MICHELLE CUNNINGHAM, RN, CPM, CCM 503 West Fifth Street

Marysville, Ohio 43040 Cell: (937) 578-8034 michellecunningham@columbus.rr.com

PROFESSIONAL PROFILE

Program Development

Quality Improvement

Project Management

Strategic Planning /

Execution

Partnership Building

Grant Writing

Advocacy

Staff Management

Training & Development

Proven organization leader with strengths in quality improvement, program development, project execution, data analysis, and public relations.

Seasoned healthcare quality improvement professional with experience assisting health care organizations in meeting regulatory and accreditation standards. Outstanding troubleshooting skills with proven ability to pinpoint problems, provide creative solutions, and follow through to resolution. Current HEDIS, STARS, and NCQA Accreditation technical experience.

Experience assessing organizational needs and analyzing gaps to create program development plans and implement actions to meet identified needs and create systems-wide improvements.

Proven grant writer and results-oriented professional with demonstrated capacity to build relationships with external partners and to foster collaboration on a wide variety of policy, program development, and quality improvement initiatives.

PROFESSIONAL EXPERIENCE

BUCKEYE HEALTH PLAN, Columbus, OH

Manager, Quality Improvement April 2014 – Present

Manages all products (Medicaid, Marketplace, D-SNP, and MMP) to design initiatives to improve HEDIS/STARS ratings and clinical performance/outcomes. Manage staff conducting Quality of Care investigations. Create, update, and revise P&Ps. Manage all aspects of NCQA, QIPs, CCIPs, PIPs, MOC. Oversee NCQA accreditation activities and clinical staff to support functions. April 2014 assumed expanded responsibilities for all department functions with subsequent increase in the number of direct reports.

Key Contributions & Results: Collaborated with QI Dept. Director on reorganization of department structure and functions –

realignment of data analytics staff, alignment of delegated vendor oversight activities with NCQA requirements, expansion of QI Dept. staff to address increased enrollment and addition of new products, formalized staff duties/primary responsibilities with back-up/cross training of staff for essential department functions.

Member Contact Forms – collaborated on tool, process and workflow development to increase member satisfaction, update demographics and PCP assignment.

Developed staff incentive – to reward staff for achieving metrics related to STARS gap closure outreach calls and OB provider scorecard mailing.

Manager, Maternal Child Health & EPSDT May 2013 – April 2014

Manages the day-to-day operations of the maternal child health and EPSDT functions communicating with external stakeholders and departmental and plan administrative staff to facilitate department functions.

Key Contributions & Results: Developed EPSDT Program Description – created standardized processes/workflows

Collaborated with Summit County Public Health and Summit County Dept. of Job and Family Services in the development of a Healthchek Pilot project – HEDIS data sharing, referral, resource sharing, communication feedback loop

MICHELLE CUNNINGHAM – PAGE TWO Cell: (937) 578-8034 michellecunningham@columbus.rr.com

Lead strategic planning addressing birth outcomes/infant mortality – primary author inter-conception program description; development of expedited outreach activities/processes for the at risk maternal population

APS HEALTHCARE, Dublin, OH Feb. 2012 – May 2013

Clinical Lead/Supervisor

Manages day-to-day operations and supervision of 11 clinical and administrative staff members providing telephonic case management and support services. Responds to clinical/operational issues and ensures adherence to regulatory/accreditation standards and performance metrics. Assures appropriate and timely service delivery. Troubleshoots clinical and contract specific issues. Develops and refines tools/processes/procedures. Provides clinical training to staff.

Key Contributions & Results:

Developed and implemented systems-wide process improvements by working collaboratively with clinical and technology stakeholders to identify the highest risk individuals and facilitate outreach and engagement in best practices clinical interventions.

Achieved 90%+ compliance through development of a process for ongoing clinical documentation audits, producing monthly and quarterly reports to disseminate key actions and process improvements.

