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Carole J. Graham, RN, BSN |
Manager
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Carole Graham applies both her nursing background and data analysis skills in helping managed care and health services organizations improve clinical care and operations. She has a broad perspective on these subjects, having worked in operations on both the provider and payer sides of managed care.
Graham’s experience includes developing programs in ambulatory quality improvement, case management and disease and utilization management. She has also assessed practice quality for acquisition evaluations, and negotiated managed care agreements and fee schedules.
She has identified opportunities to reduce health care costs based on her hands-on experience in developing and implementing medical management programs.
Carole’s work for clients includes:
- Creating claims-based datasets and tools to support clinical analysis and medical management efforts
- Developing and analyzing RVU and AWP-based fee schedules, and acting as liaison between providers and payers on fee matters
- Assisting PACE programs assess and develop their operational and financial programs
- Developing and managing PHO/IPA physician fee schedule datasets for managed care contracting
- Developing customized financial and utilization management reports, and training clients in their use
- Providing interim management services for utilization management and claims processing departments
- Developing and managing medical management programs including ambulatory quality improvement, case management, disease management and utilization management programs.
Before joining DGA Partners, Carole developed medical management programs covering over 200,000 risk lives, as Vice President of the Allegheny Health, Education and Research Foundation. She also managed quality improvement and claims analysis for Keystone Health Plan East.
Graham holds an MBA in Health Administration from Temple University and a BS in Nursing from West Chester University.
To contact Carole, call 800 241-5268. |
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