Jill Allen

Extensive experience in various areas, such as: Fifteen years in a Managed Care environment of which eleven years have been in Quality Improvement/Management as well as Compliance New Project Coordinator Working on Qua2024-2025 Project Lead tasked to work Special Projects in 2 key areas: Develop a more member friendly DENC document in an attempt to reduce SNF length of stay. Implement a plan of action to reduce the average Medicare Member’s Length of Stay by identifying root cause and develop implementation strategies Quality Improvement Projects to improve member experience and reduce business cost. Compiling QI Process, designing audit tool to meet the stakeholders goals, assess gaps, track trends and develop meaningful interventions to incorporate change. Ten plus years’ experience auditing CM, DM,UM and A&G associates for quality/compliance measure to meet Policy/Procedures and Accreditation standards. Ten plus years’ experience working in government programs, Medicare, SNP, MMP, MAPD as well as compliance accreditation with CMS, and NCQA Four years’ experience working in a CM/DM capacity for chronic condition management both medical and behavioral health conditions Most Recent Experience is working as Quality Improvement Coordinator working with UM and A&G to improve member satisfaction/outcomes and reduce business expenditure Working in Clinical Audit, creating an excel audit tool to cover all areas of quality compliance and Business Process and Procedure. Auditing to track and trend potential gaps and suggest possible interventions to address any trending gaps. Previously, worked as a DM Coordinator leading the initiation of quality-of-care projects to address improved health outcomes Frequently in direct communication with management, MD’s, Quality Committee’s, Key Stakeholders and Vendor Management, areas of project improvement as well as key gap areas and scope for health and business improvement Clinical Nurse Review Professional responsible for audits and formulation of Gap Analysis Reports as well as creation of QIPs and PIPs to address any program shortfalls within a Managed Health Care Setting. Project team lead and SME, responsible for leading teams conducting IRR’s to ensure accuracy of auditing for quality and compliance reviews, highlighting both strengths and areas of opportunity Preparation and Presentation experience for NCQA Accreditation Use of Health Data Analytics to identify and use clinical focus-based audits and assessments Perform education, support, and guidance of all levels of the multi-disciplinary healthcare team when necessary to evaluate and form interventions to facilitate growth Facilitate an improved, smoother, and more transparent process within a prompt manner, for a quality improvement/compliance review, including working with HEDIS associates to develop work plans to improve scoring of lower measurement elements Develop work groups to incorporate clinical interventions to bridge gaps and improve healthcare for our members

Career Start Entry to one of the hardest Nursing Colleges in the United Kingdom.

1992 career change as I graduated to become a licensed Midwife with prescribing privileges and licensed to independently practice.

Career has spanned almost 40 years as Registered Nurse and Licensed Midwife.

I have worked in many areas of nursing, both in the UK and the USA.

Areas of work include: Neurological High Dependency Unit, neuro Surgery and neuro Medical.

Neurological LTC and Respite Unit.

Ten years working independently in the community, provider group led. This helped keep our patients in the community where they wanted to be.

Three years of Community Palliative Care.

Over 15 years working for different Insurance companies in Managed Care.

Clinical Supervisor/Manager 4 years spread between the UK and USA.

On track to complete 6 Sigma Black Belt Certification.

The Council for Six Sigma certification

• 2025 Six Sigma White and Yellow belt Certification
• Currently working on my Green Belt, on my course track for Six Sigma black belt to consolidate my experience within a quality compliance environment

I have worked in Government Led Health Care and Private Health Care, Health Insurance. 

The diversity between the 2 health care systems has driven my passion for Quality Management, as I identify opportunities for improvement within the healthcare insurance industry.