Patricia Fowler
St Petersburg ,FL
Summary
Knowledgeable RN with background in executive leadership. Over 30 years of experience. Guided strategic initiatives that enhanced operational efficiency and fostered organizational growth. Demonstrated expertise in leadership and strategic planning.
Overview
40
40
years of professional experience
1
1
Certification
Work History
Vice President, Quality Improvement/Florida Market
WellCare Health Plans Inc/Sunshine Health Plan
02.2014 - Current
- Successfully hired staff to build the Quality Program in the Florida market
- Hired and implemented the HEDIS Practice Advisor Provider Program to establish a provider engagement strategy for the QI program
- Developed report templates to better track progress on the quality measures
- Educated new staff on Health Plan quality
- Interdepartmental staff training on the details of quality and how operational and CM activities effect the QI program
- Developed training for clinical and non-clinical staff in the market to better understand the details of the HEDIS measures.
- Developed reports to assist with data collection for the HEDIS annual data collection process
- Organized and developed a process to manage information being submitted for HEDIS year-round data collection
- Organized and executed in person and virtual provider summits which provided information to, and fostered partnerships with provider community
- Absorbed the appeals and grievance department post integration of Sunshine and Staywell
- Assisted and supported in automation of appeals and grievances letters
- Assisted with the integration of the QI departments for both Sunshine and Staywell
Vice President, Quality Management/Health Promotions
AMERIGROUP CORPORATION, MARYLAND
01.2011 - 02.2014
- Successful submission and onsite review of Amerigroup Maryland’s application to NCQA to result in a commendable rating. Lead an interdepartmental team which managed through over 300 change items to ensure NCQA compliance which encompassed both plan and corporate cooperation
- Reorganized the Health Promotion, Outreach and Quality Improvement Department to focus on quality metrics achieving year over year improvements
- Developed tracking mechanisms for outreach efforts to ensure targeted outreach efforts aligned with Quality goals
- Organized and lead efforts to ensure data completeness and accuracy of reporting for HEDIS measures, to include obtaining data from individual practices’ Electronic Health Records
- Successfully managed the annual HEDIS data collection process
Sr. Director, Care Management/Quality Improvement
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
02.2010 - 01.2011
- Oversight of the Care Management Team: Behavioral Health, Complex Medical, and the Special Disease Management Programs.
- Clinical Quality Improvement, Special Needs, HEDIS and Health Promotion Outreach.
- Care Management liaison with the Operations IT and other departments in the organization to ensure that goals, processes and reporting are aligned
Sr. Director, Quality Improvement/Provider Relations
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
10.2004 - 02.2010
- Development and coordination the Quality Improvement Program
- Maintain and monitor annual HEDIS reporting
- Member Outreach and Health Education functions.
- Appeal and Complaints & Grievance programs
- Manage Provider Relations and negotiation of contracts
- Oversee the network credentialing.
Director, Quality Improvement/Member Initiatives
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
10.1999 - 10.2004
- Development and coordination the Quality Improvement Program
- Maintain and monitor annual HEDIS reporting
- Member Outreach and Health Education functions.
- Manage Provider Relations and negotiation of contracts
- Oversee the network credentialing.
Manager, Quality Improvement
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
10.1998 - 10.1999
- Develop and implement the Quality Improvement Program for Johns Hopkins Health Care (JHHHC).
- Create and manage the plan’s complaint process in compliance of Medicaid line of business
- Develop and implement policies which assured compliance with the new HealthChoice regulations
Quality Improvement Coordinator
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
02.1997 - 03.1998
- Development, implementation, of the Quality Improvement Program for Johns Hopkins Health Care (JHHHC).
- Assisted with data collection of quality indicators to aggregate, trend, analyze and report results appropriate.
- Creation of the quality of care and peer review process
- Medical Record review
- Coordination of materials for annual state External Quality Review Organization audit
Quality Improvement Manager
CMG HEALTH (Mid Atlantic), Owings Mills, MD
09.1995 - 02.1997
- QI Program development and implementation
- Development Targeted Case Management for mental health/substance use population
- Co-chaired Quality Improvement Committee
- Directed peer review process
- Organized and prepared mortality reviews for committee
- Organized and monitored medical review process
- Liaison on clinical quality issues.
- Attended and presented monthly UM and QI committees
- Assisted in preparation for and accreditation interviews for NCQA
- Interacted on member complaints with the Insurance Commissioner
Registered Nurse II
SPRINGFIELD HOSPITAL CENTER, Sykesville, MD
05.1992 - 04.1995
- Admission assessment
- Originate plan of care by patient
- Implemented appropriate therapeutic interventions based on patient condition
- Administration and evaluation of prescribed medication
- Evaluation of patient progress and effects of medication
- Reported to and worked with Interdisciplinary team on patient treatment plan
- Assumed charge duty responsibilities when required
- Monitored and staffed weekly patient education group’s
- Monitored and staffed daily patient milieu meetings
- Supervision and education of LPN’s
Float Pool Nurse
SHEPPARD PRATT HOSPITAL, Towson MD
08.1985 - 04.1995
- Mental Health Worker Child and Adolescent Division
Education
Associate of Arts - Nursing
Catonsville Community College
Catonsville, MDBachelor of Science - Psychology, Education
University of Maryland
College Park, MDSkills
- Strategic team guidance
- Effective relationship management
- Analytical decision-making
- Problem-solving skills
- Coaching expertise
- Complex Problem-solving
- Client relationship building
- Strategic planning
- Training and mentoring
Certification
Registered Nurse # RN 9376855
Timeline
Vice President, Quality Improvement/Florida Market
WellCare Health Plans Inc/Sunshine Health Plan
02.2014 - Current
Vice President, Quality Management/Health Promotions
AMERIGROUP CORPORATION, MARYLAND
01.2011 - 02.2014
Sr. Director, Care Management/Quality Improvement
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
02.2010 - 01.2011
Sr. Director, Quality Improvement/Provider Relations
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
10.2004 - 02.2010
Director, Quality Improvement/Member Initiatives
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
10.1999 - 10.2004
Manager, Quality Improvement
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
10.1998 - 10.1999
Quality Improvement Coordinator
JOHNS HOPKINS HEALTHCARE LLC (JHHHC), Glen Burnie, MD
02.1997 - 03.1998
Quality Improvement Manager
CMG HEALTH (Mid Atlantic), Owings Mills, MD
09.1995 - 02.1997
Registered Nurse II
SPRINGFIELD HOSPITAL CENTER, Sykesville, MD
05.1992 - 04.1995
Float Pool Nurse
SHEPPARD PRATT HOSPITAL, Towson MD
08.1985 - 04.1995
Associate of Arts - Nursing
Catonsville Community College
Bachelor of Science - Psychology, Education
University of Maryland