Shawna Maliglig, MBA

San Dimas, CA / 909-917-1818 / smaliglig@msn.com

Work Experience

UnitedHealthcare Community Plan of California – Medi-Cal, San Diego, CA

Quality Compliance Manager, 08/17 - Present
 Hire, train, and lead the quality compliance team. Guide them in successful completion of their day-to-day activities. Conduct
regular meetings with team members to offer guidance, discuss possible challenges, and identify opportunities for growth.
 Analyze processes and review data to identify opportunities of improvement. Collaborate with team members to implement lean
process improvement strategies and ensure efficient use of resources, optimal department operations, and alignment with
organizational mission and values.
 Meet with department leads at DHCS to discuss best practices in quality improvement, and share current processes to make
certain Medi-Cal members are receiving quality and accessible healthcare.
 Prepare regulatory reports; monitor evidence; draft policies and procedures; validate data; draft responses to corrective actions
and requests for information; and implement new regulatory processes.
 Lead NCQA monitoring and submission.
 Participate in the planning and implementation of Quality Improvement Projects to improve patient health outcomes.
 Plan and facilitate the Quality Management and Provider Advisory Committees. Oversee subcommittees, including but not
limited to, the Consumer Advisory and Public Policy Committees.
 Draft Quality Management Program Description, Annual Evaluation, and Annual Work Plan.
 Analyze member satisfaction and appointment availability surveys to identify areas of improvement and plan interventions.
 Implement standard operating procedures to ensure processes are flowing efficiently and effectively.

Inland Empire Health Plan, Rancho Cucamonga, CA

Quality Management Business Analyst II, 07/16 – 08/17
 Ensured Quality Management compliance with regulatory agencies (NCQA, CMS, DHCS) by preparing reports; monitoring
evidence; drafting policies and procedures; validating Facility Site Review data; preparing for routine audits; drafting responses to
corrective actions and requests for information; triaging All Plan Letters and Policy Letters for the department; and managing an
extensive repository to manage all deliverables.
 Identified and implemented lean process improvement strategies to ensure efficient use of resources and optimal department
operations (example, Credentialing review process, monitoring evidence for NCQA compliance, Nurse Auditor productivity
reports).
 Lead interdepartmental process improvement activities.
 Lead NCQA monitoring activities to ensure health plan was compliant with Standards. Reviewed evidence for compliance,
coordinated inter-departmental meetings, prepared status updates, and monitored project progress. Served as liaison with NCQA
Consultant.
 Participated in the planning and implementation of Quality Improvement Projects per DHCS requirements.
 Supported the planning and facilitation of Quality Management Committee and Quality Improvement Subcommittee. Prepared
Quality Reports for review by Credentialing Committee.
 Audited Delegate’s Quality Management policies, procedures, work plans, and semi-annual Evaluations.
 Created audit tools, tracked data, and generated reports to ensure regulatory compliance.
 Reviewed internal and external policies for consistency and adherence to regulatory standards.
 Ensured accuracy of HEDIS data and recommended alternative methods in order to increase compliance during data validation
activities.
 Drafted Quality Management Annual Evaluation and prepared annual work plan. Managed work plan activities to ensure
compliance with annual charter. Submitted documents to regulatory agencies per compliance requirements.

Inland Empire Health Plan, Rancho Cucamonga, CA

Delegation Oversight Business Analyst I, 10/15 – 07/16
 Responsible for administrative support required to implement monthly delegation audits.
 Worked to identify and implement process improvement opportunities.
 Trained new Team Members within the QM department. Served as Subject Matter Expert for auditing activities.
 Collaborated with Audit Nurses to successfully complete monthly audits. Validated monthly data. Prepared reports for IPAs
complete with corrective actions and sanctions as needed.
 Audited IPA’s Quality Management policies and procedures as part of annual Delegation Oversight audit.
 Created audit tools, completed time studies, tracked data, and generated reports.
 Planned monthly Delegation Oversight Committee meetings. Prepared materials for review.

Comprehensive Community Health Centers, Glendale, CA

Electronic Health Record Business Analyst, 08/13 – 10/15
 Troubleshoot issues in the electronic medical record system (EMR).
 Trained new and current medical staff how to successful navigate throughout the EMR.
 Provided on-site system support.
 Provided recommendations to ensure workflow efficiency.
 Project management.

Comprehensive Community Health Centers, Glendale, CA

Interim Quality Improvement Manager & Quality Improvement Coordinator, 07/12 – 08/13
 Manage Quality Improvement department staff by providing direct supervision and performance reviews.
 Performed data collection, management, and analysis activities in all aspects of the agency as they relate to the QI program.
 Conducted quality assurance audits and ensured that processes and documentation was compliant with required standards.
 Prepared reports and provided feedback to personnel.
 Investigated, monitored, documented, and reported on quality of care and services issues regarding health care and services
rendered.
 Assured that improvement activities were documented and reported within the organization to engage staff in continuous quality
improvement.
 Assessed QI training needs and planned and implemented training for support staff.
 Reviewed and evaluated staff trainings for improvement and feedback for the program.

East Valley Community Health Center, Pomona, CA

Fundraising Associate, 07/11 – 7/12
 Created and maintained company social networking sites, including Facebook, Twitter, and Blogger.
 Grant writing.
 Established and maintained business relationships with donors and potential donors.
 Utilized i2i in order to gather information for reports.

East Valley Community Health Center, Pomona, CA

Teen Pregnancy Prevention Coordinator (Management Position), 03/08 – 06/11
 Prepared and maintained department budget.
 Supervised all teen pregnancy prevention staff, including Health Educators, Adult Educators, Teen Peer Educators, interns, and
volunteers (17-50 staff).
 Conducted outreach for HIV testing.
 Developed, implemented, and evaluated appropriate use of prevention education program, curricula, and evaluation tools.
 Maintained program data and completed subsequent program reports internally and contractually.
 Conducted quality assurance and improvement review and evaluation of programs.
 Served as a liaison with community agencies, schools, and contract monitors, and assured compliance with all program
guidelines.
 Provided trainings to clinic staff and community members on various health topics.
 Utilized i2i Population Management software in order to gather information for reports.

East Valley Community Health Center, Pomona, CA

Health Educator, 12/06 – 03/08
 Provided comprehensive sexuality education to over 1,000 middle and high school age students.
 Developed and maintained community supports in order to link clients to needed services.
 Designed, implemented, and evaluated health education programs to determine program effectiveness, affect behavior change,
and promote Family PACT services.
 Implemented CDC evidence-based pregnancy prevention curriculum entitled, “Reducing the Risk”.
 Designed, developed, and implemented 20-hour training for teen and parent educators.
 Produced quarterly reports exemplifying program success to funders.
 Planned and facilitated Community Advisory Board Meetings with key community stakeholders.

Multilingual Medical Social Services, Covina, CA

Administration-Office Manager, 02/2002 - 08/2004
 Routed referrals to over 100 home health agencies.
 Linked social workers with clients needing support services.
 Handled confidential client information.
 Created social service related projects and materials, including creating service area boundaries for regional social workers.
 Provided needed resources for patients.
 Ensured credentialing requirements were maintained by social workers.

Education
MPH Major: Public Health Azusa Pacific University August 28, 2020
MBA Major: Business University of La Verne 2013
B.A. Major: Sociology University of La Verne 2006

References available upon request