Sheree Gordon
Los Angeles,CA
Summary
Healthcare quality improvement and compliance leader with experience across PACE and community health settings. Leads audit readiness, CMS and HPMS reporting, grievance resolution, and performance monitoring, while training staff and supporting regulatory compliance across seven sites.
Overview
1
1
Certification
11
11
years of professional experience
Work History
Quality Improvement Specialist
WelbeHealth
03.2024 - Current
- Conducted annual mock audits across seven Pacific PACE markets to support regulatory readiness and compliance improvement initiatives.
- Conducted quarterly site reviews and chart audits to evaluate documentation accuracy, operational compliance, and quality performance.
- Managed HPMS reporting and auditing activities, ensuring timely and accurate monthly submissions in compliance with CMS requirements.
- Monitored and reported on Corrective Action Plans (CAPs) and SDAG compliance activities, enhancing quality metrics oversight.
- Trained and mentored compliance staff on quality improvement processes and audit readiness, strengthening adherence to HIPAA standards.
- Investigated and resolved grievances, appeals, and incident reports within required regulatory timelines.
- Prepared CMS quarterly agenda materials and Board Quality Improvement presentation slide decks.
Interim Quality Improvement Director (QID)
WelbeHealth
08.2024 - 03.2025
- Directed quality improvement and compliance operations across seven clinic sites within the PACE program environment.
- Chaired Quality Improvement Committee and facilitated monthly Quality Improvement Triad meetings to drive strategic quality initiatives.
- Managed HPMS submission processes and ensured timely and accurate regulatory reporting compliance.
- Coordinated CMS quarterly agenda preparation and facilitated CMS monthly and quarterly calls.
- Led Joint Operations Incident and Grievance preparation activities and monitored corrective action implementation.
- Oversaw grievances, appeals, CTM complaints, Notice of Action letters, and involuntary disenrollment processes in compliance with CMS requirements.
- Conducted quarterly site checks, annual mock audits, and root cause analyses to support audit readiness and performance improvement initiatives.
- Collaborated with executive leadership and medical directors to identify, investigate, and resolve quality-of-care concerns.
- Monitored quality metrics, adverse events, utilization management data, and participant satisfaction surveys to identify and prioritize improvement opportunities.
- Generated quality reports and presented actionable findings to leadership committees and regulatory stakeholders to inform decision-making.
- Trained and mentored quality improvement and compliance staff on HIPAA requirements, operational workflows, and quality standards.
Quality Improvement Coordinator
THE Health and Wellness Center
08.2015 - 02.2024
- Led organization-wide quality improvement initiatives across six healthcare clinic sites and one mobile health unit serving primary care, women's health, pediatrics, dental, behavioral health, and substance use populations.
- Facilitated compliance with HEDIS, UDS, HRSA, Title X, Joint Commission, LA Care, and payer reporting requirements across multiple care domains.
- Conducted monthly and quarterly chart audits for coding accuracy, documentation compliance, and quality measure performance improvement.
- Developed quality improvement plans, policies, procedures, workflow process maps, and clinical competencies to support regulatory compliance and operational standardization.
- Oversaw reporting analytics using i2i Tracks Population Management and eClinicalWorks reporting systems to support quality improvement efforts.
- Implemented workflow and system improvements to enhance operational efficiency and patient outcomes.
- Trained physicians, nurse practitioners, LVNs, medical assistants, and support staff on clinical quality standards, workflows, infection prevention, and compliance requirements.
- Led infection prevention and patient safety programs across all health centers, including annual competencies, sterilization oversight, hand hygiene education, and healthcare-associated infection monitoring.
- Delivered training on sterilization procedures and autoclave maintenance protocols for 33 employees, ensuring adherence to safety and compliance standards.
- Coordinated smoking cessation, diabetes management, hypertension, and retinal screening quality improvement initiatives.
- Expanded retinal clinic services and trained staff to support additional clinic operations.
- Supported implementation of the Patient-Centered Medical Home (PCMH) model through protocol reviews, chart scrubbing standards, and daily operational huddles.
Education
Master of Science - Healthcare Administration
Southern New Hampshire University
Hooksett, NH09-2022
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
Hooksett, NHSkills
- Quality control and compliance
- Issue resolution management
- CMS data reporting and analysis
- Analytical reporting
- Joint Commission compliance standards
- Root cause identification
- Patient safety initiatives
- Healthcare regulatory strategies
- Data reporting and analytics
- Proficient in systems: Epic, Athena, eClinicalWorks, Power BI, SharePoint, Genesys Cloud, Welteam, Propio, i2i Tracks
- Systems: Epic Athena eClinicalWorks Power BI SharePoint Genesys Cloud WelTeam Propio i2i Tracks Population Management
Certification
- Six Sigma Lean Green Belt in Healthcare, Management and Strategy Institute, Medical Assistant/Cardiac Technician Certificate, Associated Tech College — Los Angeles, CA
Accomplishments
- Resolved an average of 75 grievances monthly within regulatory turnaround requirements
- Reduced grievance resolution timelines to an average of three weeks
- Supported quality improvement and compliance oversight across seven clinic sites
- Chaired Quality Improvement Committee and Participant Advisory Committee meetings
- Managed HPMS submission processes and CMS quarterly agenda preparation
- Led Joint Operations Incident and Grievance preparation activities
- Developed workflow transition processes to ensure uninterrupted departmental coverage
- Conducted mock audits and regulatory readiness activities across multiple PACE markets
Affiliations
- National Society of Leadership and Success
- American Cancer Society Colon Cancer Initiatives
Timeline
Interim Quality Improvement Director (QID)
WelbeHealth
08.2024 - 03.2025
Quality Improvement Specialist
WelbeHealth
03.2024 - Current
Quality Improvement Coordinator
THE Health and Wellness Center
08.2015 - 02.2024
Master of Science - Healthcare Administration
Southern New Hampshire University
Bachelor of Science - Healthcare Administration
Southern New Hampshire University