Senior Clinical Consultant
Peg Novak is Senior Clinical Consultant at Gorman Health Group (GHG). In this role, she provides senior consulting services pertaining to health plan medical management and health services, with a focus on Star Ratings improvement and the regulatory compliance of quality performance measures through the functions of Utilization Management, Prior Authorization Management, Case Management, and Disease Management. Peg brings GHG clients more than 30 years of experience in multiple arenas of the healthcare profession, including management and administration in the medical services and provider contracting areas of managed care and long-term care; hospital systems, with the focuses on quality and federal and state compliance; and military ambulatory healthcare, with the focuses on risk assessment, performance improvement, compliance, and customer service.
Since joining GHG, Peg has assisted health plans in obtaining compliance with Centers for Medicare & Medicaid Services (CMS) through the improvement of their processes in health services, provider networks, appeals and grievances and customer service. In addition, she has worked with multiple plans in mock CMS audits and remediation, provided Medicare training for plan medical management staff, and has assisted health plans in the development of corrective action responses for CMS.
Throughout her career, she has successfully developed effective organizational policies and procedures, created new staff training, set up case management programs, and was instrumental in the development of the first utilization management program for a regional managed care organization. She led two military ambulatory care centers to excellent health care compliance ratings and a regional ambulatory care service center to its highest ranking in customer service.
Peg holds a bachelor’s Degree in Nursing and a master’s Degree in Business Administration, with a focus in Healthcare Management. She resides in Tucson, Arizona.