Falissia Graggs

• Monitored Managed Care Organization (MCO) compliance with state and federal Medicaid regulations, policies, and contractual requirements.
• Analyzed healthcare program data, quality metrics, and performance indicators to identify trends and support program improvement initiatives.
• Collaborated with managed care plans, healthcare providers, and internal stakeholders to address operational issues and improve service delivery.
• Monitored corrective action plans and tracked progress toward resolution of identified compliance and operational issues.
• Supported program integrity efforts through data review, documentation analysis, and process improvement activities.
• Served as a liaison between Medicaid managed care organizations, providers, and state agencies to facilitate communication and ensure program effectiveness.
• Participated in cross-functional projects focused on improving healthcare quality, member outcomes, access to care, and operational efficiency.

• Deliver emergency and routine patient care while maintaining compliance with military clinical, documentation, and patient-safety standards.

• Conduct patient assessments, clinical procedures, emergency response, and medical readiness evaluations while supporting healthcare quality assurance and protocol adherence.

• Lead medical readiness and Basic Life Support training and mentor personnel on clinical procedures, documentation, and patient safety.

• Led quality and performance improvement initiatives focused on patient safety, regulatory compliance, risk reduction, and operational effectiveness.
• Conducted clinical documentation and medical record audits to evaluate compliance with Joint Commission, CMS, regulatory, and organizational standards.
• Analyzed incident reports, safety events, and quality data using Riskonnect and Tracers to identify trends, compliance gaps, and process improvement opportunities.
• Developed dashboards and performance reports to monitor quality indicators and support data-driven decision-making by clinical and operational leadership.
• Coordinated corrective actions, root cause analyses, regulatory readiness activities, and staff education to address performance deficiencies and strengthen patient safety and compliance.