MAURA T. MCDONALD

HEALTHCARE QUALITY LEADER & PROGRAM/PROJECT MANAGER with10 plus years of experience focused on Quality Improvement, Risk Adjustment, Population Health, Operations, and IT transformation. Over10 years of experience leading & implementing large complex projects and initiatives within a matrix organization. Healthcare Program Management experience includes leading critical initiatives for United States Fortune5,100 &500 Managed Care Organizations, delivering solutions in product life cycle management, segment strategy, marketing and health plan operations, compliance programs, and technology solutions. Experience leveraging expertise across a variety of key business areas using lean methodologies to facilitate change management to produce successful outcomes.

• Successfully lead and achieved National Accreditation for Quality Assurance (NCQA) for the State of Virginia Health Plan and Long-Term Care Program. The Plan also received100% in all areas of the survey renewal audit by Chief Medical Offers at NCQA.
• Was selected and successfully lead a National clinical accreditation Pilot for CVS Health focusing on Telehealth/Telemedicine that will be rolled out to all50 States within the United States.
• Successfully lead a variety of strategic cross-departmental Quality Improvement Workgroups that is turn helped save the company Millions of dollars in total capitation revenue at risk for key Healthcare Effectiveness Data and Information Set (HEDIS) Measures impacting over20 Medicaid, Marketplace, MMP & Medicare Markets.
• Worked and implemented a variety of new national Quality reporting & outreach processes to help improve Behavioral Health & Medication Adherence Healthcare Effectiveness Data and Information Set (HEDIS) Measure results while saving the company millions of dollars with using internal resources in Pharmacy and BH instead of a3rd party vendors.
• Created and implemented highly successful Quality Based National interventions for the Organization.
• Implemented a variety of successful National & Market based Population Health Clinical Programs including Implementing New: Discharge Planning, ER Diversion, Maternity & High-Risk Pregnancy, Diabetes, Foster Care, Adoptive Services & Additional Key Chronic Conditions Programs.

• Strategic Planning
• Health/Managed Care
• Organizational Leadership
• Lean Six Sigma (LSS)
• Key Process Improvements
• Strategic Communications
• Project Management
• Quality HEDIS, CAHPS and HOS
• Risk Adjustment
• Cross-Departmental Collaboration
• Statistical Reporting
• Health Equity
• Virtual Care/Telehealth Accreditation
• Data and Analytics
• Leadership Meeting Facilitation and Presentations
• Behavioral Health
• Population Health
• Case & Disease Management
• Vendor Management
• Member Engagement & Interventions
• Provider Engagement & Interventions
• Clinical & Quality Program Management
• Pharmacy Quality Improvement/Medication Adherence

• Consumer Assessment of Healthcare Providers and Systems (CAHPS): CAHPS surveys follow scientific principles in survey design and development. The surveys are designed to reliably assess the experiences of a large sample of patients. They use standardized questions and data collection protocols to ensure that information can be compared across healthcare settings.
• Healthcare Effectiveness Data and Information Set (HEDIS): More than235 million people—72% of the US population—are enrolled in health plans that report quality results using NCQA Healthcare Effectiveness Data and Information Set. Americans receive better care and can lead healthier lives thanks to the accountability and benchmarking that HEDIS makes possible.
• Long-term services and supports (LTSS): the term long-term services and supports (LTSS) encompasses a array of medical and personal care services for people who struggle with self-care due to aging, illness, or disability. People commonly receive LTSS services for months or even years (and this is why LTSS are sometimes referred to as “long-term care”).
• Medicare: Medicare is federal health insurance for anyone age65 and older, and some people under65 with certain disabilities or conditions.
• Medicaid: Medicaid is a joint federal and state program that provides health coverage for some people with limited income and resources.
• Marketplace: A service that helps people shop for and enroll in health insurance. The federal government operates the Health Insurance Marketplace, available at HealthCare.gov, for most states. Some states run their own Marketplaces.
• National Committee for Quality Assurance (NCQA): An independent501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The National Committee for Quality Assurance operates on a formula of measure, analyze, and improve and it aims to build consensus across the industry by working with policymakers, employers, doctors, and patients, as well as health plan.
• National Committee for Quality Assurance (NCQA) Health Plan Accreditation: is a widely recognized, evidence-based program dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers, and consumers. It’s the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures).
• Process Improvement Project (PIP): in healthcare refers to a structured initiative aimed at identifying, analyzing, and implementing improvements to specific processes within a healthcare facility or system, with the goal of enhancing patient care quality and outcomes by addressing areas that need optimization; essentially, it’s a systematic approach to making healthcare delivery more efficient and effective.
• Population Health: the health outcomes of a group of individuals, including the distribution of such outcomes within the group. It is an approach to health that aims to improve the health of an entire human population. It has been described as consisting of three components. These are health outcomes, patterns of health social determents of health (SDOH), policies and interventions.