Executive Vice President, Clinical and Quality
Jane brings over 35 years of experience in healthcare as one of the industry leaders on Special Needs Plans (SNPs), development and implementation of Models of Care (MOCs), as well as the Star Ratings Quality Bonus Payment Program. Her experience expands to the areas of quality improvement (QI), utilization and medical management, claims operations, and provider/associate education. She has extensive knowledge of federal regulations and health plan compliance as well as experience with new Medicare Advantage plans and Accountable Care Organizations in the development of CMS applications and plan implementation processes.
Jane has utilized her broad health industry expertise to guide plans in the development of MOC and QI Programs, leading CMS-required submissions such as QI Projects, and preparing plans for CMS MOC reviews. Jane has also helped to ensure health plan compliance with Medicare regulations and CMS guidelines by performing audit readiness assessments, mock audits, policy and procedure development, and corrective action plan submission, and has helped lead plans through development and submission of CMS applications and plan implementations to operational assessments and audits.
Jane often speaks at industry conferences on topics such as Star Ratings management, SNP population management, MOC, and Medicare Part C and Part D industry requirements.