Health Management Associates
Patricia Miles is a performance-driven managed care leader with over 25 years of experience in the Medicaid and Medicare markets. A certified Six Sigma Greenbelt, she utilizes six sigma protocols to identify and implement health plan quality and performance improvements. She is focused on helping clients work through system and process challenges to raise Star ratings, increase Healthcare Effectiveness Data and Information Set (HEDIS) measurements, achieve National Committee for Quality Assurance (NCQA) accreditation, and ensure regulatory compliance. She utilizes her skills to assist managed care organizations in improving the quality of the member experience along the engagement continuum, putting her mantra ‘every touch counts’ into practice.
Prior to joining Health Management Associates, Patricia was senior director of quality and accreditation with Health Services for Children with Special Needs, Inc. She provided executive-level leadership for all quality functions with full accountability for compliance with state and federal clinical quality requirements for a special needs managed care organization. Patricia served as the organizational lead and resource for NCQA, HEDIS, external quality review (EQRO) activities and other contractual requirements. She also oversaw the organization’s grievances and appeals, Early Periodic Screening, Diagnostic and Treatment (EPSDT), home care oversight and health education programs.
Under her leadership, the organization received NCQA case management (CM) accreditation and the organization’s first NCQA health plan accreditation, earning Interim Health Plan accreditation. She also reconstructed the HEDIS program by bringing the management services in-house, reconfigured the risk management program, hired and trained the organizations first ever Risk Manager, developed and implemented a Culturally and Linguistically Appropriate Services (CLAS) program, and developed the organization’s first NCQA compliant population health management program description.
Patricia has over 20 years of executive experience working in quality, accreditation, and compliance. She was the senior director of quality and accreditation with Trusted Health Plan, Inc., a start-up MCO in the DC Medicaid market. There, she built the quality program from the ground up and led the organization-wide contract gap assessment, ensuring policies and programs were implemented for the 90-day assessment. As the quality director/EPSDT and outreach manager with United Health Care, she facilitated a Medicaid special needs early interventions think tank program using a Six Sigma approach, avoiding over $1 million in potential regulatory sanctions. She also served as a senior consultant with Booz Allen Hamilton and performed audits and made key contributions to identify Medicare marketing violations in support of Centers for Medicare and Medicaid Services (CMS) in its oversight of the Medicare Part C and Part D programs.
Prior to her civilian career, Patricia was a bioenvironmental engineering journeyman with the United States Air Force. She studied environmental health from the Community College of the Air Force and the US Air Force Technical School of Aerospace Medicine. She received her Six Sigma Green Belt certification and her project management training from Villanova University.
Patricia is also an inventor and a minister, holding a bachelor’s degree in Christian education from Shalom Bible College & Seminary. She founded and directs a non-profit organization focused on providing a community for other ministries, nationally and internationally, to be accountable, share spiritual principles, teach and credential other ministers, and perform local and global outreach.