Sheila Muller, RN
Senior Consultant, Clinical
Sheila’s background includes 40 years of nursing and healthcare management experience in strategic planning, compliance, operations, standards of practice, accreditation, privacy, quality, clinical risk management, contracting, credentialing, utilization management, case and care management, pay-for-performance and quality incentive (QI) programs, disease management, life planning (hospice and palliative care), infection control, health information management services, grievances and appeals in varied settings including acute and long-term care hospitals, community-based organizations, private equity groups, managed care plans, provider organizations, clinics, PACE centers, and behavioral health/chemical rehabilitation care centers, including many senior leadership positions, as well as clinical nursing focused on Emergency Department and Trauma control nurse in a level II trauma unit.
Sheila serves as a clinical leader conducting due diligence reviews for mergers, acquisitions, bankruptcies, and consolidations and prepares organizations for CMS audits, TJC (Joint Commission), NCQA Accreditation and other voluntary accrediting organizations such as AAHC, URAC, and CHAPS. Additionally, Sheila works with organizations to drive improvement with HEDIS outcomes and Star Ratings and has provided review, investigation and/or expert testimony in over 40 matters for medical management, credentialing and compliance matters and multiple case investigations for fraud, waste, and abuse.
Sheila is a recognized speaker on compliance and credentialing, including publications with the American Health Lawyers Association and healthcare operations. She is licensed as a Registered Nurse in the state of California and is a current California state auditor and a contractor with the Centers for Medicare and Medicaid Services (CMS) to conduct Independent Validation Audits (IVAs).