LeeAnn Moore, RNC, BSN, CCM

Experience

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  Interim Healthcare

  Dec 1993 - Feb 1999

  Home Care Case Manager/Supervisor
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  Highmark, Inc

  Mar 1999 - Jun 2017

  Pediatric Case Management Specialist

  Proposed position to management and built out role to better meet case management goals and outcomes for families of children with special needs. Utilized motivational interviewing and other strategies to enhance transition of care activities, care planning, and care coordination among healthcare providers as well as local, state, and federal resources. Additional experience as member of Pediatric Palliative Care Coalition in PA, helping to author report to Dept. of Public Welfare on need for systemic funding for services. Show less

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  Highmark Health

  Jun 2017 - Jul 2023

  Set and communicated audit policies and procedures and engaged a team in audit reviews of utilization management, clinical quality, provider performance, and other data. I also reviewed and reported findings to senior leadership and fostered collaboration across units in the use of audit data to improve processes, initiatives, and outcomes. Highlights of my contributions include:• Directing processes for the expansion of existing audit programs (UM CQA, Provider, Medical Injectable, Gold Card), developing a team and establishing procedures for new audits.• Contributing to a proposal for a major clinical quality and compliance project involving the automation and streamlining of quality audit processes, with a potential for savings of $750K.• Leading an effort to transition all Inter Rater Reliability (IRR) programs from an eliminated Training & Development Department to a centralized to Clinical Quality Audit team.• Creating audit process SOPs and tip sheets to reflect updated policies and establishing a single centralized repository for housing documents across the organization.• Meeting an identified need for increased support, resources, and plans for internal professional development, boosting the confidence of audit team members while better fulfilling organizational performance goals. Show less Supervising business analysis processes in a fully remote position with a focus on elevating quality and compliance in clinical services, I hired, trained, developed, and engaged an audit team in implementing routine analysis activities and special projects. I also provided effective change management to ensure the fulfillment of objectives while navigating internal transitions in staffing and program administration.Highlights of my contributions include:• Directing a project to transition audit activities from an interim team to a dedicated team within just six weeks' time, ensuring the successful recruitment and onboarding of a high-caliber audit team to meet needs.• Driving improved medical record audit scores over the course of 2022 through targeted provider education in collaboration with leadership in the quality function.• Heading the development of a new audit tool to enable the validation of policies and compliance with newly passed West Virginia House Bill 2351. Show less Engaged as a remote-based internal consultant specializing in compliance with accountability for leading a project to build out new audit tools and processes to meet changing operational needs, I led end-to-end processes to design audits, validate appropriateness and consistency, and manage data administration requirements.Highlights of my contributions include:• Creating a Utilization Management Clinical Quality (UMCCQA) audit, improving the consistency of review of authorization requests handled by UM nursing staff and creating standardized processes for the validation of appropriateness.• Building out a new Provider Medical Record audit tool to more effectively review provider documentation within an Epic-based medical record repository and validate quality, appropriateness, and compliance of documentation.• Realizing significant improvements in Provider Medical Record audit scores, boosting an 83% rate to a target 95% rate from Q2 to Q4 2022.• Liaising with Fraud, Investigation, and Pay (FIPR) in the process to design and create a comprehensive audit for opioid misuse and abuse, improving our risk management stance.• Contributing to the development of new Access database and Tableau data repository to support enhanced review and approval of authorization requests. Show less With accountability for leading audits for internal/external cases, I ensured compliance with corporate standards, partner requirements, and industry regulations; identified and reported non-compliance issues as well as determined root cases; delivered reports; and contributed to remediation processes.Highlights of my contributions include:• Introducing a new pharmacy vendor and site of care audits improving outcomes in prior authorization appropriateness alongside potential cost savings.• Managing a project to compile and analyze quarterly and annual case management member satisfaction surveys, and engaging a member workgroup in the development of strategies to enhance member response while reducing costs.• Collaborating with case and care managers to enhance program efficacy and satisfaction. Show less

  • Manager, Risk and Compliance Analysis

    Nov 2022 - Jul 2023

  • Supervisor, Business Analysis

    Jan 2022 - Nov 2022

  • Compliance Consultant

    Mar 2018 - Jan 2022

  • Senior Compliance Analyst

    Jun 2017 - Mar 2018
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  Sharecare

  Dec 2023 - now

  Manager, Compliance