Kimberly Clarridge

Experience

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  Scottsdale Healthcare

  Jun 2004 - Jun 2007

  Registered Nurse

  Responsible for providing patient care in all critical care areas including: neuroscience, cardiothoracic surgery, medical, surgical and trauma; Preceptor to student nurses, new graduates, and new hire nurses during the orientation process; Member of the Rapid Response Team fostering collaboration between critical care nurses and medical-surgical nurses.

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  Desert Palms Assisted Living

  Jun 2004 - May 2007

  Nurse Consultant

  Responsible for assessing and completing nursing care plans for each resident. Over saw the organization, planning and coordination of care on a weekly basis for Medicare/Medicaid, Long Term Care and private pay residents. Evaluated and solved quality of care issues, ensuring individualized care for all residents. Responsible for the design and delivery of a variety of training courses and other interventions for employees. Creating pro-active and responsive solutions to business needs and seizing opportunities for continuous improvement in individual, team, business unit and organizational performance. Specific duties include preparation and facilitation of training courses and other interventions for employees to include the design of instructional materials for training and participant materials. Responsible for performing miscellaneous duties related to training and development. Show less

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  Optum

  Jul 2007 - Jan 2022

  Responsibilities include resource expert for NCQA and/or URAC standards and their interpretation. Utilization of web-based accreditation platforms. Provide gap analysis; develop and manage a project plan designed to identify, track and close gaps. Conduct mock audits, identifying issues and communicating to business leads. Complete on-line applications, maintenance attestations, and organizational change notifications. Collect supportive evidence; evaluate evidence and submit relevant online documents to NCQA and/or URAC. Organize and support Clinical Operations staff for planned and unplanned site visits/audits. Develop and conduct employee training regarding the accreditation standards and their intention as needed. Communicate changes to standards to the accredited area in a timely manner and incorporate changes into the preparedness plan. Proactively identify and communicate accreditation risks and potential barriers to the accredited area; develop a plan of action to address risks and/or barriers. Interact collaboratively with Clinical Operations and Product Directors and staff to ensure continuous accreditation compliance. Interact collaboratively with other business segments as indicated. Demonstrate the ability to meet required timelines. Interact with accreditation agency and other regulatory and compliance bodies. Facilitate and attend the onsite accreditation survey and any onsite monitoring visits. Enter all issues identified during the accreditation survey into the issues database. Provide ad hoc consulting to functional areas, which may include analysis, reporting, recommendations for Quality Improvement Plans and any other accreditation related items. Take an active part in the development and documentation of Quality Improvement Projects (URAC)/Process Improvement Measures (NCQA). Provide guidance to Clinical Operations and Product and ensure completion of yearly program evaluations and program descriptions. Show less Identified candidates for case management utilizing available resources. Identified problems or gaps in care requiring intervention; ability to identify if member is able and willing to accept intervention. Developed care plan in collaboration with member/family addressing gaps and focusing on areas for maximum impact. Consistently assessed plan of care for continued opportunity for impact and intervention. Promoted cost-effective health care consistent with value proposition. Coached and influenced members to take action. Promoted, coordinated, and facilitated collaboration amongst all parties to achieve stated goals and to insure informed decision making. Coordinated health care delivery to reduce fragmentation of health care and to maximize member outcomes. Supported and encouraged members to self-management. Facilitated partner and other referrals to meet consumer needs making best use of resources. Collaborated with medical directors to attain optimal outcomes and cost-effective services. Worked directly with physicians and ancillary providers to assist in the navigation of the complex health care delivery system. Arranged appropriate high-quality services when needed. Maximized the use of community services. Strived for continuity of care. Coached members through their use of health care products and services. Assessed the effectiveness and quality of services provided through clinical, functional, and financial impact and outcomes. Served as client advocate and maintained client's privacy, confidentiality and safety. Adhered to ethical, legal/regulatory and accreditation standards. Responsible for consumers with Diabetes, Coronary Artery Disease, Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure. Thoroughly versed in the policies of assigned accounts including Medicare Primary Cross Carrier; Member of the Health Advocate Initiative providing customer demonstrations; Successfully completed United Manager Program; Phoenix ISO representative. Show less

  • Director of Clinical Quality-Accreditation

    Oct 2014 - Jan 2022

  • Senior Enterprise Accreditation Manager

    Oct 2010 - Oct 2014

  • Nurse Case Manager

    Jul 2007 - Oct 2010
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  URAC

  Sept 2021 - now

  • Chair of the Accreditation Committee

    Sept 2023 - now

  • Vice Chair of the Accreditation Committee

    Sept 2021 - Sept 2023
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  Cityblock Health

  Jan 2022 - Mar 2024

  Head of Care Management Delegation

  Implemented Cityblock’s Delegated Case Management Program to complement Cityblock’s value based care model to provide personalized, community-based care to improve the health and well-being of underserved populations. Oversight of federal, state & contractual quality compliance requirements.Responsible for conducting end-to-end audits for CMS and state-led care management program audits to support Cityblock’s health plan clients. (e.g. MMPCC, D-SNP, EQR, ISCA, PMV, etc.)

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  Aetna, a CVS Health Company

  Mar 2024 - now

  Executive Director of Delegation