Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Languages
Work Availability
Timeline
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Hala Ibrahim

Healthcare executive
Naperville,IL

Summary

Dynamic Sr. Director of Quality Improvement at Health Care Service Corporation, leveraging HEDIS expertise and strong team-building skills to drive innovative quality initiatives. Proven track record in enhancing performance through data-driven strategies and fostering collaboration, resulting in improved outcomes and sustained partnerships. Committed to excellence in NCQA Accreditation and quality reporting.

Overview

17
17
years of professional experience
1
1
Certification

Work History

Sr. Director, Quality Improvement

Health Care Service Corporation
04.2022 - 08.2025
  • Optimized project timelines by effectively delegating tasks and prioritizing workload among team members.
  • Cultivated a culture of innovation by promoting creative thinking and encouraging employees to take calculated risks in pursuit of solutions.
  • Developed strong relationships with key industry partners, fostering collaboration and mutual growth opportunities.
  • Operating as a leader in the Enterprise Quality Improvement team with assuming responsibility for Retail QRS, and Federal Employee Program HEDIS/CAHPs scores improvement as well as meeting Accreditation requirements.
    • Leading the Federal Employee Program HEDIS Operations, Accreditation, Marketing communications and Quality pilots and Innovation teams to build a strategy YOY to achieve the highest QCR scores.
    • Leading Enterprise QI Initiatives such as Colorectal cancer screening in-home testing, Antimicrobial Stewardship Practitioner mailing, Diabetes Dilated Retinal Eye Exam and Breast Cancer Screening.
    • Operating as the lead on the Quality Pilots Work Group to design and implement innovative and groundbreaking Quality Improvement Initiatives using data intelligence.
    • Operated as quality reporting leader for all accountable care programs and managing daily operations of staff and quality reporting for contracted Accountable Care Organizations.
  • Directed design and execution of business transformation initiatives to drive performance, profit optimization and growth opportunities.
  • Fostered work culture of collaboration and inclusion to increase morale and reduce turnover.
  • Established data-driven decision-making processes and implemented best practices in analytics to optimize performance across the organization.

Director, Quality Reporting

Health Care Service Corporation
05.2016 - 04.2022
  • Leading Enterprise QI Initiatives such as Colorectal cancer screening in-home testing, Antimicrobial Stewardship Practitioner mailing, Diabetes Dilated Retinal Eye Exam and Breast Cancer Screening.
  • Operating as the lead on the Quality Pilots Work Group to design and implement innovative and groundbreaking Quality Improvement Initiatives using data intelligence.
  • Operated as quality reporting leader for all accountable care programs and managing daily operations of staff and quality reporting for contracted Accountable Care Organizations.
  • Worked with the Enterprise Data team and vendor to build a provider Quality Reporting platform for Primary Care and Specialists.
  • Worked with Enterprise Quality Reporting to select Best Practice Quality Metrics for Provider Quality Reporting.
  • Worked with GPD and FEP teams to meet NCQA Population Health Management Standards for Accreditation for BCBSIL, BCBSTX, and BCBSNM.
  • Provide tactical execution of the quality reporting objectives to drive success.
  • Implement analysis of barriers and potential opportunities for QI interventions to incorporate and address social determinants of health.
  • Work collaboratively with Data Delivery on supplemental data updates and data integrity for multiple ACOs
  • Act as subject matter expert to ACOs and ensure availability to support all questions/issues which may arise daily
  • Follow up on open issues including maintaining trackers and other action items.
  • Appropriately prioritize and escalate quality issues leadership in support of ongoing relationship management.

Sr. Manager, Clinical Outcomes

Health Care Service Corporation
03.2013 - 05.2016
  • Provided strong leadership to enhance team productivity and morale.
  • Led cross-functional teams to achieve project milestones and deliver high-quality results.
  • Established strong relationships with clients and stakeholders, ensuring long-term partnerships and repeat business.
  • Improved team performance by providing comprehensive training and fostering a collaborative work environment.

Manager, Clinical Outcomes

Health Care Service Corporation
03.2013 - 09.2015
  • Managed and motivated employees to be productive and engaged in work.
  • Accomplished multiple tasks within established timeframes.
  • Maintained professional, organized, and safe environment for employees and patrons.
  • Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
  • Manage and control the annual HMO Clinical Pay-for-Performance projects, including oversight of the Condition Management Programs, for the HMO product.
  • Ensures successful HMO audit and timely submission of results to the Illinois Affiliate Board, the Public Policy Committee, NCQA, and BCBSA.
    • Monitor NCQA and HEDIS specifications and translate specifications into programming logic used to identify members for the HMO Clinical Pay-for-Performance projects, and the Condition Management Programs.
    • Oversee the medical record abstractions process.
    • Oversee the development of reports to support quality improvement initiatives. Perform population-based analyses to identify areas of opportunity for improvement. Provide for ad hoc reporting of data that facilitates the implementation of business decisions and supports the HCSC Strategic Plan.
    • Ensure appropriate training of staff to facilitate independent functioning in the creation of their assigned reports and responsibilities. Provide training to designated team members on population-based data and analytical applications.
    • Ensure appropriate member and provider interventions are in place to fulfill NCQA requirements for Disease Management.

