Costa Mesa, CA
With a proven track record of increasing quality metrics and improving Medicare stars ratings, Linda Lee ensures operational alignment for health plans – increasing efficiency and compliance and integrating regulatory requirements into day-to-day operations.
Linda has over 20 years of experience in the managed care industry. She joined HMA most recently from L.A. Care Health Plan where she was responsible for analyzing and improving Medicare performance and clinical operations for a Medicare Advantage Special Needs Plan (SNP) and Cal MediConnect duals demonstration project. She led an enterprise-wide program to evaluate and improve Medicare Part C and D star measures. Additionally, she conducted an analysis of performance measures including HEDIS, Consumer Assessment of Health Plan Provider and Systems (CAHPS), and Health Outcomes Survey (HOS) survey results, while identifying priority areas and implementing improvement plans.
With extensive knowledge of health plan clinical operations, Linda developed and implemented an integrated Medicare model of care that incorporated industry best practice care management models to improve member engagement and health outcomes. She oversaw product operations and strategic planning in the areas of Medicare Advantage applications, risk adjustment programs, and rapid cycle improvement projects for Medicare-Medicaid Plan (MMP), including reducing potentially avoidable events, improving long-term care claims timeliness, and reducing readmissions.
During her twelve-year tenure at CalOptima, Linda coordinated the integration and communication of all activities associated with CalOptima’s quality improvement efforts. As an internal consultant to the management team, Linda worked collaboratively throughout the organization to promote evaluation and improvement of quality performance and outcomes. She led the organization in achieving its initial health plan accreditation by NCQA, improved HEDIS scores which received high performance recognition by the California Department of Health Care Services, and developed various member and provider quality improvement and incentive programs.
Linda received her master’s degree in public health and a bachelor’s degree in molecular biology from UCLA.
A native of Los Angeles, Linda enjoys exploring the latest foodie trends with family and friends.