MPA, CHCA, Chief Executive Officer, & HEDIS® Auditor
A Certified HEDIS® Compliance Auditor since 2005, Suzan has performed nearly 300 National Committee on Quality Assurance (NCQA) HEDIS® Commercial, Medicaid, and Medicare compliance audits as well as Centers for Medicare Services (CMS) Data Validations reviews. Suzan’s additional work experience includes California’s Integrated HealthCare Association (IHA)’s Value Based Pay for Performance audits and consultancy work in the area of quality and performance improvement for health plans, medical group, and hospitals. Suzan holds a Master’s of Art degree in Public Administration with a focus on Healthcare Administration.
MA, Chief Health Economist
James (Jim) is responsible for analytical reporting design, statistical analysis, and oversight. As a previous HEDIS® auditor, Jim performed HEDIS® audits and performance measure validation reviews across the country. Jim has developed value propositions, ROI models, and statistically based predictive models targeting multiple aspects of managed care. Jim also has devoted many years to developing standard analytical methods and reporting processes for HEDIS® and CAHPS®. Jim was responsible for all survey research and statistical analysis in a health plan setting. Jim holds a Master’s of Arts in Economic Theory and Econometrics with a focus on health care economics and health policy.
JD, Chief Compliance Officer & Sr. VP Regulatory Affairs
Stacy earned her J.D. from the University of San Diego School of Law and has been working in the regulatory compliance field for over 15 years. Stacy served as the Director of Legislative & Regulatory Affairs and Medicare Compliance Officer at Sharp Health Plan for the past 10 years. Stacy has extensive experience interpreting and implementing both state and federal statutory and regulatory provisions and sub-regulatory guidance. Stacy has served as the primary health plan liaison to numerous regulatory bodies including the California Department of Managed Health Care (DMHC), Covered California, CMS, the Department of Labor and CCIIO. Stacy has worked closely with all aspects of health plan operations and delegated entities to ensure compliance with new and existing laws impacting health plan operations and is keenly familiar with the impact on those health plan operations.
Information Technology Manager
With over 10 years of information technology experience, Sergio has been aiding companies grow their technological capabilities with keen insight and creative ideas. Sergio is a lifelong learner, gaining proficiencies in client-server environments, networking, information security, and cloud-based solutions. Sergio brings a unique blend of education, change management experience, and a deep understanding of the technical and organizational aspects of information systems. Over the course of his career, Sergio has helped various organizations develop and implement strategic IT roadmaps that align with and support business process improvements, innovation, and organizational growth. Sergio is a strong proponent of lean-agile IT methodologies. He believes information technology is an integral part of a company that fosters productivity, collaboration, and innovation to a business organization. He has led QMetrics over the years in adopting and implementing technologies that align with these IT principles. Sergio earned a Bachelor of Science in Applied Arts and Science in Management Information Systems from San Diego State University.
MHA, Vice President Surveys & Applied Analytics
As a nurse April, has been in local and national roles in healthcare quality at corporate insurance organizations such as Sharp Healthcare, United Healthcare, and Health Net/Centene. April’s main objective was to lead population health strategy and address the factors at the intersection social health and health outcomes. Most recently, she served as the Chief Operating Officer (COO) of San Diego Workforce Partnership and as the Vice President of Population Health and Performance Excellence at San Ysidro Health. April is from Sacramento and moved to San Diego 16 years ago while in the Navy with her husband. The couple now has one daughter. April earned her Bachelor’s of Arts degree in Health Education from Trident University, and her Master’s of Arts in Healthcare Administration from the University of Southern California.
MBA, Senior Director Strategy & Program Management
Applying her strong background in project management and communications, Kelly has successfully driven organizational transformation, change management, and process improvement initiatives for several health care companies. Kelly has also led large-scale implementations for information technology (IT) systems and driven new business development projects. She has significant experience in building programs targeted to improve employee satisfaction and improve internal company culture as well as programs to improve the customer experience. Kelly has created and implemented public relations and marketing campaigns. She has worked with both Medicaid and Medicare health plans, direct delivery provider clinics, and Medicaid Management Information Systems. Kelly holds an MBA with an emphasis in Organizational Leadership from Brandman University.
MS, Health Care Data Analyst
Jeff has extensive experience in the fields of public health and continuous quality improvement. His work has been focused on improving patient outcomes through QI projects with providers, health plans, and consumers. Jeff has created analytic reports, presented to provider groups and health plans with a focus on understanding the underlying data and its implications on processes, and developed software to track patient care and enhance processes of care delivery. Jeff earned a Master’s of Science in Mathematics with a concentration in Operations Research.
MPH, Senior Healthcare Consultant
Erin has developed a wealth of knowledge about survey methodology, implementation, analysis, and process improvement through her education and 15+ years in the healthcare field. Working in Quality at a health plan, Erin implemented HEDIS, managed the Access & Availability survey, and chaired the Service & Operations Quality (SOQ) Council with a focus on CAHPS improvement strategies. In the Consumer Research department at a large integrated healthcare delivery system, Erin led patient experience, provider loyalty, and ad-hoc marketing surveys for the entire system. In her role as a Lean Six Sigma Black Belt, Erin led teams to improve key metrics using the DMAIC, LEAN and Change Acceleration Process models. Erin holds a Master’s of Public Health degree with a focus on Public Health Administration and earned a Lean Six Sigma Black Belt certification.
Administrative Project Manager
Applying her strengths in project management, budget compliance and interpersonal skills, Rachael managed a Fortune 300 company’s largest national accounts. As a result, her contributions directly impacted the organization’s ability to expand, gaining Rachael recognition and accolades from the executive team. At QMetrics, Rachael is responsible for the oversight of daily operations for the company including the role of liaison between the executive team and support staff.
Regulatory Affairs Senior Advisor
Bob has extensive experience in the health care industry and working for health plans in Operations and Regulatory and Compliance serving as a Director and Executive leader for multiple full service and specialty health plans. Bob was the Director of Compliance at Health Net of California and Director of Policy and VP of Government Contracts at Molina Healthcare of California. Bob has served as the liaison for multiple health plans with key regulatory agencies and government contracts including the Department of Managed Health Care, Department of Health Care Services, Covered California, and CMS. Bob has also created and led legislative and regulatory implementation including implementation of the Affordable Care Act.
MS, Data Analyst
Dana has developed her knowledge and understanding of healthcare data analytics and project management through her education and two years working as a HEDIS data analyst at a managed care plan. She managed the administrative portion of the HEDIS audit as well as a HEDIS software platform transition. Her work on improving data management processes, sourcing new data, and implementing new data sources improved the managed care plan’s ability to report accurately. Dana earned a Masters of Science in Biostatistics.
Sarah works as an Administrative Assistant supporting QMetrics’ President & Founder, Suzan Mora Dalen. Sarah has an uncanny ability to remain calm while managing many project and tasks. Her enthusiasm to support, learn, and contribute have earned her many accolades in her various positions and roles. Sarah is a graduate of San Diego State University with a Bachelor’s degree in English and is a published author.
MA, Quality Programs Consultant
Megan has utilized her strong background in project management to drive operational excellence and process improvement at several healthcare organizations. Her work has been primarily focused on improving the quality of care provided to healthplan members by improving the implementation of HEDIS, CAHPS, and quality improvement initiatives at a managed care plan. As a result, Megan’s contributions directly impacted the organization’s confidence in quality measurement and areas of opportunity within the network. Megan earned her Master’s of Arts degree in Healthcare Leadership.