Clinical Manager , Medicaid

Independent Health Inc.
01.2011 - 02.2012
  • Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.
  • Regularly evaluated employee performance and provided feedback.
  • Promoted high morale and staff retention through dynamic communication, prompt problem resolution, proactive supervisory practices and facilitation of positive work environment.
  • Ensured compliance with regulatory guidelines and accreditation standards through consistent monitoring and implementation of corrective actions when needed.
  • Assist the Director of Care Coordination with the planning, implementation, development, and ongoing evaluation of projects and programs related to the company Medicaid membership. Such projects and programs are designed to improve the health status of IHA members through targeted clinical interventions.
  • Supervising multi-disciplinary team consisting of RNs, social workers, mental health counselors, and community health outreach workers. (20 staff members)
    • Develop and monitor individuals responsible for providing case/disease management, preventive health care, and management of high-risk members in alignment with the Independent Health strategic goals to improve clinical quality and overall efficiency.
    • Ensure that the population segments meet the goals for utilization, cost and quality by coordinating, developing, implementing and evaluating the following: initiatives to identify high-risk members; day-to-day clinical operations of the state government programs; and care management efforts as put forth by the Health Care Services department to include chronic disease management (Diabetes, Asthma), prenatal case management and acute care facilities utilization.
    • Develop, recommend, and implement effective and efficient standards, protocols and processes, reports and benchmarks that support and further enhance utilization and quality management function and quality of healthcare services.
    • Identify areas and communicate opportunities regarding the products against monthly and quarterly financial/utilization performance to budget.
    • HEDIS monitoring, member planning and provider interventions and performance improvement plan.
    • Work with Independent Health Foundation to apply for local and national grants to fund innovative projects to target high risk, underserved & diverse population.

Disease Management Program Coordinator

Independent Health Inc.
11.2008 - 02.2011
  • Facilitated regular meetings with team members to discuss progress updates, address challenges, and brainstorm solutions for ongoing success.
  • Disease management program development and evaluation:
  • Assess the need for and develop disease management programs based on criteria developed by the company related committee.
  • Develop and measure processes and outcome indicators and the programs based on specific measure.
  • Develop and maintain the necessary reports for management purposes.
  • Evaluate the clinical practice guidelines in accordance with national publication and program’s needs.
  • Develop, coordinate and implement appropriate interventions for both members and providers to improve the health status for focused disease states.
  • Ensure compliance with NCQA standards for disease and complex case management and maintain excellent accreditation status.
  • Coordinate peer review guidance and oversight for target disease state management and health clinical advisory group.
  • Support the quality management initiatives and plans through assisting with development of health management programs, development and implementation of interventions to target specific HEDIS/ Medicare star ranking measures or Medicaid incentive measures.
  • Established strategic partnerships with external organizations, expanding program reach and impact.
  • Maintained detailed records of program activities and participant data, ensuring compliance with internal policies and external regulations.
  • Led training sessions for staff and volunteers, fostering a knowledgeable and cohesive team environment.

Education

Master of Public Health - Public Health

SUNY Buffalo State
Buffalo, NY
02-2009

M.D. - Medicine And Surgery

Tanta University
Egypt
02-1999

Skills

  • HEDIS experience and deep knowledge
  • Medical Record review
  • Data entry with high accuracy
  • High proficiency in Microsoft office ( Word, excel, power point, etc )
  • Extensive experience in NCQA Accreditation
  • Vendor management
  • Team building and collaboration
  • Collaborative leadership
  • Team management
  • Team building and motivation
  • Strategic planning
  • Decision-making
  • Budget management
  • Strategies and goals

Accomplishments

  • Oversee HEDIS Operations for five FEP Plans for hybrid season and all year round including but not limited to medical record requests, review, and abstraction, EMR access, submission of standard and non-standard supplemental data to improve quality scores.
  • Medical record review and data entry into the HEDIS certified software for selected quality measures such as WCC, CBP and PPC and assisting with overreads to ensure accuracy.
  • Leading the Marketplace Quality Improvement Strategy to improve QRS scores, monitor Quality Improvement initiatives and Oversight Committee meetings.

Certification

Certified Case Manager (CCM)

Languages

Arabic
Native or Bilingual
English
Full Professional

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Type

Full TimePart Time

Work Location

RemoteHybrid

Timeline

Sr. Director, Quality Improvement

Health Care Service Corporation
04.2022 - 08.2025

Director, Quality Reporting

Health Care Service Corporation
05.2016 - 04.2022

Sr. Manager, Clinical Outcomes

Health Care Service Corporation
03.2013 - 05.2016

Manager, Clinical Outcomes

Health Care Service Corporation
03.2013 - 09.2015

Clinical Manager , Medicaid

Independent Health Inc.
01.2011 - 02.2012

Disease Management Program Coordinator

Independent Health Inc.
11.2008 - 02.2011

Master of Public Health - Public Health

SUNY Buffalo State

M.D. - Medicine And Surgery

Tanta University

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