MARIA UREÑA

Work History

Director

Optum California

09.2023 - Current

Oversaw operations and provided corrective feedback to achieve daily and long-term goals.
Responsible for overseeing Network wide performance related to Risk/ STARs and Pay for Performance
Worked closely with organizational leadership and Medical Directors to guide operational strategy.
Managed daily operations while overseeing multiple locations to foster increased productivity.
Established departmental performance STAR and Amp. Commercial goals and provided feedback and strategy for underperforming areas.
Monitored and coordinated workflows to optimize resources.
Formed strategic partnerships and connected with potential clients to drive business development and performance.
Monitored office workflow and administrative processes to keep operations running smoothly.
Evaluated company documentation to verify alignment with regulatory requirements.
Spearheaded innovative approaches to resource allocation and strategic planning.
Leveraged professional networks and industry knowledge to strengthen client relationships.
Optimized operational processes using analytics tools to address client-specific metrics.
Drafted and distributed reports to assist Executive IPA leadership, Medical Directors and Optum leaders with critical business decisions.
Evaluated scripts to identify creative strategies and resource needs.
Remained highly composed and calm in very fast-paced, stressful and constantly changing environments to provide optimal leadership and achieve desired results.
Remained composed and highly professional in fast-paced and constantly changing environment, effectively handling challenging situations and difficult individuals to achieve objectives.
Conducted meetings with staff to discuss production progress and to attain production objectives.
Observed tight deadlines and strict budgetary controls to avoid waste and streamline costs.
Collaborated with network executives to define and propel organization's mission and vision.

Associate Director

Optum Care Network Formerly PrimeCare/NAMM

01.2022 - 09.2023

Responsible for overseeing Network wide performance related to CMS 5 STAR measures and P4P
Ensuring all measures are met (Part C and Part D)
Responsible for day to day operations of the Quality improvement department & staff including Registered
Nurses, Licensed Vocational Nurses and Coordinators
Responsible for hiring and training talent
Oversee the Quality Improvement program across 3 counties including San Diego, Riverside and San
Bernardino for over 800 primary care doctors, and 2500 specialists
Responsible for ensuring comprehensive, quality program inclusive of STAR measures, P4P, Nurse review with Care Quality Indicators, patient grievances, Standard and Non- standard supplemental data compliance, review and audit, annual and quarterly work plans, Peer Review Committee meetings, HEDIS measures, Part D & adherence measures; Access Audits, Facility site reviews, Corporate Peer Review
Committee Meetings, Quarterly PCP/OM meetings, Joint Operations Health Plan meetings
Work collaboratively with providers, provider offices, executive directors, patient service representatives, multiple health plans and committees to improve quality and clinical outcomes
Manage and facilitate leadership and staff meetings
Develop and implement strategic operations and programs to improve HEDIS scores and STAR ratings across multiple independent physician practices
Member of the Diversity, Equity and Inclusion council and co-chair of UNIDOS to develop a more inclusive member and staff engagement that is inclusive and equitable
Provide training sessions to all staff on policies and procedures; Mental Health and self-awareness and
Process improvement
Perform departmental audits for supplemental data, Potential Quality Indicators and patient grievances
Co-created the Quality Clinic process and documentation template, co-created Project Fire (Statin initiative)
Assisted in the transition and transformation of individual Care Delivery Organizations into one Network known as Optum California Network- Inland Empire
Trained and developed department leaders and management staff for specific projects and ongoing operational needs.
Assisted senior leadership in managing all aspects of operations.
Led teams of up to 17 personnel, supervising daily performance as well as training and improvement plans.
Prioritized tasks and allocated resources appropriately to keep teams focused and productive.
Engaged analytical subject matter experts outside project teams to drive troubleshooting of critical process-related deviations and enhance process improvements.
Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
Evaluated employee performance and conveyed constructive feedback to improve skills.
Established team priorities, maintained schedules and monitored performance.
Assisted in organizing and overseeing assignments to drive operational excellence.
Established performance goals for employees and provided feedback on methods for reaching those milestones.

Manager

Optum Care/ North American Management California

06.2019 - 03.2022

Responsible for overseeing Network wide performance related to CMS 5 STAR measures and P4P
Ensuring all measures are met
Responsible for day to day operations of the Quality improvement department & staff including Registered
Nurses, Licensed Vocational Nurses and Coordinators
Responsible for hiring and training talent
Oversee the Quality Improvement program across 3 counties including San Diego, Riverside and San
Bernardino for over 800 primary care doctors, and 2500 specialists
Responsible for ensuring a comprehensive, quality program inclusive of STAR measures, P4P, Nurse review with Care Quality Indicators, patient grievances, Standard and Non- standard supplemental data compliance, review and audit, annual and quarterly work plans, Peer Review Committee meetings, HEDIS measures, Part D & adherence measures; Access Audits, Facility site reviews, Corporate Peer Review
Committee Meetings, Quarterly PCP/OM meetings, Joint Operations Health Plan meetings
Work collaboratively with multiple health plans and committees to improve quality and clinical outcomes
Manage and facilitate leadership and staff meetings
Develop and implement strategic operations and programs to improve HEDIS scores and STAR ratings across multiple independent physician practices
Member of the Diversity council
Provide training sessions to all staff on policies and procedures; Mental Health and self-awareness and
Process improvement
Perform departmental audits for supplemental data, Potential Quality Indicators and patient grievances
Co-created the Quality Clinic process and documentation template, co-created Project Fire (Statin initiative)
Managed and motivated employees to be productive and engaged in work.
Accomplished multiple tasks within established timeframes.

