Sarah Hisle
Healthcare Quality and Compliance Professional
Sedalia,MO
Summary
Results-driven business professional prepared for role. Expertise in managing high-stakes projects and optimizing operational workflows to drive organizational success. Known for fostering team collaboration and adapting to dynamic business environments. Proficient in strategic planning and problem-solving, with focus on achieving measurable outcomes.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Compliance Business Lead
Optum Home and Community Care
01.2024 - Current
- Resource to business regarding CMS regulations and requirements
- Established process for reviewing multiple regulatory mandates, state and federal that was later implemented across Home & Community, improving communication of mandates and implementations.
- SME on NCQA requirements, standards and processes
- Led compliance work plans for Care Transitions and Housecalls resulting in process improvements such as Improved DRE documentation.
- Developed collaborative process with Quality for Compliance investigations to ensure monitoring of remediation for substantiated cases to closure.
- Provide expertise to business regarding state and federal regulatory requirements
- Oversight of Audits, CAPS, and Remediation
Assoc. Director, Quality Consulting, Compliance
Care Transitions (formally naviHealth, part of Optum/UHG)
09.2019 - 01.2024
- Led work on the quality work plan, ensuring successful completion of quality projects such as redesigning the complaints reports, leading to process improvement projects to improve clinician interaction with members.
- Large scale redesign of Quality Assurance Reviews and Member Satisfaction Survey
- Develop data analytics for Quality initiatives, Process Improvement
- Successful oversight of NCQA accreditation surveys- 3 year accreditation during tenure.
- Oversight of Internal Audits
- Collaborate and lead responses to HP/external audits
- Provide leadership, manages, and contributes insights/analysis to:
- Provides UM services on behalf of Health Plan Clients for the Medicare Advantage and SNP population
- Data abstraction/audits
- SNP programs
- Valued Based Care CMS programs/audits
- Vendor contracts
- Compliance Committee, Quality Executive Committee, Quality Committee, Delegation Oversight Committee, UM Committee
Manager, Quality Management
Lucet (previously New Directions Behavioral Health)
04.2015 - 09.2019
- Data Abstraction/Oversight for HEDIS projects, supporting HEDIS outcomes such as:
- Improved ER Utilization, Medication Reconciliation, Reducing Readmissions, Discharge Planning, Diabetic Screenings
- SME regarding: Project identification/implementation, PI, change management, team processes
- Participated in and led sections of NCQA and URAC surveys
- Assisted with launching new BOBs including 10-year government contract at 16 mil/year
- Primary Quality Consultant for BCBSM
- Spearheaded implementation of complaints/patient safety management platform (RLDatix)
- Collaborated to build customizable EMR for EAP program
- Developed reports and presentation for HP clients, collaborated with HP clients
- Developed EAP Quality Program for government contract
- Provides Managed Behavioral Health Care and UM Services on behalf of Health Plan Clients
- HEDIS projects and outcomes
Health Care Integrator (HCI) /Contractor
US Air Force 509 MDG, Multi -Specialty PCMH Clinic
10.2014 - 04.2015
- Chaired Population Health Committee; smoking cessation, chronic disease treatment, cardiac disease, cancer screenings, vaccinations, and compliance with medications
- Spearheaded projects to improve KPIs with a HEDIS focus and enhanced reports:
- Decreased ER utilization by 27 percentage points (pp)
- Improved patient compliance with antidepressants
- Improved 7 day follow up after discharge: decreased readmissions
- Surpassed Diabetes HEDIS goals of 75th percentile
- TeAM, Inc.
Clinic Site Manager/Quality Improvement Coordinator
Katy Trail Community Health, Multi- Site, Regional PCMH Clinics
10.2013 - 10.2014
- Directed and supervised clinical teams at 3 sites including CM, DM, UM, Nursing.
- Chaired Quality Management Committee:
- Improved KPIs resulting in successful quality outcomes: Diabetic A1C decreased by 7 pp; controlled hypertension by 21 pp.
- Implemented patient safety/risk management program- pro-active risk assessment, incident and near miss reporting, and risk mitigation.
- Customized EMR to enhance clinician satisfaction resulting in better data capture/reporting
- Romeo Quality Award
- Subcommittees: CM, DM, Population Health; Nursing
Education
Master of Healthcare Administration -
Walden University
Bachelor of Science in Nursing - undefined
William Jewell College
Skills
- Change Management
- Analytical thinking
- Intermediate level expertise Excel, Tableau, Power BI
- Team collaboration and leadership
- Risk Analysis and Mitigation
- Lean Six Sigma/Green Belt
- Data analysis to identify barriers and opportunities
- Process improvement/project management
- NCQA: MBHO, UM
- Public speaking
- Report preparation and presentation
Accomplishments
Achieved strong data analytics and management of complaints by implementing complaints/patient safety management platform. Resulted in powerful Root Cause Analysis and trending, leading to effective process improvements.
Executed strong NCQA survey process that resulted in 3 year accreditations in MBHO, and UM.
Spearheaded redesign of Member Satisfaction survey leading to increased engagement and meaningful responses resulting in improvements in delivery of services.
Led a cross functional project to deliver effective Quality Assurance Reviews, resulting in meaningful results and identifying areas of opportunities.
Certification
- Registered Nurse: Missouri
- Certified Professional in Healthcare Quality (CPHQ): NAHQ
- Lean Six Sigma Green Belt (LSSGB): Johnson County Community College
- Patient Safety Officer: Duke University
Timeline
Compliance Business Lead
Optum Home and Community Care
01.2024 - Current
Assoc. Director, Quality Consulting, Compliance
Care Transitions (formally naviHealth, part of Optum/UHG)
09.2019 - 01.2024
Manager, Quality Management
Lucet (previously New Directions Behavioral Health)
04.2015 - 09.2019
Health Care Integrator (HCI) /Contractor
US Air Force 509 MDG, Multi -Specialty PCMH Clinic
10.2014 - 04.2015
Clinic Site Manager/Quality Improvement Coordinator
Katy Trail Community Health, Multi- Site, Regional PCMH Clinics
10.2013 - 10.2014
Bachelor of Science in Nursing - undefined
William Jewell College
Master of Healthcare Administration -
Walden University