Renee McCord
Pewaukee
Summary
Dynamic Quality Management Specialist with a proven track record at Network Health, excelling in HEDIS reporting and URAC accreditation. Expert in quality improvement and data management, achieving 100% re-accreditation. Strong communicator and project manager, adept at streamlining processes and enhancing compliance in healthcare settings.
Overview
34
34
years of professional experience
Work History
Quality Management Specialist
Network Health
Menomonee Falls
08.2021 - Current
- Currently training and learning all aspects of Network Health HEDIS chart requesting process, for our 5 STAR rating. Seeking outreach from health systems for medical records, while maintaining processes for communicating and sharing files to the team that is receiving and entering the medical records into data system for HEDIS audit. Gaining an understanding of the process and workflow for HEDIS data abstraction, and HEDIS reporting for the Health Plan.
- Work with Exceedent Quality Management and Clinical Services leadership on URAC HUM (Health Utilization Management) accreditation. Responsible for the standardization of policy and procedures. Maintain UM Program policies and procedures, Quality Improvement Plan, Clinical team data and report to leadership. Facilitate Quality Management Committee and provide leaders with updates on process improvement work and quality metrics.
- Subject matter expert of URAC accreditation standard requirements while working closely with Clinical Services Health Utilization review nurses to assure that accreditation standards are maintained. Prepare and submit for re-accreditation audits. Achieved successful 100% re-accreditation status upon recent site audit with no correction action.
- Prepare monthly QI audits of the Clinical Services team (Prior Authorization and Pre-Determination), to assure documentation standards, timely processing and service standards are met. Run reports on work standards for Customer Service work standards that are reported out monthly as well.
- Responsible for the Credentialing and Re-credentialing of Exceedent Network Providers. Collaborate with vendor that validates primary source verification for applicants (new and recredentialing). Facilitate monthly meetings with the Exceedent Credentialing Committee comprised of physician leader credentialing experts. Prepare and follow-up on agenda, minutes, application review, recording of status and notification to the applicants via letters. Work closely with Exceedent administrative staff to maintain and update provider network.
System Quality Improvement Coordinator
Advocate Aurora Healthcare
Elm Grove
01.2015 - 01.2021
- Worked with System Quality Improvement leadership to implement quality improvement processes, workflows, decision support tools, best practices, following system recommendations to reach goals with Care Management Quality Initiatives. Was responsible for the following initiatives: Diabetes, Well Child Exams, Cardiac Statin, was source expert on numerous other initiatives such as Asthma, Depression, IVD, Chronic Kidney Disease and all 10 MSSP (MIPS) ACO reported measures.
- QPP-reporting (ACO and MSSP for CMS Quality Reporting initiatives): was responsible for maintaining, updating, and implementing programming changes to successfully submit annual quality data submission for multiple TIN’s accounting for majority of AHC medical group. Work directly with data warehouse programmers to identify and abstract discrete data items from the EHR into the reporting to improve outcomes on risk managed measures and populations. Responsible for testing and validation of measures to assure valid data submission.
- Collaborated with Advocate Aurora programmers to write specifications and test data for monthly internal QI data releases tied to provider/clinic/market QI Impact scores, and public reporting to WCHQ. Submitted, followed, and evaluated any requested changes and enhancements, reported updates and recommended changes. Worked closely with EPIC IT, clinical informatics, population health, education resources, and represent System Quality Improvement on various teams for decision support or EPIC build (examples: alerts management team, implementation of Health Maintenance for Chronic Disease Management and Depression Screening tool).
Quality Analyst
UW Health Partners Watertown Regional Medical Center
Watertown
01.2010 - 01.2015
- Worked collaboratively with the UWHP WRMC clinics along with the independent clinics that belong to the Watertown Network, LLC on specified quality initiatives, as specification content expert, and quality improvement work.
- Reported to the Executive Director of the Physician Hospital Organization (PHO), Director of Quality and Patient Safety and CMO. Worked as a leader that successfully created a change in culture, engaging staff and clinicians while providing necessary tools and resources to report and improve quality initiatives. This resulted in a progressive increase in risk and dollar distribution from insurance companies.
- Was responsible for leading various routine meetings within the organization, (staff, managers, physicians, board, and administrative leaders). Provided administrative support and functioned as liaison for the PHO Ex. Director while in negotiation of managed care contracts, while maintaining QA responsibilities.
