Lisa McCloud
Lutz,FL
Summary
Dedicated and experienced healthcare professional with a robust background in clinical oversight, regulatory compliance, and utilization management. As the Chief Regulatory and Compliance Officer at a Federally Qualified Health Center (FQHC), I spearheaded compliance programs, ensured adherence to HRSA guidelines, and managed accreditation processes, safeguarding the organization’s ethical and regulatory standards. In my role as Vice President of Health Services, I provided strategic leadership for clinical operations, optimized referrals management, and collaborated with interdisciplinary teams to enhance patient care. Additionally, my experience as a Utilization Management Nurse, including telephonic reviews using InterQual, and leading as a Charge Nurse in a Women’s Surgical Unit, reflects my commitment to patient-centered care, operational excellence, and effective resource management. My diverse expertise enables me to drive quality improvements and ensure compliance across all levels of healthcare delivery.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Chief Regulatory Officer
Tampa Family Health Centers
Tampa, FL
01.2024 - Current
- Spearheaded the development, implementation, and management of comprehensive compliance programs, ensuring adherence to HRSA (Health Resources and Services Administration) guidelines and all federal, state, and local regulations.
- Provided strategic guidance to the executive team and Board of Directors on regulatory compliance, risk management, and ethical standards, with a focus on maintaining accreditation and meeting the highest standards of care.
- Managed accreditation processes and ensured continuous compliance with accrediting bodies' standards, facilitating successful audits and inspections.
- Led investigations related to compliance violations, including fraud, ensuring timely resolution and reporting to relevant authorities.
- Collaborated with various departments to align internal policies with HRSA requirements, current regulatory standards, and best practices.
Chief Health Services Officer
Tampa Family Health Centers
Tampa, FL
12.2022 - 01.2024
- Analyzed data from various sources such as surveys, metrics and reports to identify areas needing improvement in patient satisfaction or outcomes.
- Created policies, procedures and standards for nursing practice.
- Developed and implemented strategies to improve patient care quality and safety.
- Promoted an environment that values diversity, inclusion and respect for all individuals.
- Provided leadership in the development of clinical programs, including recruitment, retention and succession planning initiatives.
- Participated in organizational committees focused on improving nurse engagement, patient experience and overall quality of care.
- Engaged in local community outreach activities aimed at increasing public awareness about health topics relevant to the organization's mission.
- Oversaw the budgeting process for all nursing departments within the organization.
VP of Health Services
Tampa Family Health Centers
TAMPA, FL
08.2021 - 12.2022
- Provided executive leadership and strategic direction for all health services, including clinical operations, ensuring the delivery of high-quality patient care across multiple service lines.
- Oversaw clinical teams, ensuring compliance with healthcare regulations, HRSA standards, and accreditation requirements while fostering a culture of continuous improvement and patient-centered care.
- Managed and optimized the referrals process, ensuring efficient coordination between primary care providers, specialists, and external healthcare partners to improve patient outcomes and access to care.
- Collaborated with cross-functional teams to enhance service delivery, streamline operations, and implement best practices in clinical care and patient management.
- Led initiatives to improve health outcomes, patient satisfaction, and operational efficiency while maintaining a focus on the FQHC's mission to serve underserved communities.
Utilization Management Nurse
Humana
TAMPA, FL
12.2019 - 08.2021
- Managed Medicare processes related to denials, ensuring adherence to regulatory requirements and company policies.
- Conducted detailed reviews of patient admissions to assess medical necessity, applying clinical guidelines and criteria to determine appropriate levels of care.
- Collaborated with healthcare providers to facilitate timely decision-making and ensure optimal patient outcomes.
- Provided clinical expertise in the evaluation of cases, contributing to the reduction of inappropriate admissions and the management of healthcare costs.
- Acted as a liaison between healthcare providers, patients, and insurance representatives to resolve issues related to coverage and medical necessity.
Clinical Review Nurse
Florida Blue
Tampa, FL
08.2017 - 12.2019
- Conducted telephonic reviews of acute inpatient admissions, utilizing InterQual criteria to assess medical necessity and appropriateness of care.
- Ensured compliance with URAC standards in all utilization management activities, maintaining high-quality care while adhering to regulatory guidelines.
- Collaborated with interdisciplinary teams, including physicians, case managers, and social workers, to coordinate care and optimize patient outcomes.
- Played a key role in discharge planning, facilitating smooth transitions of care, and reducing readmission rates by ensuring patients received the necessary post-discharge resources and support.
- Provided clinical expertise in the review and approval process, contributing to the efficient utilization of hospital resources and the management of healthcare costs.
Clinical Nurse
Baycare Health Systems, St. Joseph Hospital
TAMPA, FL
06.1999 - 01.2008
- Led the nursing team in the Women's Surgical Unit, coordinating patient care and ensuring adherence to best practices and clinical guidelines.
- Managed daily operations, including staff assignments, patient flow, and resource allocation, to optimize efficiency and quality of care.
- Provided direct patient care, overseeing preoperative and postoperative care for women undergoing surgical procedures.
- Acted as a liaison between physicians, nurses, and other healthcare professionals to ensure effective communication and collaboration across the unit.
- Ensured compliance with hospital policies, safety standards, and regulatory requirements while fostering a supportive and patient-centered environment.
Education
Nursing
Hillsborough Community College
Tampa, FLBachelor of Science - Nursing
St. Petersburg College
Clearwater, FLMBA - Health Care Administration
Keiser University
Fort Lauderdale, FLSkills
- Compliance Monitoring
- Documentation Review
- Auditing procedures
- Effective Communication
- Decision-Making
- Operational planning
- Healthcare regulations
- Budget Administration
- Needs Assessment
- Continuous Improvement
- Clinical Quality Improvement
- Nursing Staff Supervision
- Electronic Medical Records
Certification
- Registered Nurse (RN) License
State of Florida - Active
Languages
Spanish
Native/ Bilingual
References
References available upon request.
Timeline
Chief Regulatory Officer
Tampa Family Health Centers
01.2024 - Current
Chief Health Services Officer
Tampa Family Health Centers
12.2022 - 01.2024
VP of Health Services
Tampa Family Health Centers
08.2021 - 12.2022
Utilization Management Nurse
Humana
12.2019 - 08.2021
Clinical Review Nurse
Florida Blue
08.2017 - 12.2019
Clinical Nurse
Baycare Health Systems, St. Joseph Hospital
06.1999 - 01.2008
Nursing
Hillsborough Community College
Bachelor of Science - Nursing
St. Petersburg College
MBA - Health Care Administration
Keiser University
- Registered Nurse (RN) License
State of Florida - Active
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