Nancy Sullivan
Summary
Experienced Project Manager focused on driving quality improvement and improved member experience. Years of experience in meeting accreditation standards, case management, and utilization review.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Sr. Clinical Quality Program Manager
Zaffre Health Solutions
12.2019 - 02.2024
- Responsible for meeting NCQA accreditation standards
- QI lead for the Case Management Member Satisfaction survey
- Demonstrated ability to facilitate project teams focused on quality improvement for HEDIS measures and member experience
- Worked with BCBSMA data and analytics teams as needed for reporting and performance insights.
Quality Improvement Manager
NH Healthy Families
11.2015 - 05.2019
- Responsible for the day to day operations of the quality improvement (QI) program promoting health care benefits and services for managed Medicaid and Marketplace members
- Initiated and sustained performance improvement initiatives for increasing compliance with HEDIS preventive and clinical care measures
- Developed and implemented a quality improvement project with key external stakeholders for improving colorectal cancer screening
- Responsible for meeting the NH DHHS contract requirements and NCQA accreditation standards
- QI Lead for the administration of the CAHPS survey with the external vendor
- Co-Chair Provider Satisfaction Workgroup responsible for developing and implementing targeted action plans for low performing elements
- People manager with responsibilities of staff performance and development.
Infection Prevention and Control Manager
Emerson Hospital
04.2015 - 11.2015
- Responsible for the infection prevention and control hospital program
- Collecting, analyzing, and reporting surveillance data to internal stakeholders and external regulatory agencies
- Prevent and control the transmission of infectious diseases
- Provide oversight and partnership with numerous departments on infection prevention improvement activities
- Actively involved in the infection control risk assessment (ICRA)
- Co-Chair Sharps Committee.
Clinical Specialist Infection Prevention
St. Joseph Hospital
01.2012 - 12.2014
- Responsible for the hospital wide infection control program
- Key member of the emergency preparedness team during Ebola outbreak
- Organization wide responsibility for managing the Root Cause Analysis (RCA), Failure Mode Effects Analysis (FMEA), and process improvement activities
- Collaborated with physicians for identification, implementation, and evaluation of departmental quality performance improvement indicators
- Hospital Lead for the implementation of Q-HIP, an Anthem BCBS Pay for Performance Program
- Tri-Chair Patient Safety Committee.
Program Manager, Anthem Hospital Incentive Program
Anthem BCBS
07.2008 - 01.2012
- Responsible for the Q-HIP program design, implementation and evaluation of hospitals utilizing nationally recognized evidence based goals/metrics
- Facilitated operational activities with outside vendors on the design and maintenance of a Web based documentation submission tool and the hospital performance evaluation process
- Performed presentations and conducted training on program requirements to internal stakeholders, hospital leadership, and staff.
Nurse Educator/Trainer
TILL, Inc.
08.2005 - 08.2011
- Nurse consultant overseeing the medication administration process for individuals with intellectual and developmental disabilities.
Sr. Healthcare Consultant
Anthem BCBS
01.2003 - 01.2006
- Developed and implemented a hospital and PCP quality incentive program
- Clinical liaison between the Health Plan and Physician Hospital Organizations (PHOs) on the development and implementation of Clinical Quality Initiatives
- Accountable for meeting several NCQA performance standards, which contributed to the achievement of an excellent accreditation status by the Health Plan
- Served as the Quality Department's Lead for the company wide operating system conversion.
Team Advisor and Case Manager
Anthem BCBS
01.2000 - 01.2003
- Performed case management and utilization management
- Met with key employer groups to review the cost drivers and the case management interventions employed to reduce cost and improve health outcomes
- Responsible for leading the department Federal Employee Program, the New England Managed Care Initiative, and co-Chair of the Interplan Case Management Workgroup
- Member of the Medical Management Accreditation Team and actively involved in demonstrating compliance with the NCQA performance standards.
Case Manager
CIGNA
06.1990 - 03.1997
- Performed inpatient utilization review and outpatient case management
- A community focus approach was adopted in the management of quality, utilization, cost/cost savings.
Education
Bachelor of Science in Nursing -
Rivier University
Nashua, NH05.2017
MT. AUBURN HOSPITAL SCHOOL OF NURSING -
CAMBRIDGE, MA
1976
Skills
- Well versed on national quality, infection prevention, and patient safety performance measures, regulatory requirements, and accreditation
- Results driven individual focused on systems and processes that impact the provision of cost effective quality healthcare
- Track history on successfully developing and managing programs and projects
- Enjoys the art of facilitation, collaboration, and team building
- Detail oriented, proactive with strong follow through
- Excellent written and verbal communication skills
Certification
Registered Nurse in New Hampshire and Massachusetts
References
Available upon request
Timeline
Sr. Clinical Quality Program Manager
Zaffre Health Solutions
12.2019 - 02.2024
Quality Improvement Manager
NH Healthy Families
11.2015 - 05.2019
Infection Prevention and Control Manager
Emerson Hospital
04.2015 - 11.2015
Clinical Specialist Infection Prevention
St. Joseph Hospital
01.2012 - 12.2014
Program Manager, Anthem Hospital Incentive Program
Anthem BCBS
07.2008 - 01.2012
Nurse Educator/Trainer
TILL, Inc.
08.2005 - 08.2011
Sr. Healthcare Consultant
Anthem BCBS
01.2003 - 01.2006
Team Advisor and Case Manager
Anthem BCBS
01.2000 - 01.2003
Case Manager
CIGNA
06.1990 - 03.1997
Bachelor of Science in Nursing -
Rivier University
MT. AUBURN HOSPITAL SCHOOL OF NURSING -
CAMBRIDGE, MA
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