Khadija Anderson
Powder Springs
Summary
Healthcare leader with 15+ years of experience specializing in quality improvement, regulatory compliance, and performance optimization. Strong background in managing large budgets and high-stakes projects, with proven results in achieving CMS 4-Star ratings. Skilled in data analysis and vendor oversight, facilitating cross-functional collaboration to optimize operational performance.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Manager, Quality Manager
HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY
Pennington
08.2020 - Current
- Spearheading our quality improvement initiatives for HEDIS Medicaid, Medicare Stars, and Commercial lines of business
- Managed and evaluated vendor programs and budgets, including in-home screening kits, IVR campaigns, and Member Rewards programs
- Manage $2M+ annual budget, vendor contracts, state work plans, member reward programs, and care coordination initiatives.
- Led several projects and workplans, collaborating with cross-functional teams, i.e. Data Teams, Pharmacy, Care Management, and Behavioral Health, to close gaps, solve discrepancies, identify areas with opportunities for improvement and implement comprehensive solutions
- Ensured compliance with QM Medicaid state contract and DMAHS standards by leading cross-functional teams to identify and address performance gaps.
- Analyzed dashboard reports, on an ongoing basis, to identify trends and opportunities for improvement, along with keeping track of noncompliant members, for HEDIS and Stars.
- Achieved CMS 4-Star Rating Medicare Advantage (MY 2021, MY 2024), 4-Star Rating FIDE SNP (MY 2021, MY 2024), and NCQA 4-Star Rating NJ Medicaid (MY 2023, MY 2024)
- Supervised team of 9 direct reports, fostering a collaborative environment that enhanced team effectiveness.
- Presentations to Quality Improvement Committees, CMS Stars Workgroups, NJ State Lead collaborative (state MCO), and several workgroups; Program Development and Evaluation and establishment of SOPs (i.e., Programs for the Elderly and Disabled)
Quality Assurance/Performance Improvement Specialist
EAST ORANGE GENERAL HOSPITAL
East Orange
07.2019 - 07.2020
- Led administrative revival of Stroke Program, developing new nursing documentation and revising policies to align with stroke management guidelines.
- Conducted eCQM chart abstraction for stroke, sepsis, venous thromboembolism and ED throughput measures.
- Directed CMS validations and implemented PI projects using the IHI Model/Framework
- Developed and implemented hospital-wide Hand Hygiene Initiative, supervising data collection and reporting to leadership committees.
- Facilitate several subcommittees, including stroke program committee which reports to the Performance Improvement Committee.
Quality Improvement Manager
VISITING NURSE SERVICE OF NEW YORK
New York
12.2018 - 07.2019
- Managed Quality Management (QM) work plan and New York State Department of Health (NYSDOH) corrective action plans for HIV SNP line of business.
- Developed and executed PIPs, coordinated HEDIS chart reviews, and supervised performance data collection and analysis.
- Served as primary contact for regulatory investigations, ensuring timely resolution and compliance.
Senior Project Manager/Associate Director Hospital
METROPLUS HEALTH PLAN/ NEW YORK CITY HEALTH & HOSPITALS
New York
03.2016 - 11.2018
- Orchestrated PIPs that reduced preterm birth rates by 2% and increased provider preventive code usage by 5% in one year.
- Executed maternity initiatives to improve prenatal and postpartum visit adherence.
- Managed QM state work plans, coordinated with NYSDOH and oversaw quality-of-care compliant resolutions.
- Developed and managed Performance Improvement Projects, including documenting performance indicators, outcome measures, process measures, procedures and interventions.
- Represented Health Plan in Quality Management meetings, trainings, and programs throughout the New York City Health and Hospitals system.
- Performed ad hoc tasks as assigned by the Senior Associate Executive Director or by the Deputy Executive Director of Quality Management. Assisted with HEDIS project and Article 44 audit.
Quality Improvement Manager
MONTEFIORE CMO
Yonkers
01.2013 - 03.2016
- Led ten-member quality team managing ACO/Shared Savings programs with multiple insurers.
- Developed and implemented physician engagement strategies, EHR enhancements, and quality initiatives to meet evolving payer requirements.
- Trained physicians and staff on ACOs, PCMH, HEDIS, MU, and quality reporting standards.
- Conducted and trained how to properly perform a work analysis. Present and implement performance improvement initiatives in physician offices and ambulatory settings, using PDSA quality improvement model.
Directors of Health Promotion and Education Intern
CENTERS FOR DISEASE CONTROL AND PREVENTION
Atlanta
09.2009 - 12.2009
- Conducted literature reviews on American Indian/Alaska Native youth health disparities, informing CDC resources and contributing to peer-reviewed publication.
- Represented Division of Adolescent and School Health in internal meetings, coordinating health initiatives with grantees to enhance program effectiveness.
- Publication: Everett Jones S, Anderson K, Lowry R, Conner H. Risks to health among American Indian/Alaska Native high school students in the United States. Preventing Chronic Disease 2011;8(4):A76. http://www.cdc.gov/pcd/issues/2011/jul/10_0193.htm
Education
MPH - Health Promotion/Disease Prevention
Florida International University
Miami, FL01-2009
BS - Health Administration
University of Central Florida
Orlando, FL01-2005
BS - Health Information Management
University of Central Florida
Orlando, FL01-2005
Skills
- HEDIS & Medicare Stars SME
- Quality Improvement, HEDIS Management & Stars
- NCQA Knowledge
- Healthcare Regulatory Compliance
- Program Management
- Project Management & Workflow Planning
- Data Analysis & Reporting
- Process Optimization
- Cost Control
- Vendor & Budget Oversight
- Strategic Planning
- Cross-functional Leadership
- Stakeholder Engagement
- Training
- Facilitation
- Clinical Quality Improvement
Publications
Risks to health among American Indian/Alaska Native high school students in the United States, Everett Jones S, Anderson K, Lowry R, Conner H, Preventing Chronic Disease, 8, 4, A76, 2011, http://www.cdc.gov/pcd/issues/2011/jul/10_0193.htm
Personal Information
Title: LPN, MPH
Certification
- Licensed Practical Nurse License-Florida State Board, Issued 2001
- Licensed Practical Nurse License- New York State, Issued 2011
- Licensed Practical Nurse License- New Jersey State, Issued 2019
Timeline
Manager, Quality Manager
HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY
08.2020 - Current
Quality Assurance/Performance Improvement Specialist
EAST ORANGE GENERAL HOSPITAL
07.2019 - 07.2020
Quality Improvement Manager
VISITING NURSE SERVICE OF NEW YORK
12.2018 - 07.2019
Senior Project Manager/Associate Director Hospital
METROPLUS HEALTH PLAN/ NEW YORK CITY HEALTH & HOSPITALS
03.2016 - 11.2018
Quality Improvement Manager
MONTEFIORE CMO
01.2013 - 03.2016
Directors of Health Promotion and Education Intern
CENTERS FOR DISEASE CONTROL AND PREVENTION
09.2009 - 12.2009
MPH - Health Promotion/Disease Prevention
Florida International University
BS - Health Administration
University of Central Florida
BS - Health Information Management
University of Central Florida