Donna Brock
Bristol,Virginia
Summary
Strategic healthcare leader with extensive experience in managing complex clinical and operational programs across various care settings. Expertise in regulatory compliance, quality improvement, and leading multidisciplinary teams. Proven track record of enhancing organizational performance, optimizing workflows, and improving communication to boost service quality and operational efficiency. Skilled in data-driven decision-making, risk mitigation, and fostering high-performing teams focused on accountability and continuous improvement, specializing in regulatory compliance, audit readiness, and enterprise‑wide quality improvement. Skilled in developing policies, conducting risk assessments, and implementing corrective action plans that strengthen organizational integrity and regulatory alignment. Proven ability to lead cross‑functional teams, optimize quality programs, and deliver measurable improvements in performance, accuracy, and service delivery. Recognized for analytical rigor, operational discipline, and fostering a culture of compliance and continuous improvement.
Overview
38
38
years of professional experience
Work History
Manager Case Management
Sentara Health Plan
Virginia Beach, Virginia
06.2016 - 07.2026
- Led strategic oversight of LTSS programs including SMI/Behavioral Health, Nursing Facility, and Waiver teams.
- Implemented process improvements that streamlined workflows and increased operational effectiveness.
- Directed restructuring of care coordination team, enhancing onboarding process and team dynamics.
- Led the HEDIS team to analyze data and close care gaps.
- Evaluated performance metrics to identify improvement areas.
- Designed and implemented new HRA and productivity tools improving efficiency and data accuracy.
- Direct care management operations across multiple regions, ensuring compliance with NCQA, CMS, and regulatory requirements.
- Ensured compliance with all applicable laws, regulations, industry standards.
- Oversaw case management operations for diverse patient populations at a leading health plan.
- Developed and implemented care coordination strategies to enhance patient support services.
- Managed team performance and provided mentorship to improve case management practices.
- Monitored and evaluated performance metrics to identify areas for improvement in case management services.
- Evaluated existing processes and systems used by the organization's case managers; recommended improvements where necessary.
- Established relationships with external organizations such as community resources or government agencies that can provide additional support for patients.
- Participated in data collection projects to monitor effectiveness of case management interventions at both individual level and population level.
- Maintained up-to-date knowledge on current trends in healthcare industry related to case management practices.
- Ensured compliance with all applicable laws, regulations, policies and procedures related to case management services.
- Actively participated in utilization review activities such as concurrent review, discharge planning and pre-authorization requests.
- Developed benchmarks for measuring and monitoring strategic changes and organizational goals.
Director for Nurse Case Management
Lifestyle Care Inc
San Antonio, Texas
10.2015 - 01.2017
- Case Manage Humana Medicare Members
- Oversaw case management operations across multiple departments, improving coordination and client outcomes.
- Managed contract for Humana Medicare clients, ensuring adherence to company standards and enhancing service quality.
- Developed strategic plans to enhance patient care and service delivery.
- Led multidisciplinary teams in case review and problem-solving sessions.
- Implemented policies that ensured compliance with regulations, strengthening operational integrity and service delivery.
- Analyzed case data to identify trends and improve service effectiveness.
- Created and implemented case management programs after analyzing quantitative data about patient intake and discharge.
HEDIS Abstractor / RN Quality Analyst
BCBST
08.2016 - 01.2017
- Conducted HEDIS abstraction with 95–98% accuracy, ensuring timely reporting for quality improvement initiatives.
- Reviewed medical documentation to ensure compliance with guidelines.
- Extracted and organized patient data for accurate records management.
- Collaborated with healthcare professionals to clarify information needs.
HEDIS RN Quality Analyst
VA Premier Health Plan
12.2015 - 06.2016
- Team lead reviewing records with 95–98% accuracy.
- Achieved turnaround within 24–48 hours by streamlining processes.
- Coordinated schedules to ensure optimal resource allocation among team members.
- Oversaw project timelines to meet deadlines and maintain workflow efficiency.
- Implemented best practices for communication within the team and stakeholders.
- Evaluated team performance regularly to identify areas for improvement.
- Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
Director Operating Room
Big Stone Gap Hospital
Big Stone Gap , Va
01.2014 - 06.2016
- Implemented policies to ensure compliance with healthcare regulations and standards.
- Managed staff recruitment, training, and performance evaluations for healthcare teams.
- Oversaw budgeting and financial planning for hospital initiatives and projects.
- Collaborated with department heads to streamline healthcare processes and workflows.
- Directed hospital operations to enhance patient care and service delivery.
- Recruited, trained, supervised, evaluated and mentored staff members.
- Directed the organization's daily operations, ensuring compliance with applicable laws and regulations.
- Developed policies and procedures to ensure compliance with corporate standards.
- Created detailed plans outlining timelines, goals, budgets, staffing needs and other requirements for projects.
HEDIS RN Quality Analyst
Inovalon Healthcare Inc
01.2016 - 06.2016
- HEDIS abstraction with 95–98% accuracy and rapid turnaround.
- Led quality assurance team to maintain product standards and compliance.
