Senior Vice President, Clinical ServicesJane brings to Gorman Health Group clients more than 33 years of experience in the healthcare industry. Her experience expands to the areas of quality improvement, utilization and medical management, claims operations, and provider/associate education. She also has an extensive knowledge of federal regulations and health plan compliance. To complement her health plan background, Jane has more than two decades of clinical nursing experience.
In her role at GHG, Jane has provided her broad health industry expertise to dozens of health plans and providers across the country. As one of the industry leaders on the topic of the Centers for Medicare & Medicaid Services (CMS) Quality Bonus Payment Program, Jane leads GHG’s Star Ratings optimization program, facilitating assessments and strategic plans to drive plan ratings. She has also guided plans in the development of Model of Care (MOC) and Quality Improvement Programs, CMS-required submissions such as Quality Improvement Projects (QIPs), and prepared plans for CMS MOC review with great success. Jane also has experience with new Medicare Advantage plans and Accountable Care Organizations (ACOs) in the development of CMS applications and plan implementation processes.
Jane has 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. From leading plans through development and submission of CMS applications and plan implementation to operational assessments and audits, Jane has contributed to the success of many of GHG’s clients.
Prior to joining GHG, Jane served as the Medicare Compliance Officer and continued on as the 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 over six percent per year. Jane has held a number of other senior positions in the Medicare managed care industry.
Jane is in demand as a speaker at industry conferences on such topics as Star Ratings management, Special Needs Plan population management, Models of Care, and Medicare Part C and Part D industry requirements.