Felicia Thomason
Anderson,SC
Summary
Detail-oriented RN with 26 years of healthcare industry experience, including over a decade of NCQA HEDIS® quality measure expertise across all lines of business in managed care. Skilled in Stars rating systems, provider incentive programs, data analysis, project management, and strategy development for process and outcomes enhancement. Proficient in creating training materials, educating providers face-to-face, training staff remotely via Teams, and consistently improving training effectiveness annually. Recognized for collaborative approach and dedication to achieving excellence.
Overview
18
18
years of professional experience
Work History
Manager, Clinical Review Operations
United Health Group - UnitedHealthcare
01.2019 - Current
- Made a lateral transfer in 2019 to Clinical Review Operations under the UnitedHealthcare National Quality team umbrella. My team and I are dedicated to excellent performance during HEDIS season to optimize the organization’s quality ratings by reviewing medical records, or auditing, the abstractor’s work and working to correct any discrepancies in order to remain in compliance with NCQA standards
- Oversee and direct my team’s day-to-day operations
- Manage the various projects team members are assigned, both during HEDIS season and otherwise
- Manage and motivate employees to be productive and engaged in work
- Develop training tools for my team, both full-time and contract workers; provide Teams-based training using these tools along with live demos
- Accomplish multiple tasks within established timeframes; instrumental in helping my team meet deadlines
- Participate in Medical Record Review Validation and EQRO audits
- Lead my team to a successful HEDIS seasons year over year
- Collaborate with our vendors to ensure quality measure alignment according to NCQA Technical Specifications
- Collaborate with our training team to help them produce accurate, quality training materials for all staff
- Oversee seasonal contractors
- Cross-trained existing employees to maximize team agility and performance
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives
- Conduct annual performance reviews, conduct one-on-ones and team meetings, and provide guidance and feedback as needed, as well as disciplinary action as needed
Manager, Quality Field Operations
United Health Group - Optum
01.2017 - 01.2019
- Promoted to manager in the same department
- Led a team of 11 direct reports for STARs/HEDIS measure improvement for UHC’s M&R segment in South Carolina. Four years of experience with STARs.
- Built a strong team of dedicated individuals, each of whom strives for excellence
- Led my team to a successful HEDIS seasons year over year
- Continued to consult with provider groups alongside my staff and collaborate on process improvement
- Participated in the over-read process and led the over-read team in SC
- Experience with gaining EMR access with multiple providers, gaining experience in many different EMR platforms, such as EPIC, ECW, Athena, NextGen, Greenway, Soapware, Med Informatics, Success EHS, etc., to extract documents meeting documentation requirements for M&R HEDIS measures
- Experience with multiple systems, to include SharePoint, Tableau, Cognos, UHC Care Connect, ICUE, etc.
- Instrumental in helping my team meet deadlines
- Conduct annual performance reviews, conduct one-on-ones and team meetings, and provide guidance and feedback as needed, as well as disciplinary action as needed
- Maintained professional, organized, and safe environment for employees
- Maximized performance by monitoring daily activities and mentoring team members.
Practice Performance Manager, Quality Field Operations
UnitedHealth Group – Optum
01.2015 - 01.2017
- Consulted with assigned provider groups to enhance their HEDIS and Stars performance with UnitedHealthcare’s Medicare Advantage population. Led monthly meetings with provider groups, provided data analysis of the monthly Patient Care Opportunity Report to help the providers understand their performance on a month-to-month basis.
- Collaborated on new processes to help the providers close more gaps in care. Strategized and developed goals with them to achieve desired outcomes. Effectively led assigned practices to raise their Stars ratings and earn a quality incentive bonus by educating them on M&R HEDIS measures and proper documentation.
- Provided individualized strategies to Optum Practice Performance Specialists who support the practices to meet the individual practice’s needs. Provided HEDIS and Stars education as needed to the practice staff I worked with
- Performed year-round medical record review for submission of supporting documentation which satisfies HEDIS requirements to close gaps in care and assisted the provider groups with submitting this through our online tool, UHC Care Connect, for them to receive credit for closed gaps in care
- Attended weekly and monthly meetings with Optum and UHC leadership to analyze data, review expectations, strategize internally to meet our combined goals, and to provide feedback to UHC regarding our progress with STARs
- Managed multiple ongoing projects simultaneously
- Organized events to assist members with getting the preventative screenings they needed and discussed strategies with provider groups to enhance member compliance
Nurse Case Manager / Quality Improvement Specialist
Molina Healthcare of SC (Medicaid MCO)
01.2014 - 01.2015
- Performed telephonic and field-based case management with members for health education and compliance improvement
- Collaboration with Community Connectors for locating community resources
- Consulted with physicians and other medical providers so as to assist the member in meeting their healthcare needs and goals, while removing barriers to healthcare
- Development of a care plan for each member tailored to their individual needs
- Assisted members and medical providers with referrals. Empowered the members by guiding them toward self-management of their healthcare
- Review and investigation of potential quality of care issues in collaboration with clinical and nonclinical staff
- Promoted to Quality Improvement Specialist where I performed Medical record review for quality of care issues, HEDIS, and other quality improvement initiatives and reporting
- Participated in NCQA accreditation and regulatory audit preparedness. Facilitated conversations with and between other departments within the health plan
- Assisted with CAHPS improvement