- Conducted regular audits to ensure adherence to quality control measures.
- Collaborated with production teams to resolve quality issues promptly.
- Implemented continuous improvement initiatives for operational efficiency.
- Facilitated cross-functional meetings to discuss quality performance and improvements.
- Reviewed and updated quality documentation for accuracy and relevance.
Director and Team Lead
Quality Staffing of America
01.2014 - 06.2016
- Achieved HEDIS abstraction with 95–98% accuracy, ensuring timely and reliable data for quality improvement initiatives.
- Led quality assurance team to maintain product standards and compliance.
- Conducted regular audits to ensure adherence to quality control measures.
- Collaborated with production teams to resolve quality issues promptly.
- Implemented continuous improvement initiatives for operational efficiency.
- Facilitated cross-functional meetings to discuss quality performance and improvements.
- Reviewed and updated quality documentation for accuracy and relevance.
Staff Development Director
Pikeville Medical Center
08.2012 - 02.2014
- Organized and oversaw implementation and training for staffing in first open-heart unit in region, ensuring effective team readiness.
- Developed training programs for clinical and non-clinical staff at Pikeville Medical Center.
- Collaborated with leadership to assess and prioritize staff development needs, aligning training programs with organizational goals.
- Implemented onboarding processes to ensure smooth integration of new employees.
- Evaluated training effectiveness through feedback and performance assessments.
- Coordinated continuing education opportunities for healthcare professionals on staff.
- Mentored managerial staff in leadership development and team-building strategies.
- Developed and tracked metrics to measure success of staff development initiatives, providing insights for continuous improvement.
- Oversaw administrative & operational functions for 300-bed facility with 3000+ staff.
Executive Director
Commonwealth Care Inc.
03.2010 - 08.2012
- Worked closely with organizational leadership to strategically implement and guide operational direction for onsite BH clients in community housing environment.
- Provided counseling, case management, education and job training to a diverse BH client base.
- Managed daily operations at a supportive community living facility focused on behavioral health.
Director of Endoscopy /Pre-Op/Outpatient Center
Hazard ARH Medical Center
05.2009 - 04.2010
- Led daily operations ensuring team efficiency and productivity.
- Managed staff schedules to align with operational needs.
- Oversaw inventory management and supply chain processes.
- Implemented training programs for new team members.
- Coordinated quality control measures across all units.
- Developed strategies to enhance customer service experiences.
- Facilitated communication between departments for seamless operations.
- Analyzed performance metrics to identify improvement areas.
- Actively participated in recruitment efforts by interviewing potential candidates.
Executive Director of Operations
Mountain Horizon of Hope SCL Home
05.2007 - 12.2009
- Behavioral Health Outpatient Group Home
- Oversaw budget management and resource allocation for operational effectiveness.
- Collaborated with stakeholders to enhance service delivery and program development.
- Established partnerships with healthcare providers to improve patient outcomes.
- Advocated for policies supporting public health initiatives within the community.
- Developed training programs to enhance staff skills and service quality.
- Monitored compliance with regulatory standards and best practices in healthcare delivery.
- Recruited, trained, mentored, evaluated, coached, and managed staff members to ensure success in achieving their goals.
- Managed the organization's financial resources and operations to maximize efficiency and effectiveness.
Staff Development Coordinator /Clinical Nurse Specialist / Assistant Director of Nursing
Hazard ARH Psychiatric Center
12.2004 - 05.2009
- Developed training programs for staff to enhance professional skills.
- Coordinated workshops to improve team collaboration and communication.
- Implemented onboarding processes for new employees to ensure smooth transitions.
- Organized employee evaluations to assess performance and identify development needs.
- Facilitated feedback sessions between staff and management for continuous improvement.
- Collaborated with leadership to align training initiatives with organizational goals.
- Maintained records of training activities and employee progress for compliance purposes.
- Spearheaded entire onboarding and orientation process for new employees, providing education and information to facilitate learning and improve employee job satisfaction.
- Partnered with professionals to coordinate logistics and communication regarding staff training on company products, initiatives, and programs.
- Researched, designed, and delivered top-caliber webinars with many in attendance.
Director of Nursing / Director Case Management
Caney Creek Rehab Complex, Behavioral Health Personal Care Home
02.2002 - 12.2004
- Outpatient Behavioral Health Group Home
- Developed and implemented policies to enhance operational effectiveness across departments.
- Oversaw cross-functional teams to ensure alignment with business goals and objectives.
- Managed budget allocations, ensuring resources were utilized effectively for maximum impact.
- Fostered a culture of continuous improvement through training and development programs.
- Recruited, trained, supervised, evaluated and mentored staff members.
- Conducted regular meetings with department heads to review progress on strategic initiatives.
- Developed policies and procedures to ensure compliance with corporate standards.
- Collaborated with senior leadership to set long-term objectives for the company.
- Developed and implemented comprehensive strategies to improve operational processes and organizational efficiency.
Director of Surgical Services / Education Coordinator/ Staff Development
Norton Community Hospital
01.1999 - 02.2002
- Directed surgical services, ensuring compliance with safety and quality standards.
