Tina Harris

• Through data analysis and research, identified, developed and implemented HEDIS data collection strategies, while staying within budget.
• Led the HEDIS project for the California commercial market, improving NCQA Health Plan ratings in treatment and prevention.
• Developed and revised policies and standard operating procedures and job aides to drive for operational efficiencies and excellence.
• Collaborate with Clinical Initiatives to research and brainstorm the root cause of any HEDIS measures not leading in the Market.
• Engaged collaborative accountable care groups and market-facing partners with the goal of improving HEDIS rates.

New pilot program called Absence Prediction and Prevention Program:

• Predictive Model identified customers who may have a high likelihood of going on disability within the following year.
• Assessed customers to tailor a plan based on their needs and preferences.
• Collaborated with Vocational Counselors, EAP counselors on more complex cases.
• Coached customers on lifestyle changes.
• The pilot decreased the incidence of disability by 16% in a study group vs. a control group.

• Team Lead for a new program dedicated to an employer group.
• Instrumental in developing workflows.
• Mentored a team of Health Advisor, contributing to the development of new program, workflows and achieving performance guarantees through effective case management and coaching
• Provided case management and coaching to customers with the goal of improving health and well-being, decreasing costs, and meeting performance guarantees.

• Collaborated with physicians and hospital staff to plan a smooth transition to a lower level of care from the acute hospital setting to Acute Rehab, SNF, or home health.
• Facilitated physician-to-physician communications to avoid gaps in care.
• Achieved average cost saving of $50,000 per month

• Performed telephonic review of customers in acute care, evaluating clinical data for medical necessity.
• Assisted with timely discharge planning and approval of transportation, skilled nursing, or home health.
• Promoted to Inpatient Case Manager Supervisor after 9 months.
• Promoted to Inpatient Case Manager Supervisor after 9 months, who performed onsite and telephonic utilization review in 10 states.
• Strong knowledge of provider contracts and hospital contracts to improve cost effectiveness.