Angela M. Panotes, LCSW, CPHQ, PMP

Experience

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  Healthfirst

  Sept 2006 - now

  • Lead cross-functional teams and drive the NYS DOH PIP, Quality Matrix, Focus Study, and EQRO quality improvement activities required for Medicaid, CHIP, and MLTC products; the CMS CCIP mandated for Medicare Advantage and D-SNP contracts; and the NCQA HEDIS Roadmap for all lines of business.• Develop root cause analyses/corrective action plans in accordance with regulatory standards and implement process improvements across the enterprise from inception to completion that increase HEDIS, CAHPS, and Medicare Star ratings.• Monitor, analyze, and report on KPIs to ensure that organizational goals, performance targets, and regulatory requirements are met.• Prepare project proposals, progress reports, and presentations for regulatory entities, executive leadership, and stakeholders. Show less • Designed health promotion programs for smoking cessation and pediatric obesity that established new workflows; optimized technology and clinical tools; created content for member education materials, provider newsletters, and the corporate website; and leveraged partnerships within the community.• Conducted interdepartmental reviews and coordinated audit preparedness efforts for the NYS DOH Article 44/49 and NCQA HEDIS & QRS Compliance audits, achieving no deficiencies within Clinical Quality for the past 6 years. Show less • Promoted within 3 years to direct a team of 11 clinical staff (MDs, RNs, LMSWs, allied health professionals) who conducted on-site provider education visits and implemented work plans that closed care gaps, securing the plan’s top tier ranking in overall quality and member satisfaction scores in Medicaid.• Facilitated staff training on HEDIS/QARR guidelines; created medical record review workflows; administered inter-rater reliability testing; and quality-checked chart abstraction activities to ensure compliance with NCQA standards. Show less

  • Senior Manager, Clinical Quality

    Mar 2016 - now

  • Clinical Studies Manager, Clinical Quality

    Jun 2010 - Feb 2016

  • Manager, Quality Improvement

    Sept 2009 - May 2011

  • Quality Improvement Clinical Manager, Quality Improvement

    Sept 2006 - Aug 2009
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  NewYork-Presbyterian Hospital

  Apr 2011 - Jun 2012

  Weekend Per Diem Discharge Planner, Social Work

  • Expedited discharges for a 32-bed adult inpatient medicine unit in collaboration with a multidisciplinary team and facilitated referrals to SNFs, hospice, SUD facilities, shelter system, and Adult Protective Services, as necessary. • Provided concrete services, crisis intervention, and supportive counseling.

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  Hospital for Special Surgery

  Aug 2012 - now

  Weekend Per Diem Case Manager, Case Management

  • Conduct comprehensive psychosocial assessments of pediatric and adult patients to identify discharge planning needs and coordinate services between CHHAs, home infusion agencies, DME vendors, acute/subacute rehabilitation facilities, transportation companies, and community resources.• Lead interdisciplinary medical rounds and collaborate with patients and their families to develop safe, appropriate discharge plans in compliance with JCAHO standards and case management best practices.