Night Cha, BS, MPA, MHA

Experience

• 

  Blue Cross Blue Shield of Rhode Island

  Sept 2002 - Sept 2013

  • Provide direction and education to members identified as having a condition and/or need, which will benefit from these interventions. • Enroll members into health management programs utilizing engagement and motivational interviewing techniques. • Conduct outreach assessments to members to develop, monitor, and implement personal lifestyle plans. • Research extensive information as requested by nurses, members and managers. • Collaborates on cross-functional teams including clinicians; providers, nurses and other case managers into bridging the gap in care for members in compliance with company expectations.• 5 Star Medicare Rating Projects: Osteoporosis; BMI Well Visit• Special Projects: HEDIS, Osteoporosis, State of RI, HA Care Levels. • Health Advocate Role: Assisted with the creation of duties of the role of the HA. Show less • Liaison to coordinate peer to peer reviews, fostering professional relationships with providers and their office staff. • Maintain tracking system to ensure regulatory and accreditation of compliance with timeliness of medical records. • Budget: Establish and maintain Disease Management, Medical Management and External consultant budget of 300k+. • Administrative Support to the Office of Medical Directors, Chief Medical Officer, Senior Medical Directors, and Senior Directors as well as Disease Management, Fulfillment Team and Health Coaches. • Coordinator for Medical Peer Review Committee Meeting Show less

  • Health Advocate

    Apr 2010 - Sept 2013

  • Support Specialist

    Sept 2002 - Apr 2010
• 

  Neighborhood Health Plan of Rhode Island

  Sept 2013 - now

  • Manages a diverse team of managed care professionals • Oversees operational activities of the Care Management area of the Medical Management department, as it relates to member outreach and engagement. • Staff development, hiring, coaching and managing the day-to-day activities. • Identifies and recommends opportunities for improvement and implements process improvement activities • Assists in developing and operationalizing new programs, and ensures regulatory and contractual requirements.• Ensures ongoing monitoring, evaluation, and outcome measurement for all Case Management (CM) member outreach programs: SUB, CSN, RHP, Bright Start• Collaborates with Director of Case Management, VP of Medical Management, Chief Medical Officer and Medical Director on new and existing member outreach programs• Manages the development of policies and procedures and ensures annual review and revision Show less • Integral member of the Care Management Team working closely with members, providers and peers to ensure quality of healthcare needs are met. • Research and develop plan of care that meets compliance. • Provide planning and support to MMP Integrity Program• Facilitate direction, community resource assistance, and education to high-risk member population. • Developed and recorded Community Care Coordinator (CCC) manual, provided onboarding training and mentor new CCC staff members.• Collaborate with Nurse Case Manager, Housing Specialist, Social Worker and Rehabilitation Specialist on any needs• Collaborate with an interdisciplinary team and external home care agencies in order to coordinate care including home care services. Show less • Project management reporting process updated with appropriate information including preparing and compiling periodic progress reports to the Senior Management Team.• Special Projects: HEDIS Team - HEDIS Improvement Team Lead and the HEDIS Specialists to collaborate with provider sites to improve clinical outcomes and performance measures as well as address gaps in care.• Coordination of training of HEDIS nurses in preparation of medical record review and provide continuous support throughout the HEDIS season to them.• Provide administrative support to the Evaluation & Improvement Department. Support to HEDIS team to reach NCQA standards.• Liaison responsible for maintaining positive professional relationships with in network and out of network hospitals, clinics, private practices and other healthcare facilities as well as interdepartmental collaboration Show less

  • Manager of Clinical Engagement - Medicaid

    Sept 2022 - now

  • Community Care Coordinator - Case Management

    May 2016 - Sept 2022

  • Project Administrator-Department of Evaluation and Improvement

    Sept 2013 - May 2016