Summary
Work History
Education
Skills
Accomplishments
Presentations Papers
Adjunct Career
Earlier Career Business Owner
Skills Affiliations Honors Awards Certifications
Timeline
Generic

Dorothy Moore

Atlanta,GA

Summary

Highly accomplished executive leader with extensive experience in healthcare management, quality, and operations. NCQA accredited surveyor and recognized for developing strategies that impact ROI and implementing quality tools and processes to affect bottom-line results positively. Able to use healthcare management data analytics to supercharge results and programs. I am an exceptional leader who values teamwork and builds collaborative and integrative relationships with my team, colleagues, and stakeholders. Public Health leader dedicated to promoting community health through prevention and educational outreach. An effective mentor and natural leader focused on fostering a positive and collaborative organizational culture. Dedicated to promoting health among at-risk populations through education, special services, and preventive health care.

Work History

COO of Public Health Operations- Transformation

D’Wellington HealthCare Group – Contractor (Mental /Physical Health)
01.2021 - Current
  • Provide strategic planning initiatives, leadership and development training, and organizational consulting
  • Maintain a high level of oversight, accountability, and leadership for all operation-quality functions
  • Oversight of risk management, corporate governance, monthly, quarterly, and annual reporting/analysis
  • Manages financial performance, operating budget, and variances to ensure cost-effective delivery of service
  • Manage proposal writing for all RFP, RFSO, and RFI
  • Oversees compliance with operations performance standards
  • Responsible for developing and fulfilling service-level agreements with resources
  • Work with all technical teams to ensure the product meets compliance standards and the implementation is supported for high-quality results
  • Continually monitors services and programs to ensure that client needs and contract obligations are being met by policies and procedures
  • Creates and manages high-performing, cross-functional, matrixed team, ensuring staff provide appropriate and efficient services
  • Effective coordination between Business Development, Division Operations, Proposal Development, Subcontracts, and Pricing to successfully develop solutions to meet new business opportunities
  • Develop and implement a framework to include subject matter experts and enterprise-level functions
  • Successfully functions within the Strategy and Growth of the new business timeline to coordinate effectively with all entities and develop winning solutions to deliver contract requirements effectively
  • Identifies gaps in resources and mitigation plans to plan for required services for contract solutions effectively
  • Actively participates in Strategy and Growth activities, which may include developing solutions as a solution facilitator, proposals, staffing estimates, and new business opportunities to promote business growth of existing and future work
  • Maintains a thorough knowledge and understanding of existing capabilities and resources to inform new business solutions
  • Maintains a thorough knowledge and understanding of enterprise support functions (IT, HR, Subcontracts, Finance) which informs business solutions
  • Constructed a new DEI program utilizing data and governance to support Medicaid, Medicare, Indigenous and commercial population.

Executive Director of Quality

CHRISTUS Health Plan (CHP)
03.2021 - 06.2023
  • Supports the organization in achieving strategic and operational goals for quality management, reporting, patient safety, performance improvement, and information management to capture opportunities and efficiencies
  • Created the RFP and had oversight of our improved Communication system, the SDOH system expansion
  • Assesses compliance with the National Accreditation Quality Assurance standards with recommendations for improvement
  • Instrumental in creating, developing, and implementing a fraud and waste program
  • Manage and implement NCQA accreditation policies and procedures and manage compliance to standards on a monthly – quarterly basis
  • Evaluate clinical data to align, create, and implement programs or adjust existing programs
  • Use data to develop strategies for meeting contractual expectations
  • Aligns with Enterprise the design, implementation, and monitoring of the effectiveness of a comprehensive Risk and Quality intervention strategy, acting as a critical stakeholder in establishing the strategic direction from the interventions
  • Designed and led the strategy to manage population health data/analysis and programs (per NCQA standards)
  • Managed the DEI program, created policies and data feed, and developed an internal HEDI program between departments
  • Did predictive analytics on data points utilizing BI and Tableau reporting
  • Key stakeholder to CHP for planning and implementing evidence-based quality intervention strategies and initiatives that met state and federal intervention rules
  • Repurposed the HEDIS program and developed a relationship with the vendors (better collaboration)
  • Project managed a revised CAHPS and HEDIS-STARS workgroup for consistent reporting
  • Collaborated with the IT and EPIC departments as well as vendors to correct errors in data collection
  • Manage privacy data for all members and collaborate with Compliance/Regulatory where gaps exist (HIPAA/HITECH)
  • Develop and Implement Program Management processes, initiatives, and implementation for internal and external programs
  • Oversight of Quality improvement committee and Member Advisory Committee
  • Manage Quality and Compliance reporting for DHA, CMS, and TDI Performance Improvement Projects
  • Responsible for partnering with CHP and other C-suite leaders to develop the Medicare STARS work plan and execute interventions to improve CAHPS, HEDIS, STARS, QHP, and HOS scores
  • Monitoring Part D, med adherence, and Operational health insurance metrics, coordinating with Product Management and Pharmacy to improve all metrics
  • Collaborate with the ACO team in managing quality metrics and measures
  • Supports the development of interventions and a strategy to improve withhold payments earned to meet or exceed budgeted goals
  • Collaborates with CHP business intelligence, risk management, and quality analytics for broad-based quality data analytics
  • Led cross-functional teams that oversaw the implementation of risk and quality interventions
  • Develop a work plan to quantify expected ROI
  • Generate data analysis to monitor critical performance indicator development, reporting, and development of program materials and policies
  • Led a minimum of 2 focus studies and research projects per year
  • Responsible for developing a Care Compare Program to address the quality of care
  • Collaborated with Network, UM, Compliance, and stakeholders to construct Value-based metrics
  • Eventually set up a project and program management team in Quality to service output/input more expeditiously.

