Sue Baker-Kohnke, BSN, RN, MBA, CCM
Senior Consultant, Clinical
Sue has over 35 years of health care industry experience working in clinical nursing and government-sponsored (Medicare Advantage, Medicaid, Marketplace) insurance programs. Her areas of expertise include utilization management (which includes monitoring and making recommendations for over- and under-utilization), medical management, appeals and grievances, quality improvement, and NCQA certification. Also, Sue has experience in improving HEDIS and STAR rating performance as well as improvement of population health management programs and outcomes. Sue’s overall mission and vision is to support health care industry providers in achieving optimal outcomes for both individuals and populations as well as improved patient/member experience in navigating the complex health care industry.
Prior to consulting, Sue served in various health plan leadership roles acting as Senior Director, Utilization Management as well as Director Quality Improvement and HEDIS Reporting.
Sue has twenty-one years of leadership experience and earned a Master of Business Administration in Health Care Management from the University of Phoenix. She holds a Certification in Case Management (CCM) credential and is in the process of obtaining her Certified Professional in Healthcare Quality (CPHQ) certification.