Donna Brock

• Coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, makes recommendations for program enhancements to improved care delivery, ensures compliance with NCQA guidelines and provides leadership presence in the satellite offices throughout the state.
• Instrumental in the strategic implementation, program development and oversight of clinical operations for the LTSS program while managing 3 regions in the state during implementation of the LTSS program.
• Lead Care Coordination team in NCQA re-accreditation
• Developed new HRA process which allowed MCO to be able to show better efficiency while tracking metrics for state regulatory body (DMAS)
• Initiated productivity tool to assist care coordination team to monitor productivity of staff and assure that contractual agreements were being maintained.
• Instrumental in development of metric dashboard to allow monitoring of members data to improve reporting to DMAS.
• Monitor, track and trend program metrics, dashboards, and other reporting tools to drive action and improvements.
• Guide and educate team to ensure program processes and policies are aligned with NCQA and CMS Standards.
• Part of a dynamic team who assisted to create department specific policies and procedures and Job Aides to guide the care coordination team, thus improving the knowledge and quality of care coordination staff.
• Lead management team to restructure care coordination team to develop focused onboarding and leadership development to empower, engage, and develop our care coordination staff and retain staff.
• Project lead on reorganization of orientation/onboarding plan for staff.
• Evaluated employees' strengths and assigned tasks based upon experience and training while cross-training existing employees to maximize team agility and performance .
• Applied customer feedback to develop process improvements and support long-term business needs through the Annual Employee Press Ganey Survey.
• Worked with providers to define quality metrics and outcome reporting process. (FOCUS CARE)
• Assisted with ensuring the operational program needs met compliance with state and federal health plan requirements, made recommendations for program enhancements to improve care delivery, ensure compliance of and federal guidelines.

Team lead with over reading of records

• Met accuracy standards of 95 – 98% and turn around time of 24 – 48 hours for medical record review and data entry

• Hedis abstractor for Blue Cross Blue Shield of Tennessee
• Met accuracy standards of 95 – 98% and turn around time of 24 – 48 hours for medical record review and data entry

• Case Manage 40- 60 members

Direct day-to-day administrative and operational functions for 300-bed facility, providing guidance and leadership to over 158 employees across more than 6 departments.

• Implemented open heart facility, only open heart unit in the region

• Supportive Community Living facility (Behavioral Health)
• Worked closely with organizational leadership and board of directors to strategically affect operational direction.
• Provided exceptional counseling, case management, education and job training to diverse client base.

• Behavioral Health Outpatient Group Home

• ADON – assisted DON with administrative tasks
• Developed and delivered new hire training programs and continuous professional development.

• Outpatient Behavioral Health Group Home

• Assisted with development of TELEMEDICINE PROGRAM