- Developed initiatives for improved member compliance, decrease of gaps in care, and improvement of HEDIS scores
Utilization Management
Select Health of SC (Medicaid MCO)
01.2011 - 01.2014
- Began in the Utilization Management Department as a Precertification Review Nurse, where prior authorization requests were reviewed for medical necessity of durable medical equipment, therapies, procedures, home health services, and surgeries
- Conducted secondary review with the Medical Director for medical necessity approval when authorization criteria were not met
- Deployed to work from home after 6 months of employment
- Promoted to Concurrent Review Nurse in 2012. Transitioned into new role quickly and continued to work remotely
- Reviewed inpatient hospitalizations for medical necessity using our criteria and established guidelines
- Referred members to Case Management as needed for further follow up
- In both roles, consulted with providers for additional information as necessary, so as to make the best decision possible for the member
- Became well versed in the use of InterQual and its criteria subsets
RN Case Manager
Intrepid Home Health
01.2010 - 01.2011
- Managed a group of 25-30 patients (mostly Medicare); visited 6-10 patients per day in their homes. Consulted with their physicians and the home health agency interdisciplinary team as appropriate to manage their care
- Assisted patients with ordering durable medical equipment and performed instruction as needed
- Performed wound care and venipunctures
- Educated patients on their medications and their disease processes, thus assisting them with managing their medications and overall healthcare. This empowered them to be independent with their healthcare needs
- Followed Medicare guidelines for patient care
Patient Care Coordinator
Trident Medical Center
01.2008 - 01.2010
- Weekend charge nurse for the Ortho/Neuro unit. This is a fast-paced 42 bed unit; supervised approximately 40 employees total
- Responsible for coordinating patient care, managing the staff during my shift, and choreographing new admissions with existing and discharged patients so that everything ran smoothly and effectively
- This unit cares for patients who have had joint replacements, strokes, seizures, back surgery and cervical (neck surgery), as well as general medical patients and patients with other orthopedic injuries
- Transitioned into a weekday Patient Care Coordinator position once I parted ways with Home Health, Inc.
- NIH Stroke Scale Certified
Clinical Manager
Home Health, Inc.
01.2007 - 01.2008
- Manager for both the nursing and therapy staff. Responsible for payroll and coordinating patient care in accordance with physician orders and DHEC regulations, as well as with Home Health, Inc. policies and procedures
- Participated in interviewing and orientation of new staff and promoted staff development. Led the interdisciplinary team meetings and staff education
- Performed annual clinician performance appraisals, approved time off requests, and requests for training seminars. Oversaw the on-call schedule. Followed up on staff certifications, such as CPR and professional licensure, as well as their PPD’s, physicals, auto insurance, etc., and ensured all were current.
- Performed chart audits on a regular basis, as well as assessment reviews on a daily basis for performance improvement purposes.
- Finally, I was there as a resource for all clinicians, patients and their caregivers, physicians and their staff and assisted the Director of Professional Services in overseeing the agency’s clinical services program
- Also served as Admission Nurse for Dorchester County, conducting field-based admission evaluations and developing initial care plans and became Chemotherapy Certified
Education
Bachelor of Science - Nursing
Ohio Christian University
01.2019
Associate of Science - Nursing
Trident Technical College
12-2003
Certified Nursing Assistant - undefined
Dorchester County Career School
01.1993
Skills
- 26 years of diversified healthcare industry experience
- Extensive experience in clinical quality evaluation
- Thirteen years of managed care experience working with all lines of business, to include Medicaid, Medicare, and Commercial; familiar with NCQA, CMS, CAHPS, HOS, and Stars
- Ten plus years of clinical quality / HEDIS experience which involves fast-paced, complex, highly-matrixed environments where one must be able to multitask and meet deadlines for simultaneous projects
- Skilled in managing data-driven projects and strategic planning
- Proficient in Microsoft Office Suite
- Proficient in claims systems: Facets, iSET, and Cosmos
- Detail oriented with problem solving, critical thinking, and analytical skills
- Proficient in working with management and collaborating with others to achieve defined objectives
- Strong communication and presentation skills
- Strong interpersonal skills with diverse stakeholders
- Innovative mindset: present ideas for improvement and speak up when current processes are not meeting expectations
- Growth mindset
- Strong organizational skills
- Team leadership with proven track record in people management spanning ten years
Other Experience and Continuing Education
- College of Charleston for Basic and Intermediate Excel courses
- Knowledge of coding and claims
- Ongoing online education offered by UnitedHealth Group
- Served on the Quality Improvement and Credentialing Committees at Molina
- Served as a member of the UHC Transitions Super User Team
- Have participated in review projects as needed for UHC Transitions program enhancements
- Began an SQL course in May 2025
- Would like to pursue CPC certificate soon
Timeline
Manager, Clinical Review Operations
United Health Group - UnitedHealthcare
01.2019 - Current
Manager, Quality Field Operations
United Health Group - Optum
01.2017 - 01.2019
Practice Performance Manager, Quality Field Operations
UnitedHealth Group – Optum
01.2015 - 01.2017
Nurse Case Manager / Quality Improvement Specialist
Molina Healthcare of SC (Medicaid MCO)
01.2014 - 01.2015
Utilization Management
Select Health of SC (Medicaid MCO)
01.2011 - 01.2014
RN Case Manager
Intrepid Home Health
01.2010 - 01.2011
Patient Care Coordinator
Trident Medical Center
01.2008 - 01.2010
Clinical Manager
Home Health, Inc.
01.2007 - 01.2008
Certified Nursing Assistant - undefined
Dorchester County Career School
Bachelor of Science - Nursing
Ohio Christian University
Associate of Science - Nursing
Trident Technical College
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