Rene McNerhany
Canton,NC
Summary
A highly experienced Quality and Accreditation Manager. Strong management and regulatory qualifications with a successful track record of project management and quality improvement planning and implementation.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Consultant, Employee Assistance Program
Evernorth
Remote Home Office , North Carolina
06.2020 - 07.2022
- Advised HR Executives and Managers on appropriate interventions based up on employee mental health or performance issues.
- Coordinated services with account managers to provide customized wellness and onsite assistance programming
- Evaluated and reported on program performance.
- Created process improvement projects to increase program efficiencies, improve employee utilization of assistance programs and increase client satisfaction.
- Streamlined internal workflows to decrease handle time.
Quality and Accreditation Manager
Cigna
Home Office , North Carolina
10.2013 - 06.2020
- Prepared and presented comprehensive reports to upper management and audit team, covering issues and recommendations.
- Verified consistency in quality planning, quality control, quality insurance and quality improvement.
- Played instrumental role in company-wide risk assessment efforts, supporting enhancements in business processes and controls.
- Delivered subject matter expertise for internal and external customers on compliance best practices and quality control.
- Evaluated compliance with NCQA processes and requirements among commercial behavioral health plan including behavioral health organization, case management, utilization management and credentialing through mock audits and ad hoc reviews.
- Participated in and successfully earned accreditation from NCQA for all accreditation cycles.
- Participated in meetings to provide guidance and education around new and existing standards and requirements.
- Authored annual quality improvement program descriptions, reports and evaluations.
- Responded to requests for information from various accrediting bodies.
- Responsible for creating and updating behavioral organization policies and procedures to remain in compliance with NCQA and other accrediting body standards and requirements.
Quality Improvement Project Manager
Cigna
Home Office , North Carolina
07.2011 - 10.2013
- Improved quality processes for increased efficiency and effectiveness.
- Coordinated and monitored quality improvement and organizational projects from inception to closure.
- Analyzed data and developed presentations and materials for governing committee.
- Coordinated and implemented projects to improve HEDIS measurements.
- Worked with matrix partners at all levels to gather appropriate stakeholder input in development and implementation of defined projects.
Clinical Supervisor
Cigna
Remote Home Office , North Carolina
04.2006 - 07.2011
- Facilitate hiring of qualified Behavioral Health Operations personnel by interview applicants and making recommendations for employment.
- Monitored staff performance implemented training and performance improvement action plans.
- Lead and directed team of 25 clinical personnel and support staff.
- Implement new policies and educate staff on changes.
- Created and implemented department metrics and performance plan.
- Developed improvement plans to solve problems and improve lagging areas.
Education
Master of Arts - Counseling Psychology
St. Mary's University of Minnesota
Minneapolis, MNMBA - Business
Salem International University
Salem, WVSkills
- File Review
- Complex Problem-Solving
- Operational Procedures
- Accreditation Planning
- Accreditation Coordination
- Quality Control Procedures
- Certification and Accreditation
- Compliance Reviews
- Quality Improvement Plans
Certification
Six Sigma Green Belt
Timeline
Consultant, Employee Assistance Program
Evernorth
06.2020 - 07.2022
Quality and Accreditation Manager
Cigna
10.2013 - 06.2020
Quality Improvement Project Manager
Cigna
07.2011 - 10.2013
Clinical Supervisor
Cigna
04.2006 - 07.2011
Master of Arts - Counseling Psychology
St. Mary's University of Minnesota
MBA - Business
Salem International University
Six Sigma Green Belt
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