Senior Strategic Quality and Process Improvement Manager

Centene Corporation (Acquired WellCare Health Plan in 2020)
01.2017 - 01.2021
  • Ensured Federal, State, and industry regulatory requirements were met for Medicare and Medicaid products, thereby ensuring robust and successful business outcomes and process improvement-development year-over-year
  • Developed and managed an accreditation team in the GA market
  • Managed NCQA standards, policies, and procedures
  • Contracted, delegated, and conducted annual audits
  • Issued CAP as needed and monitored all business partners
  • Pulled monthly and quarterly reports for monitoring as well
  • Led Project management team to develop and work with other departments to create PHM standards for the GA-NC market
  • Improved processes and closed gaps by creating a follow-up work team on open Consumer Assessment Health Plans results using the theory of constraint
  • Manage privacy data for all members and collaborate with Compliance/Regulatory where gaps exist (HIPAA/HITECH)
  • Create governance for data internal and external distribution and monitor access to data
  • Built a new Access database for Potential Quality of Care and member engagement issues
  • Continual Process Improvement around programs-projects using an accreditation work plan
  • Ensured the state regulatory board fully understood the work product by ensuring quarterly customized reports were accurate and captured qualitative and quantifiable results
  • Collaborate with vendors, IT, and the market to ensure reporting goals are met
  • Developed the Quality Assessment Performance Improvement programs (QAPI) to speak to Disease management/Utilization management results
  • Oversight of risk management, reporting, analysis, governance and policy structure
  • Managed several programs and projects with direct communication to C-Suite and other State vendors, as needed
  • Initiated new processes for HEDIS and quality results, created workflows, managed doc management program
  • Re-engineered- NCQA trilogy documents; PCMH program and Behavioral Health (BH) reporting structure
  • Led team on CAHPS, HOS, Grievances, QOC, BH ECHO survey, cultural competency, and patient safety
  • Managed provider profiling process, Patient Safety, credentialing committee oversight, and created policies-procedures
  • Consulted with Medical Directors to assess data analytics to identify cost-effective opportunities
  • Increased STAR levels for MEDICARE and health plan rating using internal data and processes through Project/Program management model
  • Partnered with the Performance Improvement team to improve and close gaps in healthcare (i.e., Diabetes, Behavioral health, and more)
  • Managed Behavior Health, interventions, outreach, Case Management and PCMH program.

Vice President of Quality and Operations

Proactive Healthcare, LLC
01.2013 - 01.2017
  • Managed quality and operations that included NCQA, policies and procedures, Human resources (hiring, training, motivation), design/implementation of a new system, risk management, ethical/HIPAA, diversification, and cultural competency
  • Participated in constructing a business plan to set goals and optimize growth over a 3–5-year period
  • Improved processes and developed action plans for maximum productivity
  • Created and implemented workplan to grow and expand the business
  • Developed business strategy and HIT workflow
  • Re-engineered patient safety processes and policies
  • Managed Program/Project Management teams to meet stakeholders and other standards
  • Provider management, enrollment, directory oversight
  • Created new databases to capture input/output
  • Increased quality and managing a cost-effective program through a new policy structure
  • Collaborated with vendors to create data needed to meet the contract requirement
  • Analyze data monthly and report bi-annually to assess new and existing program performance
  • Produced workflow and work plan to track results easily
  • Created a new compliance and regulatory program
  • Developed a cross-functional work plan to sustain accountability
  • Accelerated the credentialing program
  • Improve data analysis and produce a new reporting structure
  • Hiring, training, and terminations
  • Implemented NCQA standards to improve output and leverage more excellent quality results.

Director of Credentialing/Delegation

Vertical Screen
01.2013 - 01.2015
  • Developed, created, and implemented the Department of Credentialing
  • Leadership consisted of all activities related to NCQA, training, and business development and a compilation of pricing statement of work (SOW) details
  • Created policies and procedures and harmonized training programs with the existing program and compliance-regulatory requirements
  • Developed all activities related to new specs for the NCQA program and developed some digital processing
  • Serves as the in-house resource expert on NCQA standards
  • Has overall responsibility for accreditation processes and regulatory programs
  • Assesses compliance with NCQA standards with recommendations for change
  • Evaluate the effectiveness of the monitoring system annually
  • Generated new specs for system requirements to align data to results better
  • Implemented provider engagement and payment structure
  • Followed regulatory body requirements for all licensures for patient safety purposes
  • Implemented a Business Development plan to increase vendor participation
  • Work with the CEO, COO, management, and vendors to improve processes
  • Created training sessions and strategies to drive more excellent quality work products
  • Acquired new accounts to develop the credentialing area of the business
  • Leadership role for enhancing the training department through collaboration & integration with other department managers
  • Provided HR strategy, hiring, termination, and training program and reviewed all incoming Senior level management.

