Shetikee L.M. Ware
Boca Raton
Summary
Results and mission driven quality, risk and compliance management professional with over fifteen years of solid leadership and work experience in managed care, government contracting and both long-term and short-term acute care hospital settings. Expertise in creating and execution of quality, risk and compliance management programs. Expertise in reading, analyzing and applying healthcare law and regulations. Key strengths include: Exemplary leadership skills and a trusted counsel, leading with a proactive, mission-driven, tactical and logistical leadership style. Instilling strong sense of responsibility, resilience, discipline, productivity measures, coaching/guidance, motivation/vision, stewardship, making sound and measurable decisions and exercising superior judgment Highly productive/effective, analytical, energetic leadership with expertise with developing strong teams with training and management skills. Proven leadership ability in the implementation of strategic goals, plans and enterprise-wide projects. Demonstrated excellence in problem solving, taking complex information and tailoring to audience, planning, organizing, time management and ensuring compliance in organizational standardized processes Superior communication skills with demonstrated ability to speak at all levels of organization (frontline to Board of Directors), effective listening, and exceptional interpersonal skills with diplomacy and tact. Consistently successful in implementing corporate structure and objectives in health plan operations: Medicare/Medicaid regulatory requirements, National Committee for Quality Assurance (NCQA) standards and accreditation, Healthcare Effectiveness Data and Information Set (HEDIS), STAR rating results, Consumer Assessment of Healthcare Providers and Systems (CAHPS), delegation, reporting, health plan audits, population health management, annual satisfaction survey oversight, clinical quality program management, Request for Proposals (RFPs), Intent to Negotiate (ITNs), Regulatory compliance, accreditation and survey readiness, regulatory audits, driving and implementing change.
Senior Director of Quality Improvement with extensive experience in providing strategic leadership for quality improvement initiatives across diverse business units. Successfully organized and managed resources and procedures to implement enterprise-wide quality improvement strategies, ensuring compliance with NCQA accreditation requirements. Oversaw a team responsible for HEDIS program management, delivering effective oversight that contributed to improved quality outcomes. Demonstrated ability to influence stakeholders and drive change through innovative solutions in compliance and quality improvement programs.
Accomplished professional adept at driving team performance, business strategies, and making data-supported recommendations for continuous process improvement. Skilled at identifying optimal tactics for motivating teams and engaging clients.
Accomplished management professional adept at building high-performing teams. Proven ability to drive cross-functional collaboration and implement innovative solutions to complex business challenges. Committed to delivering results that exceed expectations while maintaining a focus on continuous improvement and sustainable growth.
Overview
9
9
years of professional experience
Work History
Senior Director of Quality Improvement
Premier Eye Care of Florida
Boca Raton
02.2019 - Current
- Provide strategic leadership and direction for all business units on quality improvement initiatives, and developing innovative initiatives to improve overall quality outcomes.
- Organize and oversee activities, resources and procedures to achieve enterprise-wide quality improvement strategy.
- Execute effective oversight of enterprise HEDIS offering to ensure profitability.
- Deliver effective oversight of enterprise NCQA accreditation requirements.
- Manage a team of 7 direct reports.
Director of Quality Improvement, Delegation and Compliance
Premier Eye Care of Florida
Boca Raton
02.2019 - 12.2024
- Provide oversight of Quality Improvement (QI), Compliance and Delegation program management for this managed eye care plan that provides routine vision, medical and surgical eye care for four million insured members through a national network of contracted physicians and facilities.
- Conduct ongoing communication with health plans.
- Support the organization by providing compliance leadership in the specific areas of ongoing NCQA accreditation surveys and federal/state QI compliance activities.
- Responsible for internal and external audits, compliance training, analysis of data and quality systems improvement and ensure ongoing compliance with all applicable regulations and standards through the continuous review of these systems.
- Manage a team of 3 direct reports.
- Review and implement health plan regulatory requirements, health plan contract agreements and implement new delegation regulatory requirements.
- Develop and maintain compliance program, work plan and policies and procedures.
