Kara Fischer
Purcell,OK
Summary
Registered Nurse with 10 years of healthcare experience and 8+ years in population health and care management programs, with experience supporting utilization management, clinical operations, and regulatory compliance. Currently serving as an Operational Support Specialist and Interim Manager of Quality Programs, leading clinical quality, accreditation readiness, regulatory compliance, and audit programs across Utilization Management (UM), Case Management (CM), and Disease Management (DM).
Experienced in supporting URAC and NCQA accreditation, state Utilization Review Organization (URO) licensure, clinical audits, credentialing oversight, corrective action planning, and Quality Management & Compliance Committee (QMCC) governance, with a strong focus on building standardized quality infrastructure and business-wide quality improvement.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Operational Support Specialist
Telligen, Inc.
03.2024 - Current
- Support clinical quality, accreditation readiness, and regulatory compliance activities across UM, CM, and DM programs.
- Manage Telligen's ongoing URAC and NCQA accreditation readiness, including mock surveys, compliance audits, and staff training.
- Develop and maintain standardized audit tools aligned with URAC, NCQA, CMS, and state UM regulations.
- Track accreditation standards, elements, and compliance requirements
- Support corrective action planning (CAP) including root cause analysis, remediation tracking, and validation.
- Lead preparation, submission, and, and maintenance of state Utilization Review Organization (URO) licensure:
- Monitor and track multi-state utilization management regulations and licensure requirements.
- Provide credentialing compliance oversight, including primary source verification (PSV) audit reviews, credentialing file audits, and delegate credentialing oversight
- Support development, revision, and maintenance of clinical and credentialing policies and procedures.
- Develop and deliver staff education related to accreditation standards, regulatory compliance, and clinical documentation requirements.
Transitional Care Health Coach
Telligen, Inc.
04.2016 - 03.2024
- Address gaps in care.
- Process improvement in collaboration with provider practices.
- Complete initial outreach, assessments, and follow-ups within contract timelines.
- Provide education to members (patients), Case Management staff, and Providers.
- Coordination of care post-hospitalization
- Collaboration with Providers, Case Management staff, and members (patients) to improve health outcomes
- Arrange meetings among community partners for collaboration
Registered Nurse
Norman Regional Hospital
06.2014 - 04.2016
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Educated patients, families, and caregivers on diagnosis and prognosis, treatment options, disease process and management, and lifestyle options.
- Precepted and trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Provided direct patient care.
Education
Bachelor of Science - Nursing
University of Oklahoma College of Nursing
Oklahoma City, OK05-2014
Skills
- Quality Assurance and Performance Improvement (QAPI)
- Clinical Operations and Standardization
- URAC and NCQA Accreditation
- Corrective Action Plans (CAPs)
- State URO Licensure and Regulatory Filings
- Clinical Audits
- Credentialing Oversight and PSV Audits
- Policy and Procedure Development
- Staff Education and Training
- Regulatory Monitoring and Compliance
Certification
- Registered Nurse (RN) - Active
- Certified Case Manager (CCM) - Active
Timeline
Operational Support Specialist
Telligen, Inc.
03.2024 - Current
Transitional Care Health Coach
Telligen, Inc.
04.2016 - 03.2024
Registered Nurse
Norman Regional Hospital
06.2014 - 04.2016
Bachelor of Science - Nursing
University of Oklahoma College of Nursing