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Karla Loper
EXPERIENCE
Present Position
Health Net Federal Services, Inc.
Director, Clinical Quality Management
Responsible for leadership of a 37 member staff in achieving contractual
compliance and excellence in Clinical Quality Management, Retrospective
Review without Diagnostic-Related Group (DRG) Validation, Interface with
the National Quality Monitoring Contractor, Veterans Affairs
Community-Based Outpatient, and Clinic Clinical Quality Management for
TRICARE North Managed Care Support Contract.
Leader in research and development of clinical health care monitors used
in improving health care services delivered to 2.9 million beneficiaries
over a vast geographic area. With
substantial independence, directs assigned staff in health care quality
assessment (monitors, research and clinical quality studies), assurance
(patient safety and potential quality issue investigation), and
improvement (corrective action plans and quality improvement initiatives
using CMS protocols).
Directs comprehensive program of performance review and improvement,
such as delivering services to the Veterans Health Administration aimed
at secure continuing accreditation by the Joint Commission.
Surveys and researches emerging
standards for quality assessment and national monitors offered by or
anticipated from consensus agencies in the clinical quality arena,
including AHRQ, NQF and CMS.
Manages rigorous statistical evaluation of clinical findings and trends,
and engages industry experts and academic faculty in the effort.
Identifies and pursues professional and business opportunities to
favorably distinguish her company from market competitors.
Manages program governance (Clinical Quality Management Committee and
Quality Board) and supports appointed directors in their oversight of
the clinical quality program. Participates
in other governance entities including the Credentials Committee,
Utilization Management Committee, Quarterly Quality Committee, Quality
Improvement Council, National Capital Area Joint Command Joint Task
Force Quality Sub-Committee, and URAC Steering Committee).
Edward Martin and Associates, Inc.
Senior Consultant
Provided consultation services in executive management, health care
design and operations, and clinical management to corporations and
government agencies, particularly in support of the DOD TRICARE Program.
Consultations were provided
concerning clinical and customer services, call centers and contact
systems, patient appointing, medical service optimization, strategic
planning, executive problem solving, quality improvement, and contract
proposal writing and evaluation.
Assistant Executive Director and Director Regional Service
Center
Served as principal deputy regional chief executive for a major TRICARE
region (TRICARE Mid-Atlantic Region 2). Directed
on-site corporate staff; served as principal for communications with
Government customers; directed largest customer service call center in
the Military Health System, leading a 300+ person region-wide,
virtually-integrated call center contact system providing medical
appointing and benefit services, referral support and provider services,
and processing over 3 million calls annually. Integrated advanced
technologies into operations, ensured continuity of operations, and
enhanced service quality. Developed
Region 2 for Humana Military Healthcare Services, Inc. (HMHS)
establishing operational strategy, identifying problems and effective
solutions, and implementing internal controls in the context of
executive management systems and processes.
Directed significant regional
interests across a broad range of support services including information
management, technology and systems, facilities management, contract
administration and communications, executive correspondence, and
documentation. Key member of
regional senior team engaged in guiding operational advancement and
business process development. Engaged
directly with Government customers and regional governance to
anticipate, understand, and respond to significant program interests.
Substantially to be credited for
the high quality of the HMHS relationship with its customers.
Acting Director, North Carolina Service Area
Directed company operations serving all North Carolina customers: Fort
Bragg, Camp LeJeune, Marine Corps Naval Air Station Cherry Point, and
Seymour Johnson Air Force Base, and "white space" areas.
Led Case Managers, Discharge
Planners, Health Care Finders, Beneficiary Service Representatives and
administrative staff in achieving satisfying cost effective outcomes.
Singularly accountable for all
fiscal and contractual compliance standards in North Carolina and for
associated business and clinical optimization interests.
Led
Case Managers, Discharge Planners, Health Care Finders and
administrative staff in achieving satisfying, cost effective outcomes.
Singularly accountable for all
fiscal and contractual compliance standards for Seymour Johnson and Ft
Bragg and for associated business and clinical optimization interests.
North
Carolina Health Care Finder Manager
Responsibilities included North Carolina Managed Care Support Contractor
Staffing and Operations at Ft. Bragg, Camp LeJeune, Marine Corps Naval
Air Station Cherry Point and Seymour Johnson AFB.
Staffing responsibilities include
supervision of Case Managers, Discharge Planners, Health Care Finders
and administrative staff. Accountable
for all fiscal and contractual compliance standards in North Carolina.
Established a fully functional and fiscally responsible TRICARE Service
Center, providing excellent customer service with a competent,
productive staff. Facilitated
enrollment and education of over 10,000 beneficiaries in 1998.
Ingenuity assisted in
multi-region $3.08 billion contract success.
Many processes at Seymour Johnson
became benchmarks for Region 2.
University of Texas; Master of Science, Nursing Administration
University of North Carolina at Charlotte, Charlotte, NC; Bachelor of
Arts, Biology; Bachelor of Science, Nursing
Various continuing education and graduate level courses in Healthcare
Quality
Registered Nurse, Virginia, District of Columbia
Six
Sigma Green Belt, Certification
2008
Certified Professional in Healthcare Quality, Expiration December 2009
Member, Sigma Theta Tau, Nursing Honor Society
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