Susan Vermette
Hampton,NH
Summary
Detail-oriented clinical professional committed to improving organizational outcomes by monitoring performance initiatives. Focused on planning, implementing, and optimizing procedures. Specializing in operations and dedicated to maximizing quality.
Overview
39
39
years of professional experience
Work History
Quality Coordinator
Interim HealthCare
Manchester, NH
02.2023 - Current
- Work with the Quality Assurance- Performance Improvement (QAPI) and Compliance Managers to implement strategies for the QAPI program. Perform comprehensive assessments and OASIS reviews.
- Responsible for completing audits and OASIS reviews per regulatory requirements and corporate policy for the organization's QAPI program.
- Collect data, and develop goals and educational targets, in collaboration with the leadership team, to enhance performance improvement targets, quality service, and organizational efficiency. Educate clinicians on quality performance scoring initiatives.
- Provide leadership for implementing changes targeted at system improvement and evaluate attainment of results.
Clinical Quality Improvement Manager
WellSense Health Plan- BMC HealthNet Plan
Manchester , NH
08.2014 - 12.2021
- The Quality Improvement Manager serves as the NH Quality Improvement Director.
- Responsible for programmatic development, assuring departmental policy and clinical quality improvement initiatives comply with the health plan's State Medicaid contractual obligations, Federal regulatory requirements, and NCQA accreditation standards.
- Lead QI initiatives utilizing standard QI processes to track data and performance metrics to assure compliance with the health plan's QAPI plan.
- Collaborated with the Plan's disciplines and departments (i.e., Case Management, Utilization Review, Behavioral Health, Provider Relations, and others) to ensure alignment of organizational goals, evaluate opportunities for improvement, and develop interventions to advance QI metrics and goals.
- Oversight for the development of the Plan's Provider Quality Incentive Program initiatives, and titrated progress toward project improvement goals.
- Served as liaison to providers, health systems, local care agencies, and various NH DHHS departments in support of partnership opportunities for the enhancement of services provided to our members.
- Responsible for reviewing, investigating, and implementing contractual reporting requirements surrounding the Plan's sentinel events, adverse events, and member grievances for the Plan's New Hampshire and Massachusetts product lines.
- Provide support for achieving the Plan's NCQA accreditation for both New Hampshire and Massachusetts product lines.
- Responsible for the development and maintenance of the Plan's QAPI, Performance Improvement Projects (PIPs), and External Quality Review Organizations (EQRO) goals, communications, and activities.
Director of Quality Improvement
Meridian Health Plan, a WellCare
Manchester, NH
03.2014 - 08.2014
- Lead, coordinate, and ensure documentation of QAPI, accreditation, and regulatory activities for the health plan. Implemented the quality functions of the NH State Contract and Meridian's QAPI program in a timely manner, consistent with contractual obligations.
- Fostered partnerships with statewide Area Agencies, FQHCs, health systems, and community service agencies to enhance quality and coordination of care provided to members.
- Led and directed the plan's accreditation survey process with the External Quality Review Organization (EQRO). Developed Performance Improvement Projects (PIPs) based on the assessment of member needs and submitted PIPs to the EQRO for approval and attain authorization to implement initiatives.
- Oversight for the Member and Provider Advisory Committees, the Grievance Committee, the Quality Improvement Committee, and the CHAPS survey process.
- Served as the organizational leader for the HEDIS and CHAPS reporting and improvement initiatives, including the development of strategy and action plans for all key HEDIS measures, monitoring of HEDIS data collection, medical review, and the analysis of data to identify opportunities for improvement.
- Collaborated with interdisciplinary departments such as Case Management, Care Coordination, and Behavioral Health to evaluate opportunities for improvement and implement interventions based on the analysis of data for over- and under-utilization.
Clinical Quality Project Manager
Elliot Health System
Manchester, NH
11.2009 - 09.2013
- Accountable for the clinical project management of quality measures by supervising, educating, developing, and implementing operations for CMS Core Measures, HEDIS, Accountable Care Organizations (ACO), and Joint Commission (TJC) related indicators throughout the inpatient and outpatient sectors of the health system.
- Collected and analyzed report data in monitoring the quality of services provided, trend analysis, and results of continuous quality improvements.