Regional Clinical Operations Manager

DaVita Integrated Kidney Care

01.2018 - 06.2019

Responsible for daily operations for the Inland Empire Regional Office; Manage and supervise all clinical teammates, Case Management Program, Discharge Planning and Population Management Activities
Responsible for managing the CMS STAR program related to utilization measures; Transitions of Care
Medication Reconciliation, Plan all cause readmission for HD patients
Coached current teammates to align with the Mission and Vision to provide ProActive care vs Reactive
Care and improve Clinical outcomes
Redesigned the interdisciplinary weekly hospital call using SBAR
Redesigned and implemented streamlined processes and programs for quality improvement, change management
Decreased Admissions and Readmissions by 20%
Improved Employee Moral and Retention
Clinical Management
Relationship Management of Internal and External stakeholders
Reframe local vision; moving from caring for the chronically ill to ProActive care and getting patients “transplant ready”
Have provided several training sessions to include: Hospice/ Palliative Care, Discharge Planning, Case
Management, Community resources, improving documentation, Homeless resources, communications .
Identified opportunities to improve clinical practices, devised strategies and implemented plans to increase patient care standards and enhance operational procedures.
Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.
Promoted high morale and staff retention through dynamic communication, prompt problem resolution, proactive supervisory practices and facilitation of positive work environment.
Delivered effective onboarding and training to new and existing employees and cross-trained staff members in other job roles to maximize coverage.
Regularly evaluated employee performance and provided feedback.

Curriculum Co-Designer

Institute for Healthcare Improvement

01.2015 - 01.2019

Served as co-designer for Community Health: Population Management in the Safety Net a public health course designed to improve clinical quality by using Population Health Management tools.

Manager, QA & Infection Director

Riverside University Health Services

01.2015 - 01.2016

Oversaw the Ambulatory Care Quality Management department for compliance with all CMS 5 STAR and P4 P quality improvement initiatives, quality assurance measures, pay for performance and strategic goals for the Federal qualified health centers
Managed the day to day operations including discipline, hiring and transitioning of staff
Oversaw the Quality Improvement Task Force and the Patient Center Medical Home Assessment collaborative
Participated as a member of the Ambulatory Care Clinics Leadership council, ad hoc for the Federally
Qualified Health Centers board of directors, Inland Empire Health Plan/Public Hospital task force, and the Kaiser Permanente Peer Exchange Program
Responsible for training staff and providers regarding quality metrics, STAR ratings, and process improvement around strategic goals and chronic condition management
Served as a mentor for students at Graduate, Undergraduate and High School levels
Assisted in translating and program development around the PRIME initiative.
Managed and motivated employees to be productive and engaged in work.
Accomplished multiple tasks within established timeframes.
Maintained professional, organized, and safe environment for employees and patrons.
Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
Cross-trained existing employees to maximize team agility and performance.
Maximized performance by monitoring daily activities and mentoring team members.

RN, FNP, Clinical Quality Program Manager/ Consultant

Kaiser Permanente, Southern California Permanente Medical Group

05.1990 - 01.2015

Managed and provided technical assistance for existing CMS 5 STAR and P4 P quality improvement and disease management grant initiatives through Community Benefit to ascertain grant metrics were obtained by using quality improvement methods such as LEAN, PDSA”s and the Triple Aim
Lead senior leadership meetings between national, regional, and local Kaiser Permanente representatives and public hospital senior leadership on health initiatives in the community and public health system
Provided technical assistance to community partners related to quality improvement, pro-active office encounter, triple aim, complete care, evidence based medicine, grant writing, grant reviews, strategic planning, chronic conditions management, PDSA”s, delivery system reform incentive payment program
ALLHEART
Provided and coordinate peer to peer learning, coaching and academic detailing exchanges to all levels of medical, nursing and administrative disciplines
Am a public speaker for community health forums, events and lectures to provide health education to community, Future Physician Leadership Programs, and the Youth Empowerment Motivational Program
Coordinated, planned and led the first Physician recognition event between private and public entities to celebrate collaborative work completed which improved community care around chronic condition management
Developed and wrote the initial work plan for the Promotora Innovations grant initiative for the city of
Indio, Ca
With collaboration from Kaiser Permanente and Latino Health Access
Served on the Promotora, patient advisory council
Co-collaborator on several curriculum for Quality Improvement programs including:
Building Clinic Capacity for Quality
The Chronic Disease Management Model
Lead the successful collaboration between Kaiser Permanente, Loma Linda Health Institute, Inland
Empire Health Plan and the Safety Net Institute
Developed systematic processes and tools to improve, integrate and transfer evidence based medicine and best practices
Developed concept papers, work plans, policy and procedures for both local and regional health improvement projects
Served as a mentor for students at Graduate, Undergraduate and High School levels.

Summary

Overview

Work History

Director

Associate Director

Manager

Regional Clinical Operations Manager

Curriculum Co-Designer

Manager, QA & Infection Director

RN, FNP, Clinical Quality Program Manager/ Consultant

Education

Business Management Certificate -

Executive Business Education -

Business Administration And Management

Center For Health Professions Executive Healthcare Leadership Certificate - Clinical Fellowship

Master of Science - Family Nurse Practitioner

Master of Arts - Health Administration

Bachelor of Science - Nursing

Skills

Accomplishments

Affiliations

Additional Information

Certification

Languages

Timeline

Similar Profiles

Griselda Carranza-PandyGriselda Carranza-Pandy

Naama W. GoldmanNaama W. Goldman

Yalda Aminkashani, M.D.Yalda Aminkashani, M.D.