Stacy-Ann Samuels

About Stacy-Ann Samuels

Registered nurse with robust experience from various viewpoints within care delivery. Over a decade of dynamic healthcare experience inclusive of ICU practice and hospital case management, with exposure to care coordination, as well as, utilization review with use of InterQual for Medicare and Medicaid populations. Comparative health plan experience in concurrent review, discharge planning, front end review using MCG criteria and utilization management. Innovative ideation with contribution to various pilot programs, development of departmental best practices and interdepartmental collaboration. Transitional care case management via the PCP perspective using a patient centered interdisciplinary approach. Oversight of national quality and compliance program in homecare, supporting 23 branches across 9 states. Growing leadership experience with focus on quality, compliance and auditing while serving our most needy populations.

Experience

1. Associate Director- Bh Provider Engagement & Practice Transformation

   Humana

   Aug 2024 — Present

   Lead and manage the Provider Performance team for Ohio Medicaid and engaging with providers and internal stakeholders to drive high performance in quality and cost efficiency. Design and implement programs to maintain positive relationships between the health plan, physician, providers and practice managers. Support Stars, HEDIS & Risk Adjustment initiatives and Ohio Department of Health quality initiatives for PRAF, Diabetes and other targeted campaigns. Monitor feedback from individual providers to inform improvements to Humana processes. Collaborate with internal stakeholders on development and implementation of value-based programs and alternative payment models. Monitor provider’s performance against key performance indicators and contractual commitments and requirements. Work with health plan leadership to improve performance, develop and implement quality improvement initiatives.

Education

• Florida International University

  Bachelor's of Science , Registered Nursing/Registered Nurse

  2005 — 2010

• Western Governors University

  Master of Business Administration - MBA, Healthcare Management

• Florida College of Natural Health-Pompano Beach

  Basic Skincare

  2011 — 2011