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Cathy McClain Gordon
Senior Consultant

Cathy has over 25 years of health care industry experience working with government-sponsored (Medicare Advantage, Medicaid, HIX, and TRICARE) and commercial insurance programs. Her focus is assessing and transforming health care operations and establishing process controls for monitoring regulatory compliance, quality management, provider network contracting and maintenance, system implementations, and business development.

 

Cathy has worked across various health plan and physician group functional areas including utilization management, quality improvement, provider data management, claims, appeals and grievances, FWA, and credentialing and leverages her extensive knowledge of health plan operations and physician group management to assess current state operations and deliver exceptional solutions to managing financial risk and optimizing care.  Over the years, Cathy has helped clients to achieve operational efficiency, launch new service offerings, develop and deploy successful risk adjustment strategies, perform delegation oversight and monitoring, develop care coordination models, execute provider network incentive models, and employ quality improvement strategies to meet CMS, HEDIS, State and health plan quality measures.

 

Prior to consulting, Cathy served in various health plan leadership roles acting as VP of Commercial and Medicaid Products and VP of Health Services at Optum, Sr Director of Operations & Strategic Projects and Sr Manager of Clinical Training & Quality at Health Care Services Corporation, and Network Manager at Anthem Alliance Health Insurance Company. 

 

Cathy earned a Master of Health Administration from Governors State University.  She is also an alum of America’s Health Insurance Plans (AHIP) Leadership Development Program and current member of the Advisory Cloud Board Directory.