Senior Clinical Consultant
Jane Scott is Senior Clinical Consultant at GHG. In this role, she is responsible for leading GHG’s Clinical Innovations practice area. Jane brings GHG clients 37 years of experience in healthcare as one of the industry leaders on the topics of the Centers for Medicare & Medicaid Services (CMS) Special Needs Plans (SNPs), development and implementation of Models of Care (MOCs), as well as the Star Ratings Quality Bonus Payment Program. Her experience expands to the areas of quality improvement (QI), utilization and medical management, claims operations, and provider/associate education. Further, she has extensive knowledge of federal regulations and health plan compliance as well as experience with new Medicare Advantage plans and Accountable Care Organizations in the development of CMS applications and plan implementation processes.
During her hiatus from GHG, Jane most recently led the Professional Services Department for Censeo Health specializing in CMS risk adjustment support programs. Prior to that, Jane was the Chief Compliance Officer for Health Integrated, a care management vendor.
Jane has utilized her broad health industry expertise by guiding plans in the development of MOC and QI Programs, CMS-required submissions such as QI Projects, and has prepared plans for CMS MOC reviews. Jane has also helped to ensure health plan compliance with Medicare regulations and CMS guidelines by performing audit readiness assessments, mock audits, policy and procedure development, and corrective action plan submission, and additionally from leading plans through development and submission of CMS applications and plan implementations to operational assessments and audits.
Jane is often asked to speak at industry conferences on topics such as Star Ratings management, SNP population management, MOC, and Medicare Part C and Part D industry requirements.
Prior to joining GHG, Jane served as the Medicare Compliance Officer, before promotion to Director of Medicare Program Management for Government Programs, for Health Net of Arizona. Under her leadership, Health Net of Arizona experienced increased total revenue for their Medicare programs of more than six percent per year. Jane has held a number of other senior positions in the Medicare managed care industry. To complement her health plan background, Jane has more than two decades of clinical nursing experience.