Susan Taylor

Experience

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  New Mexico Mutual

  Oct 1991 - Oct 2010

  Corporate governance including compliance auditing and monitoring. External auditor facilitation. Operational internal audits. Complaint management and recovery. Legal assistance to General Counsel. Liaison to NM Division of Insurance and NM Workers Compensation Administration. Pioneered secure internet application for personal auto and homeowners insurance applications. Fully automated manual processes for policy management and claims administration. Coordinated all aspects of computer and telephone systems move to new building. Set strategic direction for the IT department. Selected and implemented policy administration and claims management applications for startup company including database and hardware. Comply with regulatory reporting. Implement disaster recovery model with routine testing.

  • Compliance Manager

    Nov 2004 - Oct 2010

  • IT Project Manager

    May 1997 - Nov 2004

  • EDP Manager

    Oct 1991 - May 1997
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  Hoffmantown Church

  Nov 2009 - Apr 2010

  Host Site Event Coordinator - Volunteer

  Coordinated city-wide simulcast event volunteers from four different churches. Set timelines and milestones for the group. Ran meetings and followed up on critical deadlines. Managed core team of six leaders to ensure timely and effective communication between the team members and their workers. Ensured that individuals from divergent backgrounds were invited and welcomed. Event lasted 6-hours and included a meal. Interested participants were connected with one of the partner churches for follow-up. Show less

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  Lovelace Health Plan

  Mar 2011 - Dec 2013

  Direct the daily operations, activities and personnel for the quality management program of multi-state health plan covering 210,000 lives insured by Medicare, Commercial HMO and PPO, and Medicaid. Develop implement programs and projects to assure that goals for the quality management program are reached, including NCQA accreditation, Medicare STARS rating bonus program, CCIPs, QIPs, NM HSD PIPs, and PMs. Effectively communicate results to executive leadership and throughout the health plan and garner support for quality improvement. Oversee the Quality of Care program. Strategically manage budget and consulting contracts for HEDIS data management and auditing, CAHPS and HOS survey vendor, clinical research firm, health information line, and NCQA accreditation preparation and application. Chair the cultural and linguistic competency committee developing education and awareness for providers and employees of possible member health literacy limitations, cultural preferences and language barriers. Utilize CLAS standards, CMS, State and NCQA requirements as a launching point for problem identification, barrier assessment and intervention development. Show less Demonstrated high levels of skill and proficiency to compile and analyze data, prepare reports and presentations on HEDIS, CAHPS, HOS, STARS, CCIP, QIP, PIP, and PM. Worked with various departments to ensure tasks are completed in a timely manner. Dedicated and willing to assist in projects as needed and take on new challenges. Organized and skilled in project management. Exhibited a strong ability to plan, develop and coordinate multiple projects; ability to analyze and interpret data; proven ability to lead in a complex organization. Employed excellent team building skills. Show less

  • Quality Director

    Sept 2012 - Dec 2013

  • Accreditation Program Manager

    Mar 2011 - Sept 2012
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  Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

  Feb 2014 - Oct 2014

  Sr Mgr Govt Pgm Delegation Oversight

  Responsible for the coordination and direction of the Enterprise Government Programs delegation oversight processes designed to monitor and assess health plan functions according to corporate, regulatory and accreditation requirements.

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  Presbyterian Healthcare Services

  Dec 2014 - Jul 2024

  Led, designed, and supported the PHP Population Health and Quality Program improving quality, health and wellness, health related social needs, patient safety, appropriate utilization of medical services in accordance with best medical evidence, and accreditation readiness to assure quality care and regulatory compliance.Provided pertinent perspective in development of measurement processes in conjunction with the Chief Medical Officer, and Chief Operating Officer of PHP across all lines of business. Participated in the development, collection, and reporting of clinical performance measurements. Managed regulatory and accreditation compliance activities related to PHP Quality Program functions (e.g., NCQA, HSD, CMS, etc.) Hired, trained, and coached a diverse team of population health licensed professionals and leaders. Show less

  • Director of Quality Improvement

    Sept 2021 - Jul 2024

  • PHP Performance Improvement Manager

    Dec 2014 - Sept 2021