to treat children with lead exposure leading to the reduction of children exposed to lead at a rate of 4%.
· With the completion of standard audit, discovered and assisted in recovering over 5K in missing consumer funding through quarterly monitoring of financials.
Certification
- Project Management Professional Certification Expected 04.2024
- Emergency Medical Technician
- Teacher of Students with Disabilities
- Teacher of Elementary Education K-6
Availability
See my work availability
Not Available
Available
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Affiliations
- Zeta Phi Beta
Work Preference
Work Type
Full TimeContract WorkWork Location
RemoteHybridOn-SiteImportant To Me
Company CultureWork-life balanceCareer advancementPaid sick leaveHealthcare benefitsFlexible work hoursPaid time off401k matchWork from home optionStock Options / Equity / Profit SharingSoftware
Dynamics Quality Management Database
Interests
Traveling
Reading
Exercise
Brunching
Timeline
Quality Assurance Specialist - Health Services
Department of Health, State of New Jersey
04.2021 - Current
Quality Assurance Health Specialist
Division of Medical Assistance and Health Services, State of New Jersey
08.2018 - 04.2021
Habilitation Plan Coordinator
Division of Developmental Disabilities, State of New Jersey
03.2013 - 08.2018
University of Phoenix
Master of Education from Education of Individuals With Multiple Disabilities
Xavier University of Louisiana
Bachelor's Degree from Clinical Psychology
Similar Profiles
Sharon CiceroSharon Cicero
Health Care Services Evaluator/Nurse at Department Of Health, State Of New JerseyHealth Care Services Evaluator/Nurse at Department Of Health, State Of New Jersey
Michael RobertsMichael Roberts
Security Guard/Security Monitor at State of New Jersey, Department of Law and Public Safety, Division of State PoliceSecurity Guard/Security Monitor at State of New Jersey, Department of Law and Public Safety, Division of State Police
Andra HopsonAndra Hopson
Supervising Pension Benefits Specialist at State of New Jersey, Department of the TreasurySupervising Pension Benefits Specialist at State of New Jersey, Department of the Treasury
STEPHEN McCARTYSTEPHEN McCARTY
Field Support Manager at Fulton BankField Support Manager at Fulton Bank
Thomas WareThomas Ware
Yard Associate/Mechanic- Rental and Sales at James River EquipmentYard Associate/Mechanic- Rental and Sales at James River Equipment