BSN, RN, CCM, CPHQ
Tina has been instrumental in helping organizations.
In her consulting role with MHR, Tina has been instrumental in working with organizations successfully through several NCQA accreditation programs for Health Plans, Managed Behavioral Health, Population Health Program, and Case Management. Additionally, she has consulted as part of MHR teams with health plans and behavioral health organizations on all lines of business on case management and utilization management, including review of denial and appeal files for all lines of business.
Prior to consulting, Tina was the Director of Quality Management, which transitioned into a part-time Quality Management Project Management role at Beacon Health Options in New Jersey, a Managed Behavioral Health Organization, which was formerly known as Value Options. In this role, Tina was involved in designing and implementing HEDIS Initiatives, accreditation readiness for the Commercial, Medicaid, and Medicare memberships, and collaborating with two clients (Horizon NJ Health and Horizon BCBS NJ).
Prior to the role at Beacon Health Options, Tina was the Corporate Director of Quality Management for AmeriHealth Caritas Family of Companies for two years, which included the Medicaid and Medicare product lines for seven states. As Corporate Director, Tina was responsible for oversight of Quality and Credentialing for ten plans (combined Medicaid, Medicare Duals, and Special Needs Plans) within the organization. The Quality Program included HEDIS, STARs, credentialing and ongoing maintenance of enterprise compliance with regulatory, contractual, and NCQA accreditation standards. Tina traveled extensively to work with the plans to provide direction and oversight of enterprise-wide and plan-specific Quality Management Initiatives, NCQA accreditation process, and state audit compliance.
Tina joined Keystone First Health Plan (formerly Keystone Mercy Health Plan) in 2004 as Director of Quality Management and was promoted to Sr. Director and then again to Corporate Director of Quality Management. As Corporate Director of Quality Management, both credentialing and delegation oversights were added to her responsibilities. In this role, her accountability included developing a strategic focus for HEDIS and CAHPS, NCQA Accreditation, successful State oversight audits, and standardization of key quality processes across the organization.
As an Administrative Surveyor for NCQA since 2013, Tina has surveyed several programs on behalf of NCQA that have included: Managed Behavioral Health Organizations (MBHO), Health Plan Accreditation, Multicultural Health Care (MHC), Credentials Verification Organizations (CVO), and Case Management Long Term Services and Supports (CM- LTSS), and Population Health Program accreditation. Additionally, in this same role, Tina participates in the Model of Care (CMS) review process.
Tina received a Diploma in Nursing from Our Lady of Lourdes School of Nursing, Camden NJ, and a Bachelor of Science in Nursing from Thomas Edison University in Trenton NJ. Tina has held a Certified Case Management (CCM) certification since 1998, is a Certified Profession in Healthcare Quality (CPHQ) by the National Association of Healthcare Quality since 1996 and was formerly a Fellow of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) 1995- 2019, currently Emeritus.Return to About Us