Mayling Naputi is a Registered Nurse (RN) Senior Consultant at Gorman Health Group (GHG). In this role, she has been involved in readiness assessments, the development and implementation of the Centers for Medicare & Medicaid Services (CMS) corrective action plans (CAPs), preparation for CMS audits, including remediation and validation audits, gap analysis of work flows, conducting mock audits, and ensuring regulatory requirements are incorporated into care management processes. She has experience in policy and procedure (P&P) compilation and implementation, Model of Care (MOC) development and support, and managing the Health Risk Assessment (HRA), Individualized Care Plan (ICP), and Interdisciplinary Care Team (ICT) review process.
In addition, Mayling offers clients assistance and leadership in the application of industry best practices for increasing care management effectiveness and optimizing resource utilization. She provides expertise and guidance in the care management of high utilizers and complex members, including addressing engagement issues related to homelessness and poverty.
Mayling has more than 30 years of experience in the healthcare industry. She has been afforded the opportunity to work in a variety of settings, each uniquely contributing to her specialized skillset and knowledge base. She worked as a staff nurse for the VA Behavioral Unit, and, at Sharp HealthCare, she was part of the first heart transplant program in San Diego working as a critical care RN. Later, Mayling became part of the County of San Diego’s HIV/AIDS Case Management Program whose model of care became the platform for integrating care for patients with catastrophic conditions to engage with healthcare providers and achieve better medical outcomes and improved social conditions.
Mayling also worked for UnitedHealthcare, the Medical Services Organization for the County of San Diego’s Health and Human Services Agency, where she managed the Low Income Health and County Medical Services Programs’ Medical Management Services Department. While holding this position, she developed the staff structure and operational workflows for care management practice and utilization review of inpatient stays and high-cost drugs, managed a provider call center, and assisted in the adjudication and responses for organization determinations and appeals.
Prior to joining GHG, Mayling was the Director of High Risk Case Management at a non-profit health plan. While there, she was responsible for the day-to-day operations, recruitment, hiring, and management of RN Care Managers and staff development and training of licensed and non-licensed staff.
Mayling holds a Bachelor of Science degree in Nursing from San Diego State University and resides in Chula Vista, California.