Jean

MA, RN, PLNC, PCMH CCE

Jean has over 20 years experience working as a Senior Executive in managed care. Her areas of expertise include quality improvement, regulatory compliance, new business development, process improvement and accreditation preparation.

Jean has been an NCQA Administrative Surveyor since February, 2009 and currently performs surveys for NCQA including Health Plan (HP), Managed Behavioral Health Organization (MBHO), Multicultural Health Care (MHC), Physician Organization Certification (POC) and Patient Centered Medical Home (PCMH). She holds a Certified Content Expert (CCE) Certification for PCMH and is a Legal Nurse Consultant for review of medical records for malpractice cases.

Jean has served as a Clinical Director for a Health Center with 43,000 members in a Staff HMO model and implemented principles of Total Quality Management with an increase in departmental efficiencies and a decrease in full-time employees (FTE’s). She has also held positions as a Quality Improvement Director for two HMO’s with multiple lines of business overseeing all department aspects including CMS, State Regulatory Compliance, HEDIS and NCQA Surveys. Jean has also held a position as an adjunct faculty member for six years teaching “Quality in Health Care Administration”.

Jean’s extensive background includes implementing a Quality Improvement program and infrastructure for the New Jersey Children’s Behavior Health Program. In this position Jean facilitated process improvements for three health plans fostering consistency in practices among regional plans in credentialing, appeals and contracting. She was also a project lead for successful implementation of newly awarded HMO’s, Behavioral Health programs, Medicaid and Medicare line of businesses.

Jean has also been responsible for  implementing processes at a corporate level  that lead organizations through an NCQA Accreditation survey and attaining  successful accreditations for two health plans. She has assisted clients in obtaining a successful award of proposal contracts, NCQA Accreditation, PCMH Recognition, and oversight of their Quality Improvement Departments.

Jean is an RN and obtained a Bachelor of Professional Arts from St. Joseph’s College, Windham, Maine (Health Care Administration track), and a Master of Arts in Human Services (Health Care Administration track) from Rider University, Lawrenceville, New Jersey and Certification for Legal Nurse Consulting from Jurex Center.

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