Patricia Kelly

Senior Consultant, Clinical

Patty provides clinical expertise to medical management and health services with a focus on CMS regulatory guidance, quality improvement and NCQA.  She brings over 35 years of experience in the healthcare and health insurance industry. Her areas of experience include management and administration of services, utilization management, case and disease management, discharge planning, prior authorizations, appeals and grievances, and quality across Medicare, Medicaid, Exchange, and commercial lines of business.

 

Patty has assisted in the development, implementation, auditing, and monitoring of programs surrounding Special Needs Plan Models of Care (SNP MOC) and managed care, utilization management, case management, and discharge planning to ensure compliance with regulatory guidance. She has experience in developing and implementing quality programs and processes to support regulatory guidance and STAR measures, including creation and implementation of policies and procedures and training to ensure consistency and accuracy of processes.

 

Patty has served as a Manager and Director of Utilization Review and Care Management for several leading healthcare organizations. Patty holds a bachelor’s degree in Nursing and is a certified case manager and life care planner. ​