Icela Moreno
Boston,MA
Summary
Strategic and results-driven quality leader with over 10 years of experience in quality improvement, regulatory compliance, and performance optimization in healthcare. Proven ability to enhance key performance metrics, secure accreditations, and lead cross-functional teams in achieving operational excellence. Expertise in regulatory adherence, process improvement, and data-driven decision-making to advance healthcare quality.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Manager, Quality Improvement and Health Equity
Mass General Brigham Health Plan
Somerville, MA
08.2016 - 02.2025
- Led quality and performance improvement initiatives, applying agile, Lean Six Sigma, and Plan-Do-Study-Act (PDSA) methodologies to enhance operational efficiency and regulatory compliance.
- Oversaw the Corporate Community Benefits Program to address member community needs and ensure compliance with Attorney General Office (AGO) guidelines.
- Directed enterprise-wide HEDIS improvement strategy integrating EMR data mapping, provider engagement, and multimodal member outreach campaigns, resulting in ≥15-25% increase over baseline improvement across targeted /Star measures.
- Led CAHPS improvement strategy targeting access, coordination, and provider communication; implemented provider coaching, staff training, and member journey mapping, improving CAHPS measures by 10-20% over baseline.
- Developed a centralized care gap dashboard with real-time reporting to guide targeted outreach and provider quality incentive alignment, increasing Stars/HEDIS scores by 20% in priority areas.
- Implemented MGB ACO Quality and Equity Incentive Program (QEIP), designed to reduce healthcare disparities and improve performance in quality, access, and social needs data. Achieved a score of 100% from MassHealth.
- Spearheaded the NCQA Health Equity Accreditation process for the Medicaid product, with accreditation anticipated by June 2025.
- Developed web-based performance reports for risk-based providers, enhancing quality/cost performance.
Manager, Quality Programs/Compliance – Senior Products
TUFTS Health Plan
Watertown, MA
06.2013 - 08.2016
- Developed and implemented the quality management program structure to meet Senior Products (Senior Care Options (SCO) and Tufts Medicare Preferred (TMP)) regulatory requirements, improve member satisfaction, and member health outcomes.
- Assessed and identified the impact of new regulations and legislation related to the Senior Products quality improvement programs (QIP, CCIP, and PIPs).
- Achieved a 4.5 out of 5-star NCQA rating for Senior Products lines.
- Secured a 100% SNP Model of Care (MOC) contract readiness score, winning the contract.
- Led compliance with regulatory programs (QIP, CCIP, PIPs), driving quality improvements.
- Managed the development and execution of the SCO QI program and workplan.
- Led a cross-functional initiative leveraging predictive analytics and care management redesign to reduce 30-day hospital readmissions by 22%, yielding $1.2M in annual savings.
Quality Manager
NEtwork Health/TUfts Health Plan
Medford, MA
09.2007 - 06.2013
- Developed, implemented, and evaluated QI strategies to support accreditation and regulatory compliance on the Medicaid product line. Employed quality improvement measures for enhancing health outcomes of members with chronic conditions, children, and maternal health. Met all state project requirements.
- Led NCQA accreditation efforts, resulting in NCQA Excellent accreditation and a top 3 Medicaid plan nationally.
- Designed and implemented quality improvement strategies that increased HEDIS rates by 10-15%.
- Directed QI work groups and project teams to support compliance and regulatory excellence.
Education
Master of Science (MS) - Administrative Studies with Concentration in Innovation and Technology
Boston University
Boston, MABachelor of Science (BS) - Industrial Engineering
Universidad Tecnológica de Bolivar
Cartagena, ColombiaSkills
- Leadership in healthcare quality
- Team development and stakeholder engagement
- Focus on health equity and SDOH issues
- Regulatory compliance expertise
- Risk management practices
- Accreditation readiness strategies
- Data-driven decision-making skills
- Gap analysis capabilities
- Performance enhancement techniques
- Process optimization skills
- Familiarity with NCQA criteria
- Lean Six Sigma (Green Belt) proficiency
- ISO 9000 knowledge base
- data analytics proficiency
- demonstrated knowledge of HEDIS
- demonstrated CAHPS expertise
- effective Stars program oversight
Websites
Certification
- Internal Control & Risk Management, Universidad de los Andes, Colombia
- Industrial Management, Universidad del Norte, Colombia, Universidad Politécnica de Valencia, Spain
- Lean Six Sigma & Project Management, B.U. & Corporate Education Group, Boston, MA
- ISO 9000, Colombian Institute of Technical Standards and Certification (ICONTEC), Colombia
Professional Associations
- Co-Chair, Healthcare Committee, Association of Latino Professionals for America (ALPFA), Boston, MA, 2019-2020
- The Partnership Inc., Mid-Career Fellows Leadership Program, Boston, MA, 2018
- Vice President, Coaching & Mentoring Program, ALPFA, Boston, MA, 2012-2015
- Conexion Leadership Program, Boston, MA, 2007
Professional Highlights
- Optimized Quality Measures Performance: Led strategic initiatives that increased Healthcare Data and Information Set (HEDIS)/Star ratings by 15-25% and improved Member Experience scores by 10-20%.
- NCQA Accreditation Excellence: Directed accreditation efforts, securing 'Excellent' NCQA status and ranking a Medicaid plan among the Top 3 Nationally.
- Regulatory & Compliance Success: Spearheaded MassHealth and External Quality Review Organization (EQRO) audits, achieving >95% compliance.
- CMS Model of Care Approval: Led a 100% CMS-approved SNP Model of Care (MOC) Quality Program readiness review, ensuring contract success.
- Innovative Quality and Health Equity Initiatives: Designed and implemented a groundbreaking Quality and Equity Incentive Program for Mass General Brigham ACO, earning a 100% performance score from MassHealth.
Timeline
Manager, Quality Improvement and Health Equity
Mass General Brigham Health Plan
08.2016 - 02.2025
Manager, Quality Programs/Compliance – Senior Products
TUFTS Health Plan
06.2013 - 08.2016
Quality Manager
NEtwork Health/TUfts Health Plan
09.2007 - 06.2013
Master of Science (MS) - Administrative Studies with Concentration in Innovation and Technology
Boston University
Bachelor of Science (BS) - Industrial Engineering
Universidad Tecnológica de Bolivar
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