- Directed and collaborated with multidisciplinary teams, nurse managers, medical chiefs, and chairs within the health system to assess, develop, and implement processes and performance improvement measures, as well as operational quality objectives.
- Promote quality in clinical practice by collaborating in the development of medical guidelines, best practices, and criteria for measuring quality and the appropriateness of care related to NCQA/HEDIS, pay-for-performance initiatives, and CMS core measures.
Director Medical Triage Call Center
Alicare Medical Management
Salem , NH
04.2008 - 11.2009
- Accountability for a large, nationwide, 24/7 medical triage call center representing hundreds of hospitals, primary and specialty care physician practices, and insurance companies throughout the United States.
- Assessed, developed, and implemented the ongoing customer service and telehealth care needs of all individual contracts.
- Mentored and developed a call center staff of 25 to 30 registered nurses.
- Responsible for accreditation compliance with Utilization Review Accreditation Commission (URAC) and American Academy of Ambulatory Care Nursing Standards. (AACN).
- Utilized telephonic applications, decision support tools, and EMR reporting to track and analyze staff performance, service metrics, patient outcomes data, and cost containment initiatives.
Director, Ask A Nurse Program
Catholic Medical Center
Manchester, NH
03.1999 - 11.2008
- Responsible for all aspects of a statewide 24/7 medical triage call center, providing clinical triage and comprehensive medical referral. Mentored and developed a call center staff of 15 to 20 nurses and support staff.
- Prepared and implemented a sizable departmental budget, and managed multiple marketing and customer service initiatives.
- Performed a routine analysis of the statistical quality reports in evaluating the effectiveness of processes, departmental goals, and initiatives. Assessed and modified triage guidelines to minimize legal risk and achieve call processing objectives.
- Worked alongside staff routinely to process triage calls and maintain firsthand awareness of all the challenges and rewards that providing quality service entailed.
- Routinely composed health-related articles are published in the CMC Newsletter and other publications arranged by the health systems Communications Department.
- Note: Worked as a staff triage nurse at Ask A Nurse for one year prior to attaining the Director position.
Staff-Weekend Charge Nurse, Gero-Psych Unit
Elliot Hospital
Manchester, NH
11.1997 - 03.1999
- Performed a comprehensive physical and psychiatric nursing assessment of the geriatric population in the setting of a locked psychiatric unit.
- Collaborated with multidisciplinary teams to evaluate the patient's response to treatments and modalities. Prepared patients for and assisted with the process for Electro Convulsive therapy (ECT) treatments. Performed in the capacity of the Charge Nurse on weekends.
Registered Nurse - Developemntal Disabilities
Moore Center Services Inc.
Manchester, NH
06.1986 - 03.1999
- Collaborated with physicians, nurses, therapists, social workers and other healthcare professionals to develop individualized treatment plans for each patient.
Education
Diploma in Nursing - Nursing
Catholic Medical Center School of Nursing
Manchester, NH01-1982
Coursework Towards BSN 1979-1982 -
University of New Hampshire
ManchesterCoursework towards RN to MSN Program 2012-2015 - RN To MSN Program
Southern NH University
ManchesterSkills
- Quality assurance and regulatory compliance
- Data analysis and performance improvement
- Clinical guideline adherence
- Project management
Timeline
Quality Coordinator
Interim HealthCare
02.2023 - Current
Clinical Quality Improvement Manager
WellSense Health Plan- BMC HealthNet Plan
08.2014 - 12.2021
Director of Quality Improvement
Meridian Health Plan, a WellCare
03.2014 - 08.2014
Clinical Quality Project Manager
Elliot Health System
11.2009 - 09.2013
Director Medical Triage Call Center
Alicare Medical Management
04.2008 - 11.2009
Director, Ask A Nurse Program
Catholic Medical Center
03.1999 - 11.2008
Staff-Weekend Charge Nurse, Gero-Psych Unit
Elliot Hospital
11.1997 - 03.1999
Registered Nurse - Developemntal Disabilities
Moore Center Services Inc.
06.1986 - 03.1999
Diploma in Nursing - Nursing
Catholic Medical Center School of Nursing
Coursework Towards BSN 1979-1982 -
University of New Hampshire
Coursework towards RN to MSN Program 2012-2015 - RN To MSN Program
Southern NH University
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