Shetikee Ware

About Shetikee Ware

Strategy and Results driven quality and process improvement, risk and compliance management professional with over fifteen years of healthcare operations. Solid leadership and work experience in managed care, government contracting and both long-term and short-term acute care hospital settings. Expertise in leading performance improvement, quality, compliance and risk management programs. Key strengths include:• Exemplary leadership skills and a trusted counsel, leading with a proactive, mission-driven, tactical and logistical leadership style. Instilling strong sense of responsibility, resilience, discipline, productivity measures, coaching/guidance, motivation/vision, stewardship, making sound and measurable decisions and exercising superior judgment• Highly productive/effective, analytical, energetic leadership with expertise with developing strong teams with training and management skills. Proven leadership ability in the implementation of strategic goals, plans and enterprise-wide projects. Demonstrated excellence in problem solving, taking complex information and tailoring to audience, planning, organizing, time management and ensuring compliance in organizational standardized processes• Superior communication skills with demonstrated ability to speak at all levels of organization (frontline to Board of Directors), effective listening, and exceptional interpersonal skills with diplomacy and tact.• Consistently successful in implementing corporate structure and objectives in managed care health plan operations: Medicare/Medicaid regulatory requirements, National Committee for Quality Assurance (NCQA) standards and accreditation, Healthcare Effectiveness Data and Information Set (HEDIS®), STAR rating results, Consumer Assessment of Healthcare Providers and Systems (CAHPS®), delegation, reporting, health plan audits, population health management, annual satisfaction survey oversight, clinical quality program management, Request for Proposals (RFPs), Intent to Negotiate (ITNs), Regulatory compliance, accreditation and survey readiness, regulatory audits, driving and implementing change.

Experience

1. Senior Director of Quality Improvement

   Premier Eye Care

   Feb 2019 — Present · Boca Raton, FL, US

   Provide strategic leadership and direction for all business units on quality improvement initiatives, and developing innovative initiatives to improve overall quality outcomes. Organize and oversee activities, resources and procedures to achieve enterprise-wide quality improvement strategy. Execute effective oversight of enterprise HEDIS® offering. Deliver effective oversight of enterprise NCQA accreditation requirements02/2019 - 12/2024 (previous role) Director of Quality Improvement, Delegation and ComplianceProvide senior level oversight of Quality Improvement, Compliance and Delegation program management for this managed eye care plan that provides routine vision, medical and surgical eye care for four million insured members through a national network of contracted physicians and facilities.Conduct ongoing communication with health plans. Support the organization by providing compliance leadership in the specific areas of ongoing NCQA accreditation surveys and federal/state QI compliance activities. Responsible for internal and external audits, compliance training, analysis of data and quality systems improvement and ensure ongoing compliance with all applicable regulations and standards through the continuous review of these systems.Key Duties:• Review and implement health plan regulatory requirements, health plan agreements and implement new delegation regulatory requirements• Oversight of operational compliance, privacy and regulatory process controls• Ensure that compliance related issues and risks are identified, aggregated and reported• Subject matter expertise of operational, reporting, and accrediting requirements for all lines of business (Medicaid, Medicare) that are delegated• Maintain current licenses for 39 states and apply for new licenses (Third-Party Administrator (TPA) licenses, Certificates of Authority, UR licenses)• Oversight of risk management program, adverse incident reporting

Education

• Loyola University Chicago School of Law

  Master’s Degree

  2015 — 2017

• Bellevue University

  Master of Public Administration (MPA)

  2010 — 2012

• Bellevue University

  Bachelor's degree

  2008 — 2010

• Metropolitan Community College

  Associate of Science