MICHELE DAVIS-ISHMAEL
Western Springs
Summary
Results-oriented Healthcare Quality & Medicare Stars Leader with 15 years enhancing HEDIS, CAHPS, and HOS performance for national health plans. Expertise in translating analytics into operational strategies, closing gaps, and leading initiatives that elevate Star Ratings and improve member outcomes. Skilled in HEDIS technical specifications, data strategies, vendor optimization, and provider engagement, with a strong focus on quality improvement, stakeholder alignment, and compliance.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Abstractor, