Donna K Hodge
Durham,NC
Summary
- Dynamic and credentialed healthcare leader with over 25 years of progressive experience in clinical nursing, drug safety, and healthcare quality management.
- Proven track record in spearheading accreditation efforts, driving cross-functional quality improvement initiatives, and ensuring regulatory compliance across diverse healthcare environments.
- Expertise in translating clinical data into actionable insights, mentoring multidisciplinary teams, and aligning operations with evolving standards of care.
- Recognized for pivotal contributions to successful NCQA Health Plan Accreditation through collaborative training and effective coordination with diverse teams, while designing robust data collection methodologies to enhance quality improvement initiatives and accreditation readiness.
Overview
33
33
years of professional experience
Work History
Manager-Accreditation
Alliance Health
07.2023 - Current
- Manage the development, modification, implementation and coordination of systems and processes necessary to meet all National Committee for Quality Assurance (NCQA) accreditation requirements.
- Collaborate in the design, development, and implementation strategy of quality improvement projects (QIP) and initiatives supporting accreditation.
- Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes.
- Coordinate with HEDIS SME(s) for performance improvement activities to promote NCQA Accreditation Standing.
- Effectively communicate feedback and provide ongoing coaching and mentoring.
- Facilitate intra-departmental workgroups to establish and monitor corrective action plans, interventions, process changes around annual reports.
- Work organization wide, cross-functional and multi-disciplinary teams to bring each business area to a state of readiness
Quality Performance Specialist
AmeriHealth Caritas North Carolina
07.2021 - 07.2023
- Investigated Potential Quality of Clinical Care (PQOC) and Member Complaints for suspected deviations of provider performance, clinical care, or outcomes of care to determine if an actual quality of care event exists.
- Supported annual medical record review activities for HEDIS and Clinical Practice Guidelines.
- Developed clinical Quality Improvement Activities (QIA) that monitored, analyzed, and improved healthcare outcomes for providers, members, and the community.
- Led performance improvement initiatives to enhance operational efficiency and service quality.
- Analyzed data trends to identify areas for process optimization and strategic adjustments.
- Collaborated with cross-functional teams to align performance metrics with organizational goals.
Health Care QM Project Manager
Aetna Better Health of Virginia
05.2016 - 07.2021
- Project Leader for NCQA accreditation by overseeing all aspects of project implementation, budget development and supervision of staff participants.
- Developed compliance documents, policies, and procedures that supported regulatory and accreditation guidelines.
- Conducted peer review and chart compiled audits.
- Educated cross-functional teams on quality improvement methods, workflows, and data analysis.
- Trend analyst of health documents to identify areas for improvement.
- Data collection methodology, metrics, and data elements needed to measure outcomes quality initiatives.
Health Care Quality Management Consultant
Aetna/Coventry
11.2012 - 05.2016
- Prepared and evaluated clinical information and documentation ensuring compliance with plan sponsors, federal and state regulators, and NCQA guidelines.
- Performed ongoing maintenance and implementation of quality improvement projects and initiatives and recommended corrective actions regarding potential quality concerns.
- Conducted peer review chart audits, and compiled results to report to the appropriate oversight committee.
- Developed and presented training materials on preventative health and wellness topics based on healthcare trends, barriers, and opportunities.
- Annually reviewed department policies and procedures and recommended updates based on changing needs and trends.
- Facilitated and coordinated the monthly Quality Improvement and Physician Quality committee meetings.
- Developed and implemented quality management frameworks aligning with regulatory standards.
Drug Safety Manager
Novella Clinical Resourcing
01.2011 - 11.2012
- Managed the day-to-day operations of the Drug Safety Team; collection, safety review, processing, and reporting of adverse events data.
- Performed clinical endpoint adjudication and case summary preparation and submission for Clinical Event Committee review.
- Reviewed and verified information and data for Integrated Summary Report and Clinical Study report.
- Developed and implemented safety policies and procedures to ensure regulatory compliance.
Comprehensive Care Clinician
Healthways Inc.
04.2010 - 10.2011
- Provided educational advice and telephonic nursing to empower individuals in making informed wellness decisions.
- Offering guidance on home care, preventive health strategies, and evidence-based medical information.
- Maintained up-to-date knowledge on industry best practices, attending conferences and participating in continuing education opportunities.
Field Reviewer
Outcomes Health Information Solutions
07.2010 - 07.2011
- Conducted on-site payment integrity audits at area physicians' offices and hospitals.
- Retrieved and audited medical records to support services, billing policies and to ensure charges were supported by clinical documentation.
Medical Products Safety Specialist III
RTI Health Solutions
08.2008 - 01.2010
- Processed serious adverse events in Arisg database; focusing on triage, medical narratives, query resolution, and data reconciliation.
- Gathering data for a New Drug Application (NDA); focusing on electronic media reviews and literature searches.
- Ensured paper and electronic safety files were accurate and audit-ready.
Drug Safety Scientist
Abraxis Bioscience
12.2007 - 07.2008
- Collected, processed, and analyzed adverse events for investigational and marketed pharmaceutical oncology products.
- Prepared and reviewed clinical data for clinical submission to regulatory agencies.
Clinical Safety Specialist
Quintiles
11.2006 - 12.2007
- Processed serious adverse events for oncology clinical studies; focusing on case triage, medical narratives, query resolution, and data reconciliation.
- Performed data entry and coding of medical information obtained from case review into the ArisG and Clintrace safety databases.
- Global regulatory reporting activities and Investigator letter submission for the USA, Canada, Japan, and Latin American countries.
Senior Serious Adverse Event Coordinator
PPD, Inc
09.1997 - 06.2006
- Safety lead of Phase I to Phase III investigational drugs studies.
- Serious adverse events processing; focus on the evaluation of adverse event data, case narratives, query resolution, and data reconciliation.
- Presented the safety process to the study team, investigators, and study coordinators.
- Created, prepared, and revised safety conventions, standard operating procedures (SOPs), and working practice documents (WPDs).
Registered Nurse, Pediatricso
UNC Hospitals
11.1992 - 09.1997
- Delivered comprehensive bedside care to children with complex cardiac, respiratory, and oncologic conditions, collaborating closely with multidisciplinary teams to optimize outcomes.
- Charge nurse assignment, education, and new staff nurses mentor.
Education
Bachelor of Science - Nursing
North Carolina Central University
Durham, NC05.1996
Skills
- Compliance management
- Accreditation preparation
- Project coordination
- Strategic project planning
- Health promotion strategies
- Employee training
- Development of policies and procedures
- Analytical trend identification
Timeline
Manager-Accreditation
Alliance Health
07.2023 - Current
Quality Performance Specialist
AmeriHealth Caritas North Carolina
07.2021 - 07.2023
Health Care QM Project Manager
Aetna Better Health of Virginia
05.2016 - 07.2021
Health Care Quality Management Consultant
Aetna/Coventry
11.2012 - 05.2016
Drug Safety Manager
Novella Clinical Resourcing
01.2011 - 11.2012
Field Reviewer
Outcomes Health Information Solutions
07.2010 - 07.2011
Comprehensive Care Clinician
Healthways Inc.
04.2010 - 10.2011
Medical Products Safety Specialist III
RTI Health Solutions
08.2008 - 01.2010
Drug Safety Scientist
Abraxis Bioscience
12.2007 - 07.2008
Clinical Safety Specialist
Quintiles
11.2006 - 12.2007
Senior Serious Adverse Event Coordinator
PPD, Inc
09.1997 - 06.2006
Registered Nurse, Pediatricso
UNC Hospitals
11.1992 - 09.1997
Bachelor of Science - Nursing
North Carolina Central University
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