Kate McManus

· Serve as primary contact for providers as a Quality Rep and foster a positive relationship between the providers and the health plan.

· Conduct quarterly meetings with the provider and account representatives documenting discussions, issues, attendees, and action items

· Receive and effectively respond to external provider related issues

· Provide education on health plan's quality initiatives

· Educate and assist providers with P4Q, Peak P4Q, and CoC+ Incentive programs.

*Collect, summarize and trend provider performance data and strategize opportunities for improvement.

*Collaborates with PR to improve provider performance in Quality, Risk and Operations.

*Coaching and assisting providers on gap closure and CoC submission.

*HEDIS datamining during Hybrid and Year-round season

*Provides resources and educational opportunities to provider and staff

* Supports quality improvement HEDIS and program studies as needed, requesting records from providers, and maintaining databases.

• Perform duties to act as a liaison between providers, the health plan and Corporate. Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.
• Serve as primary contact for providers and act as a liaison between the providers and the health plan
• Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution
• Receive and effectively respond to external provider related issues
• Provide education on health plan's innovative contracting strategies
• Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
• Investigate, resolve and communicate provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Perform provider orientations and ongoing provider education on incentive programs and documentation strategies.

• Connected families with necessary social services, alleviating barriers to healthcare access and improving quality of life.
• Built trust within diverse communities through cultural competency training, empathetic communication skills, and active listening techniques.
• Addressed patient concerns and provided support to vulnerable demographics.
• Participated in ongoing professional development opportunities to stay current on best practices in community health work, ensuring the delivery of quality services to clients.
• Became a Certified Diabetes Care Coordinator
• Worked directly with patient treatment teams and participated in care coordination procedures.
• Managed enrollment, transportation, and paperwork for individuals to take advantage of community resources.
• Provided ongoing support for clients managing chronic conditions, contributing to better self-management and reduced complications.
• Increased awareness of available resources by organizing and participating in community health fairs and events.
• Promoted access to healthcare services for underprivileged populations through community outreach efforts.
• Counseled patients on health-related topics and lifestyle changes for improved well-being.
• Led outreach activities to target specific demographics and promote health initiatives.
• Developed and maintained relationships with community partners to build program scope.

• Ensured compliance with regulatory requirements through diligent maintenance of essential documentation.
• Streamlined data entry and review procedures for improved efficiency and reduced errors.
• Demonstrated resourcefulness in navigating unexpected challenges such as changes in project scope or budget constraints.
• Continually sought opportunities for professional growth, staying current with industry trends and best practices in clinical data management.
• Participated in quality assurance reviews to verify accuracy and reliability of data.
• Conducted thorough chart reviews to find documentation of HEDIS measures, and uploaded to insurance portals for compliance

• Self-motivated, with a strong sense of personal responsibility.
• Worked effectively in fast-paced environments.
• Skilled at working independently and collaboratively in a team environment.
• Proven ability to learn quickly and adapt to new situations.
• Excellent communication skills, both verbal and written.
• Worked well in a team setting, providing support and guidance.
• Organized and detail-oriented with a strong work ethic.
• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Roomed patients, Vital Signs, EKG's, Referrals
• Medication Reconciliation, PA's, sample medication management
• Abdominal Ultrasounds, Vaccine and Medication injections

• Proven ability to learn quickly and adapt to new situations.
• Excellent communication skills, both verbal and written.
• Worked well in a team setting, providing support and guidance.
• Organized and detail-oriented with a strong work ethic.
• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Roomed patients, Vital Signs, EKG's, Referrals
• Medication Reconciliation, PA's, sample medication management
• Vaccine and Medication injections
• Self-motivated, with a strong sense of personal responsibility.
• Worked effectively in fast-paced environments.

• Run daily reports of patients schedule within the requested timeframe
• Pre-visit planning to include thorough chart reviews of patients' EMR chart for HEDIS measures, PCMH measures and MU measures
• Identify what is needed for the patient/provider care team to optimize the medical efficacy of the visit.
• Order specific tests in advance for the providers, including age-specific testing.
• Diagnostic testing tracking for all patients
• Assisting with procedure resulting
• Urine drug testing for all providers
• Work collaboratively with all members of the care team
• Manages reports for population health and chronic disease management
• Outreach to patients who have gaps in care, to assist in getting scheduled.
• Became a Certified Hypertension Educator

• Oversee site operations, ensuring compliance with safety regulations and organizational policies.
• Coordinate maintenance schedules and vendor management for facility upkeep and improvements.
• Implement process enhancements to streamline administrative workflows and improve efficiency.
• Mentor junior staff on best practices in site administration and operational procedures.
• Daily use of EMR for medications and progress notes for patient encounters
• Credentialing and training of new providers and staff
• Daily use of Windows products such as Word, Excel and Access.
• Assisted hiring and directed training of staff critical to health care services
• Fiscal operations such as budget planning, billing and database management
• Daily assistance to veterans and their families while navigating VA policies and procedures.
• Daily chart reviews of visits to ensure quality of care standards were met.