- Gathered, compiled, and shared information transparently at various levels of the organization, written and verbally (meetings, reports, and newsletter). Worked with the technical report writers to extract information from the EMR.
Supervisor Registration
Wheaton Franciscan Health Care Brown Deer Clinic
Brown Deer
03.2010 - 05.2010
- Responsible for the supervision of the registration staff of a large family practice medical clinic. Resigned and returned to Watertown for the Quality Analyst role.
Optimization Specialist
UW Health Partners Watertown Regional Medical Center
Watertown
01.2009 - 01.2010
- Worked jointly with the UW-WRMC–clinic management and MIS – Information Technology department to define and implement best practices. Streamlining the EMR and clinic workflow. Applied Lean concepts to process improvement projects in the clinic setting while supporting the MIS department.
Senior Clinic Coordinator (Jr. Clinic Coordinator to start) Clinic Management
UW Health Partners Watertown Regional Medical Center
Watertown
01.2005 - 01.2009
- Managed daily operations of clinics; scheduled hired, mentored (including annual reviews), disciplined, trained staff. Responsible for all daily operations of administrative staff and clinical support staff. Managed clinicians work schedule, off time, clinic schedules. Coordinated all staff, clinician meetings and all communications. Collaborated directly with the staff and reported to administration for all policy and procedures. Each location had physicians, advanced practice providers, reception, and clinical/nursing staff. All clinics had electronic medical records. Facilitated and opened two new clinics, October 2007, and January 2008. Worked to convert two independent practices to hospital owned in 2008.
Customer Service Registration Representative
UW Health Partners Watertown Regional Medical Center
Watertown
01.2003 - 01.2005
- Provided exceptional, personalized customer service as a front-line representative. Used excellent communication skills to answer calls, handle customer inquiries, updated the EMR appropriately following policy and procedure. Multi-tasked in various busy clinics and the main registration department of the hospital.
01.1992 - 01.2003
- Progressive positions from lab technician to supervisory (QM, food lab, and sanitation) while working in dairy (cheese), and meat processing facilities. Food Microbiology, Pathogenic and Chemistry Lab and regulatory requirements.
Education
Bachelor of Science - Operations Management
Marian College
Fond du Lac, WIAssociate Degree - Food Science Technician Program
Moraine Park Technical College
Fond du Lac, WISkills
- Quality Improvement
- ACO-MSSP and QPP/MIPS
- Compliance
- Operations
- TPA
- HEDIS
- Clinic Management
- Lean
- Project Management
- Data Management
- Managed Care
- EHR
- Process Improvement
- EPIC
- Smart Chart
- URAC Accreditation
- Health Utilization Management
- Credentialing
- Regulatory
- CMS Medicare
- Talk Desk Phone
- HEDIS reporting
- Quality improvement
- Data analysis
Accomplishments
- Successfully obtained full re-accreditation staus of URAC Accreditation in July 2024
Timeline
Quality Management Specialist
Network Health
08.2021 - Current
System Quality Improvement Coordinator
Advocate Aurora Healthcare
01.2015 - 01.2021
Supervisor Registration
Wheaton Franciscan Health Care Brown Deer Clinic
03.2010 - 05.2010
Quality Analyst
UW Health Partners Watertown Regional Medical Center
01.2010 - 01.2015
Optimization Specialist
UW Health Partners Watertown Regional Medical Center
01.2009 - 01.2010
Senior Clinic Coordinator (Jr. Clinic Coordinator to start) Clinic Management
UW Health Partners Watertown Regional Medical Center
01.2005 - 01.2009
Customer Service Registration Representative
UW Health Partners Watertown Regional Medical Center
01.2003 - 01.2005
01.1992 - 01.2003
Bachelor of Science - Operations Management
Marian College
Associate Degree - Food Science Technician Program
Moraine Park Technical College
Similar Profiles
Leah HansonLeah Hanson
RN Care Manager at Network HealthRN Care Manager at Network Health
Steven PfallerSteven Pfaller
Specialty Contract, Manager at Network HealthSpecialty Contract, Manager at Network Health
Melanie DraheimMelanie Draheim
Vice President of Marketing and Strategy at Network HealthVice President of Marketing and Strategy at Network Health
THOMAS M. SANDVIKTHOMAS M. SANDVIK
Associate Director Regional Marketing at Eisai, IncAssociate Director Regional Marketing at Eisai, Inc
Royce BurRoyce Bur
Landscape Worker at CJ Lawn CareLandscape Worker at CJ Lawn Care