Karen Comes, RN, MS
Senior Consultant, Clinical
Karen is a Quality Improvement (QI) and care management professional with more than 30 years of Medicare, Medicaid, and commercial health care experience in QI, accreditation, care management, special needs plans (SNPs), and regulatory compliance in multiple health settings including managed care, ambulatory care, and acute care.
Karen’s most recent role was as a Senior Director with a consulting firm providing expert quality, accreditation, regulatory, and care management consultant support to various clients. There she supported numerous health plan clients with developing their initial and renewal SNP models of care and achieving 3-year approval from CMS.
Karen has also served as the Vice President of Quality and Accreditation for a large national care management vendor. In addition to her quality, compliance, and accreditation responsibilities, she provided primary oversight of implementation and management of delegated care management processes for case, disease, and utilization management programs, as well as delegated care management processes for SNP populations to ensure compliance with client, accreditation, and CMS requirements.
Karen is a Registered Nurse with a Bachelor of Science in Nursing and a Master’s in Health Services Administration. She is a Certified Professional in Healthcare Quality (CPHQ) and has Certification in Healthcare Compliance (CHC). Karen is an accreditation surveyor with the National Committee for Quality Assurance (NCQA).