OHIO BOARD OF SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY, Columbus, OH

Licensing Administrator Dec. 2009 – Dec.2011

Oversees all license application activities, initiates the issuance or denial of a license, initiates compliance/enforcement follow-up activities, manages internal Board operations, and assumes agency operational responsibility in the Executive Director’s absence.

Key Contributions & Results:

On an ongoing basis, identifies licensing issues and participates in rule promulgation.

Developed and updated application materials and agency form letters related to statute revisions, simplified re-licensure procedures, access to confidential personal information (CPI), and revised document deadlines for clinical fellows.

Developed the blueprint adopted for addressing agency workflow issues utilizing existing resources to maximize productivity and effectiveness.

Streamlined application processes and established process for monitoring licensure performance metrics for reporting the timeframe from receipt of an application to the issuing of a license.

OHIO DEPARTMENT OF JOB AND FAMILY SERVICES, Columbus, OH Jan. 2009 – Dec. 2009

Medicaid Health Systems Specialist II - Intermittent

Provides review of clinical records and other medical information to determine eligibility for coverage of services under the Medicaid & disability assistance medical program. Provides consultative expertise and training and act as liaison to both intra-agency & extra-agency providers.

OHIO ASSOCIATION OF COMMUNITY HEALTH CENTERS, Columbus, OH Oct. 2005 – Sept. 2008 Director of Clinical Affairs (2007-2008)

Oversees the development of state, regional and national collaborations, securing resources and implementing programming to support Ohio’s Federally Qualified Health Centers with continuous quality improvement across clinical, fiscal and operational systems. Provides consultative expertise and member training for the Association’s health policy agenda. Works with the Association’s contract lobbying team in advocating for the needs of medically underserved populations with government agencies, policy makers and funders.

MICHELLE CUNNINGHAM – PAGE THREE Cell: (937) 578-8034 michellecunningham@columbus.rr.com

Key Contributions & Results:

Secured $1,000,000 in foundation funding to implement a 36 county-wide Early Childhood Oral Health Initiative to address the number one unmet healthcare need in Ohio - lack of access to quality dental care. This quality improvement and capacity building project increases access by providing, in the primary care setting, oral health screenings, caries risk assessments, fluoride varnish applications, caregiver anticipatory guidance/education and referral to a dental home by one year of age.

Developed a program plan that secured $150,000 in federal funding to support the continued development of an Ohio-based infrastructure for clinical/operational quality improvement.

Clinical Coordinator (2005-2007)

Provides technical assistance to health centers in meeting federal program requirements and expectations. Supports health centers in spreading and sustaining the Health Disparities Collaborative (HDC), the federal Bureau of Primary Health Care’s national quality improvement/disease management program.

Key Contributions & Results:

Secured equipment and supplies valued at $800,000 to provide 5 health center networks with medical surge supply caches as a component of All Hazards Preparedness.

Facilitated the inclusion of health centers in state funded influenza vaccine distribution. Collaborated with state and local public health and vaccine manufacturers to ensure the timely delivery of seasonal influenza vaccine to healthcare providers.

Worked on a team project to develop a resource manual for health centers on all aspects of EMR implementation. Facilitated distribution of manual throughout Midwest Regions V and VII.

Recognized by internal promotion for ability to step into a challenging role and expand the Association’s capacity to meet increasing needs for technical assistance, resources, training, education and mentorship.

ACADEMIC BACKGROUND

RN Diploma MERCY SCHOOL OF NURSING – Canton, OH

Ohio License: RN.189978; expires 8/31/2017 Six Sigma Yellow Belt: March 2013 HHS/HRSA Health Disparities Collaborative quality improvement/disease management trainings Ohio Certified Public Manager (CPM): February 2012

OSU JOHN GLENN SCHOOL OF PUBLIC AFFAIRS- Columbus, OH Certified Case Manager (CCM) Commission for Case Manager Certification (CCMC) http://ccmcertification.org/ccm-lookup Certification Expiration: 5/31/2018

TECHNICAL PROFICIENCIES

Inovalon QSI/QSHR, Microsoft Office Suite 2010