KAREN COMES

SENIOR CONSULTANT

 

Karen is a Quality Improvement (QI) professional with more than 20 years of experience in QI, accreditation, care management, and compliance in health settings that include acute care, ambulatory care, home health care, managed care, and care management programs. Karen worked in the managed care division of a national health services organization for more than 16 years in progressively increasing leadership roles that included Healthcare Center Manager, Project Manager and Director of QI. As the Director of QI, Karen was responsible for Healthcare Effectiveness Data and Information Set (HEDIS®), National Committee for Quality Assurance (NCQA) health plan accreditation, practitioner and provider credentialing, member and practitioner satisfaction, member and practitioner complaints and appeals, member health education, and risk management.

Karen’s most recent position was with a large national care management vendor as the Vice President of QI and Accreditation. In this role, she was responsible for NCQA and URAC accreditation for the case management, disease management, and utilization management programs, QI initiatives to include supporting client HEDIS® and Star Ratings initiatives, as well as client delegation support and oversight. In this role, Karen also provided support to clients on Medicare and Medicaid regulatory compliance to include development and implementation of processes and to support client delegation of Special Needs Plan (SNP) programs. Karen promoted organizational compliance with HIPAA privacy and security by developing policies and processes to support federal regulatory requirements to include developing and implementing processes to support oversight of downstream entities and offshore vendors.

Karen is a Registered Nurse licensed in Florida and Texas with a Bachelor of Science in Nursing and a Master’s in Health Services Administration. Karen is also a Certified Professional in Healthcare Quality (CPHQ) and has Certification in Healthcare Compliance (CHC).

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