Peg Novak, RN, BSN, MBA

Senior Consultant, Clinical

Peg Novak provides consulting services to health plan medical management and quality services, with a focus on STAR rating improvement and federal and state regulatory and accreditation compliance of quality performance measures. 

 

Since 2013, Peg has assisted health plans in obtaining compliance with CMS and Medicaid agencies as well as URAC and NCQA accreditation through process improvement.  Her extensive experience encompasses utilization management, medical claims, prior authorization management, case management, disease management, quality improvement, credentialing, provider contracting, Model of Care development, and CMS audits, remediation, and corrective actions.  She has expertise working within managed care, long term care, hospital, and ambulatory care settings, focusing on risk management, performance improvement, compliance, and customer service. 

 

Prior to consulting, Peg held managerial and executive positions in various healthcare arenas, including Sub-Acute Hospital and Nursing Home Administrator, State Director of Medical Services in managed care, Chief of Performance Improvement and Director of Nursing Services.  She led two military ambulatory care centers to excellent health care compliance ratings and a regional ambulatory care service center to its highest ranking in customer service. 

 

Peg holds a BS in Nursing and an MBA with a focus in Healthcare Management. 

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