- Collaborated with surgeons to optimize surgical workflows and processes.
- Managed staff recruitment, training, and performance evaluations for surgical teams.
- Developed and implemented policies for effective patient care in operating rooms.
- Spearheaded entire onboarding and orientation process for new employees, providing education and information to facilitate learning and improve employee job satisfaction.
- Implemented onboarding processes for new employees to ensure smooth transitions.
- Developed training programs for staff to enhance professional skills.
- Coordinated workshops to improve team collaboration and communication.
- Facilitated feedback sessions between staff and management for continuous improvement.
Director of Nursing, Education Coordinator, Infection Control Nurse, Utilization Review Coordinator
Jenkins Community Hospital
01.1989 - 12.1998
- Director of Nursing
- Director Home Health
- Director Utilization Review
- Directed emergency room operations
- Director Infection Control
- Process Improvement Coordinator
Education
MSN - Community Health Clinical Nurse Specialist (APRN)
University of Kentucky
Lexington, KY01-1999
BSN Degree -
Eastern Kentucky University
Richmond, KY05-1997
Associate Degree of Nursing ADN -
Morehead State University
Morehead, KY05-1985
Associate of Applied Science -
Alice Lloyd College
Pippa Passes, KY05-1983
Skills
- Complex case management
- Discharge planning & transitions of care
- Member advocacy & engagement
- Managed Care Operations
- Interdisciplinary collaboration
- Prior authorization review
- Level-of-care assessment
- Appeals & grievance support
- NCQA, CMS, DMAS Regulations/ standards
- Medicare & Medicaid regulations
- HIPAA compliance
- Quality assurance & audit readiness
- Policy development & adherence
- Value-based care models
- Risk adjustment awareness
- Network/provider relations
- Cost containment strategies
- Population health management
- Staff supervision & coaching
- Performance management
- Training & competency development
- Workflow optimization
- Change management
- Trend analysis & reporting
- KPI development & monitoring
- EMR/EHR & care management platforms
- Cross-functional collaboration
- Provider and vendor communication
Personal Information
Title: MSN, RN, CHCNS
Volunteer Experience
- United Way contribution ongoing annually.
- Work with Salvation Army in Hometown to feed the homeless population and find healthcare for underprivileged clients.
- Volunteer at local church food banks.
Quote
Coming together is a beginning; keeping together is progress; working together is success. - Henry Ford
Core Competency Skills
- Complex case management
- Discharge planning & transitions of care
- Member advocacy & engagement
- Managed Care Operations
- Interdisciplinary collaboration
- Prior authorization review
- Level-of-care assessment
- Appeals & grievance support
- NCQA, CMS, DMAS Regulations/ standards
- Medicare & Medicaid regulations
- HIPAA compliance
- Quality assurance & audit readiness
- Policy development & adherence
- Value-based care models
- Risk adjustment awareness
- Network/provider relations
- Cost containment strategies
- Population health management
- Staff supervision & coaching
- Performance management
- Training & competency development
- Workflow optimization
- Change management
- Clinical data interpretation
- Trend analysis & reporting
- KPI development & monitoring
- EMR/EHR & care management platforms
- Cross-functional collaboration
- Provider and vendor communication
Timeline
HEDIS Abstractor / RN Quality Analyst
BCBST
08.2016 - 01.2017
Manager Case Management
Sentara Health Plan
06.2016 - 07.2026
HEDIS RN Quality Analyst
Inovalon Healthcare Inc
01.2016 - 06.2016
HEDIS RN Quality Analyst
VA Premier Health Plan
12.2015 - 06.2016
Director for Nurse Case Management
Lifestyle Care Inc
10.2015 - 01.2017
Director Operating Room
Big Stone Gap Hospital
01.2014 - 06.2016
Director and Team Lead
Quality Staffing of America
01.2014 - 06.2016
Staff Development Director
Pikeville Medical Center
08.2012 - 02.2014
Executive Director
Commonwealth Care Inc.
03.2010 - 08.2012
Director of Endoscopy /Pre-Op/Outpatient Center
Hazard ARH Medical Center
05.2009 - 04.2010
Executive Director of Operations
Mountain Horizon of Hope SCL Home
05.2007 - 12.2009
Staff Development Coordinator /Clinical Nurse Specialist / Assistant Director of Nursing
Hazard ARH Psychiatric Center
12.2004 - 05.2009
Director of Nursing / Director Case Management
Caney Creek Rehab Complex, Behavioral Health Personal Care Home
02.2002 - 12.2004
Director of Surgical Services / Education Coordinator/ Staff Development
Norton Community Hospital
01.1999 - 02.2002
Director of Nursing, Education Coordinator, Infection Control Nurse, Utilization Review Coordinator
Jenkins Community Hospital
01.1989 - 12.1998
MSN - Community Health Clinical Nurse Specialist (APRN)
University of Kentucky
BSN Degree -
Eastern Kentucky University
Associate Degree of Nursing ADN -
Morehead State University
Associate of Applied Science -
Alice Lloyd College