- Develop and maintain quality improvement program, work plan and policies and procedures.
- Quality Improvement Committee (Chair), Compliance Committee (Chair) and member of UM and Credentialing Committees.
- Review delegation agreements, maintaining a subject matter expertise of operational, reporting, and accrediting requirements for all lines of business (Medicaid, Medicare) that are delegated.
- Maintain organizational licenses for 39 states and apply for new licenses (Third-Party Administrator (TPA) licenses, Certificates of Authority, UR licenses).
- Oversight of Risk management program, adverse incident reporting and training for providers.
Director of Quality and Risk Management
Kindred Healthcare
03.2018 - 02.2019
- Supported Kindred Hospital Bay Area Chief Executive Officer through Governing Board and quality management reviews.
- Responsible for oversight of hospital-wide quality review programs, regulatory compliance with healthcare accrediting standard for utilization review, quality improvement, infection control and risk management.
- Responsible for facility risk management activities, which include claims against the facility, interfacing with legal counsel, administering the risk management program on a day-to-day basis, managing and analyzing risk management data to control and minimize loss.
- Managed a team of 8 direct reports and evaluate performance of staff.
- Maintained current environment of care, patient care, utilization review and quality improvement plans, policies, procedures and programs endorsed by the Governing Board.
- Coordinated, integrated and assessed all quality review activities for hospital patient care, health information management, utilization review, quality improvement, infection control and risk management.
- Educated, advised and assisted Medical Staff allied health care personnel and hospital managers in the quality review and improvement processes.
- Facilitated communication and implemented changes in accrediting and regulatory standards.
- Maintained knowledge of State and Federal Laws and regulatory agency requirements for hospitals.
- Managed all Code 15 or Sentinel Events.
- Reported quality and risk management key performance indicators to Patient Safety and Reliability, Quality Council, Medical Executive and Governing Board Committees.
- Provided leadership and training to hospital operations team on complying with and survey readiness for The Joint Commission and State Risk Management requirements of the Agency for Health Care Administration (AHCA).
Manager, Quality Improvement
WellCare Health Plans
12.2016 - 03.2018
- Responsible for oversight and management of statewide Medicaid managed care contract, accreditation initiatives, state and regulatory quality compliance, HEDIS and quality improvement initiatives for process improvement plans, delegation audits, support External Quality Review Organization (EQRO), quality management Scorecard reporting and performance metrics of organizational goals.
- Oversight of all Quality Improvement (QI) contractual requirements for the Plan (Nebraska market included NE, IA, KS and SD).
- Prepared and submitted all required reporting to the State.
- Represented the Plan in government meetings with the State.
- Managed a team of 12 direct reports.
Education
Master of Jurisprudence - Health Law, compliance concentration
Loyola University Chicago School of Law
Master of Public Administration -
Bellevue University
Bachelor Science - Health Care Management
Bellevue University
Associate Science - Nursing
Metropolitan Community College
Skills
- Quality improvement strategy
- NCQA accreditation oversight
- HEDIS program oversight
- Compliance program development and oversight with state and federal regulatory bodies
- Ability to design, execute and bridge strategy with operations
- Ability to drive change and deliver creative solutions
- Ability to influence others
- Contract and vendor management
Affiliations
- Health Care Compliance Association, 03/01/17
- National Association for Healthcare Quality, 01/01/20
Professional License
Florida Multi State Compact License-Registered Nurse, #RN9483361
Timeline
Senior Director of Quality Improvement
Premier Eye Care of Florida
02.2019 - Current
Director of Quality Improvement, Delegation and Compliance
Premier Eye Care of Florida
02.2019 - 12.2024
Director of Quality and Risk Management
Kindred Healthcare
03.2018 - 02.2019
Manager, Quality Improvement
WellCare Health Plans
12.2016 - 03.2018
Master of Jurisprudence - Health Law, compliance concentration
Loyola University Chicago School of Law
Master of Public Administration -
Bellevue University
Bachelor Science - Health Care Management
Bellevue University
Associate Science - Nursing
Metropolitan Community College