KATIE D. LAZARUS
Roseville,CA
Summary
I am a dedicated business professional with more than 10 years of HEDIS and Quality Experience. I first gained my knowledge and expertise while working for Anthem Blue Cross learning the Health Plans operations, responsibilities, and regulations. I continued my career growth at Nivano Physicians where I learned the functionalities of the IPA. At Nivano I developed and supervised the Quality Department, for all lines of business including Medi-Cal and Medicare, ensuring HEDIS and NCQA compliance by collaborating with Providers and clinic staff on Quality Improvement interventions as well as risk adjustment efforts.
Overview
13
13
years of professional experience
Work History
Quality Improvement Manager
Nivano Physicians
06.2021 - Current
- Responsible for overseeing day to day operations of the Quality Department in Sacramento and Rural counties for Medi-Cal, Medicare and commercial lines of business
- Lead and manage Quality Team; Consisting of 5 Quality Improvement Provider Representatives and 4 HEDIS Outreach Coordinators
- Analyze HEDIS and Risk Adjustment Data to determine strategy and interventions
- Define and track interventions for HEDIS and Stars
- Including tracking productivity for team, as well as providers/ clinics
- Collaborate with department heads within organizations as well as Health Plans, subcontractors, and in network providers
- Facilitate training to providers, and staff in regards to HEDIS and systems.
Quality Management Supervisor
Nivano Physicians
02.2019 - 06.2021
- Responsible for overseeing day to day operations of the Quality Department in Sacramento and Rural counties for Medi-Cal, Medicare and commercial lines of business
- Build relationships and work closely with providers and clinic staff in order to improve HEDIS/ Stars Quality scores, as well as RISK and RAF scores
- Collaborate with IT/ Quality Manager, Director of Provider Relations and Director of Operations to develop, implement, and evaluate continuous quality improvement related to population health including HEDIS related measures
- Develop, coordinate, and implement Quality Improvement interventions in partnership with contracted IPA providers
- Interventions include clinic days, member outreach call projects, and standing orders
- Develop, implement and track Provider and Member incentive programs
- Create and Design promotional, marketing and education materials
- Assisted with the development of internal data bases, and member applications
- Serve as Provider Relations representative to manage claims, authorizations, and utilization management concerns
- Worked with clinics to increase membership and provide quality healthcare to the underserved
- Monitor compliance, implement corrective action, and provide training on processes, procedures, and workflows.
Quality Outreach Specialist Sr.
Anthem Blue Cross
05.2017 - 02.2019
- Lead the Northern Quality Management Departments 'Member Outreach Program'
- Oversee 3-member outreach specialists
- Develop, coordinate, and implement Quality Improvement interventions
- Interventions include clinic days, member outreach call projects, and standing orders
- Work closely with providers in order to improve HEDIS scores
- Provide 'Medi-Cal Monthly Report' for Senior Leadership for all the Northern quality department
- Utilize Microsoft Excel to create reports, pivot tables, and data charts
- Create databases in Microsoft Access
- Develop and implement desktop procedures for member outreach
- Build relationships with PMG representatives, Provider office staff, and outside vendor's ex: MedXM and Alinea
- Prioritize call projects based on need for 18 counties in CA
- Ex: Measure by County
- Create Member Outreach call lists
- Work closely with QM Regional Director and QM Nurses
- Assists with Wave Quality Initiatives
- Generate and distribute Gaps in Care (GIC) reports
- Research member's claims
- Collect medical records
- Assist members as needed, including locating PCP, and obtaining transportation.
Health Program Representative
Anthem Blue Cross
09.2013 - 05.2017
- Schedule provider trainings for the Medi-Cal rural expansion and Medical Record Reviews (MRR)
- Complete facility site reviews for Disability Access (FSRC) Surveys
- Organize, prepare and distribute materials to provider offices and Gaps in Care (GIC) reports
- Build relationships and serve as point of contact for provider offices as a resource for FSRC, and GIC
- Facilitate outbound calls, and coordinate transportation for members
- Responsible for tracking and ordering tokens, and tickets for transportation.
PowerPlay! Program Coordinator
California Health Collaborative
10.2012 - 09.2013
- Responsible for the completion of the scope of work in a state funded campaign
- Managed the PowerPlay! Campaign for 5 counties in Central Region
- Conduct trainings for teachers on the PowerPlay! resources and curriculum
- Provided technical assistance and distributed resources
- Monitor budget, submit reports to the state
- Built relationships and work closely with Community Based Organizations
- Managed 2 staff members
- Partnered with the Health promotion consultant at Anthem Blue Cross on a School garden.
Worksite Wellness Specialist
Central Valley Health Network
11.2011 - 09.2012
- Assisted Program manager with objectives in grant scope of work for state funded campaign
- Coordinated meetings, and trainings with work sites
- Completed administrative duties, and monitored budgets
- Coordinated worksite program activities and compiled quarterly reports due to the state.
HEAL Zone Administrative Assistant
Central Valley Health Network
11.2011 - 09.2012
- The HEAL Zone is a three year grant funded initiative by the Kaiser Permanente
- Worked to complete the objectives in the grant
- Monitored the budget
- Coordinated meetings, recorded minutes, facilitated trainings and workshops
- Administrative duties and conducted research
- Compiled State reports for a federally funded multimillion dollar grant
- Designed promotional and educational materials.
Community Health Leader
Central Valley Health Network
06.2011 - 09.2011
- Campaign to educate elementary school students and members of low income families on the importance of physical activity, and eating healthy
- Planned and implemented education, facilitated food demonstrations, worked with churches and community centers.
Minority Serving Institution Intern
Center for Disease Control at Anthem Blue Cross
01.2011 - 06.2011
- Reported to the Health Promotion Consultant at Anthem Blue Cross
- Planned and implemented events on health education, conducted research, and created resources for the community
- Active member of many coalitions, Tobacco and Diabetes related
- Planned outreach event, created and conducted surveys, facilitated workshops, data entry
- Worked with excel, word, and PowerPoint
- Completed weekly reports to Center for Disease Control.
Education
Bachelors of Science: Public Health -
California State University, Fresno
08.2011
Skills
- Building Collaborative Relationships
- Teambuilding & Supervision
- Staff Development & Training
- Strong Work Ethic & Self Motivated
- Critical Thinking
- Confident Public Speaker
- Report & Document Preparation
- Lean White Belt Certified
- Work-Flow Process Improvement
- Project & Time Management Skills
- Problem/ Conflict Resolution
- Effective Communicator and listener
- Conflict Resolution
- Time Management
Timeline
Quality Improvement Manager
Nivano Physicians
06.2021 - Current
Quality Management Supervisor
Nivano Physicians
02.2019 - 06.2021
Quality Outreach Specialist Sr.
Anthem Blue Cross
05.2017 - 02.2019
Health Program Representative
Anthem Blue Cross
09.2013 - 05.2017
PowerPlay! Program Coordinator
California Health Collaborative
10.2012 - 09.2013
Worksite Wellness Specialist
Central Valley Health Network
11.2011 - 09.2012
HEAL Zone Administrative Assistant
Central Valley Health Network
11.2011 - 09.2012
Community Health Leader
Central Valley Health Network
06.2011 - 09.2011
Minority Serving Institution Intern
Center for Disease Control at Anthem Blue Cross
01.2011 - 06.2011
Bachelors of Science: Public Health -
California State University, Fresno
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