Education

Ph.D. - Public Policy & Public Administration/Health Law and Policy

Walden University

Master's - Business Administration & Healthcare Management

University of Phoenix

Bachelor's - Psychology/Journalism

Kennesaw State University

Skills

  • Strategic Planning
  • Charter/Governance Outline
  • Workflow/Work Streams
  • Portfolio Management/Scrum Master
  • Change Management
  • Financial Management
  • Regulatory/Compliance Management
  • Quality/Process Improvement
  • Project Management/Agile SME
  • Stakeholder Management
  • Population Health/SDOH
  • Public Health Operations
  • Predictive Data Analysis Modeling
  • Policy & Procedure SME
  • Outreach-Interventions
  • Risk Management/HIPAA
  • MS Office (Word, Excel, PwrPT, etc)
  • Health Equity Diversity Inclusion
  • NCQA, AAAHC, Accreditation
  • Proposal-Grant Writing (RFSO/RFP)
  • Problem Solving/Resolution
  • Team Leadership
  • Quality of care/QOS
  • Effective Communication
  • Cross-functional Training
  • Clinical Health Interventions

Accomplishments

  • Organized data input for better output and data analytics to improve results
  • Re-engineered Patient-Centered Medical Homes (PCMH) program
  • Created 2(two) new databases for Quality-of-care issues (QOCs) and member engagement team
  • Improved HEDIS scores and Consumer Assessment Health Plan survey scores from 2.7% to 4.5%
  • Implement Agile processes with high Collaboration to improve ACO/HEDIS results (yield an increase of $7.5M)
  • Increase STAR rating from 3.5 STARS to 4.1 STARS, now trending in all measures four plus STARS
  • Maintained a 99% retention rate, improved collaboration, and integration within the market and Corporate
  • Accomplished 3 National Accreditation Quality Assurance programs (NCQA) and AAAHC
  • Built compliance and regulatory program with policies and procedures

Presentations Papers

  • Leadership in population healthcare management: Unpublished manuscript, Walden University, Minnesota
  • Diffusion of Innovation: Stem cell development. Unpublished manuscript, Walden University, Minnesota
  • Dissertation: U.S. Stem Cell Researchers,’ Stakeholders’ and Investors’ Perceptions of the Federal Stem Cell Policy on Stem Cell Research, Walden University, Minnesota
  • Telemedicine: Non-published, submitted December 10, 2017, for Dr. Dorothy Moore H400/HSA4191 Health Information Systems- 2017 Fall Session II
  • Annual focus study on the Impact of Depression in Dependent Military Families May 15, 2022

Adjunct Career

  • Fortis College, 10/2009, 6/2011
  • Rasmussen College, 4/2010, 9/2019
  • Colorado Technical University, 3/2011, 3/2016
  • Strayer University, 7/2012, 12/2015

Earlier Career Business Owner

  • Interim Vice President of Operations & Director of Quality/Operations - Dental Economics, Sugar Land, TX
  • Quality Analyst/Delegation Manager, Molina Healthcare, San Antonio, TX
  • Quality Analyst/Consultant, Aetna, Inc., Alpharetta, GA

Skills Affiliations Honors Awards Certifications

  • Health Equity Diversity & Inclusion- (HEDI Council)
  • Foundation of Health Equity Research
  • Project Management Professional (PMP)
  • 2023 Google Professional Management Certificate (Agile, Scrum, Project)
  • Lean Six Sigma Green Belt (LSSGB)
  • CPQH – in progress; Compliance-Regulatory
  • The National Society of Leadership and Success
  • American College of Healthcare Executives
  • Technical Skills: MS OFFICE (Excel, Word, Access, PowerPoint), S.A.S, Xcelys, Tableau, SPSS, CATS, MD Staff, CACTUS
  • American College of Health Executives
  • National Institutes of Health Office of Extramural Research
  • American Public Administration Society
  • Toastmaster International
  • 2016 PMP Certification in Project Management

Timeline

Executive Director of Quality

CHRISTUS Health Plan (CHP)
03.2021 - 06.2023

COO of Public Health Operations- Transformation

D’Wellington HealthCare Group – Contractor (Mental /Physical Health)
01.2021 - Current

Senior Strategic Quality and Process Improvement Manager

Centene Corporation (Acquired WellCare Health Plan in 2020)
01.2017 - 01.2021

Vice President of Quality and Operations

Proactive Healthcare, LLC
01.2013 - 01.2017

Director of Credentialing/Delegation

Vertical Screen
01.2013 - 01.2015

Ph.D. - Public Policy & Public Administration/Health Law and Policy

Walden University

Master's - Business Administration & Healthcare Management

University of Phoenix

Bachelor's - Psychology/Journalism

Kennesaw State University

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Dorothy Moore