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.
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.
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.
Quality Control Coordinator
Isabel has six years of call center and customer service experience. Isabel’s responsibilities include leading quality assurance within QMetrics’ surveys product line. Her strength in communication and organization are demonstrated in her ability to work well with both colleagues and clients. Isabel thrives in a team environment, allowing her to excel in coaching and training opportunities. Isabel is a graduate of San Diego State University with a Bachelor’s degree in Political Science.
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.
Project Manager, Process Excellence
Breanna brings over seven years of experience in healthcare working as a claims adjuster and project manager. Breanna has extensive experience partnering closely with Health Plan clients to manage member appeals & grievances and member reimbursement requests. She applies her strong leadership and communication skills to training team members and resolving customer service inquires. Breanna is highly focused and organized, allowing her to support the Data Aggregation Validation (DAV) program at QMetrics. She enjoys working with team members and providing her assistance on projects.
Senior Product Director, Data Aggregator Validation Program
Thuy-Tien’s passion for all things pertaining to data, strategic planning and creative solutioning empowers her deep understanding and experience in statistical analysis, campaign implementation, and project management. Her guidance with highly focused data-driven and multi-pronged strategies achieves optimal results in all the projects she is involved with. Thuy-Tien’s experience spans tech start-ups, value-based organizations, and large national health plans in the areas of healthcare operations, health services, risk management and quality improvement. This diverse experience has allowed her to navigate through some of our healthcare system’s largest challenges. She has been able to maximize the efficiency of varied processes and effectively manage and expand client operations to realize the full potential financial benefits of their operations. Thuy-Tien’s personal mission remains improving the lives of vulnerable populations and empowering individuals and families to make healthy life decisions. She earned her Bachelor’s degree from Dartmouth College, and a Master’s of Public Health from University of California Los Angeles.
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.
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.
Project Manager, Process Excellence
After obtaining her Medical Assistant certification in 2012, Jasmine set out to gain firsthand experience in face-to-face patient care where she learned the value of applying quality to every aspect of health care. Jasmine then held various positions in Claims Examination, Enrollment Leadership, and Encounter Data Analysis. Her strengths in organization and critical thinking have allowed her to successfully manage multiple projects. Jasmine’s excellent use of leadership, coordination, and communication ensured deadlines were met while reporting status updates to executive leadership. Jasmine’s current focus is dedicated to providing outstanding work and to continue to increase her knowledge of the vast world of healthcare.
VP Analytics & Innovative Technology
Robb is a seasoned expert with a passion for transforming data into knowledge — driving change within the healthcare system. His 20+ years of analytics experience includes health economics, business intelligence, predictive modeling, and data science. As the leader of Vista Healthplan’s Healthcare Economics team, Robb was instrumental in the company’s success by supporting all Commercial and Government Programs lines of business and eventually contributing to a turnaround and sale of the company to Coventry Health Care. Robb’s extensive experience includes building in-house analytics capability within Social Service Coordinators, the leading Dual Eligible Outreach organization in the Medicare Advantage space. At Change Healthcare, Robb implemented market-leading AI-driven solutions for consumer engagement, risk, and quality analytics. He holds an MA degree in Economics from Illinois State University and an MS degree in Math Education from Nova Southeastern University. He has 15+ years of experience building and leading diverse teams. Robb also taught Economics as an adjunct instructor for over 10 years at Broward College.
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.
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.
A published author, Sarah’s responsibilities at QMetrics include marketing, research, projects support, and driving employee engagement. 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.
Surveys Program Administrator
Bringing over 15 years of healthcare experience focused in customer service, Elizabeth has worked in various customer-centric roles in both provider offices and for a managed care plan. Elizabeth’s expertise in both Medi-Cal and Cal MediConnect include serving for several years as a contact center leader and is also a certified customer service facilitator. As a proactive leader, Elizabeth developed focused training tools including knowledge articles and desktop procedures to build team strengths and increase contact center agent productivity, while also improving call center service levels. Elizabeth earned a Master’s of Business Administration Degree from California State San Marcos.
Associate Director, Quality Programs
Megan has significant experience in improving the quality of care provided to patients and health plan members by improving the implementation of HEDIS, CAHPS, and other quality improvement initiatives. 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 the development and coordination of medical record abstraction for the validation of data for several quality improvement initiatives. As a result, Megan’s contributions directly impacted clients’ confidence in quality measurement and areas of opportunity within their networks. Megan holds a Master’s of Arts degree in Healthcare Leadership.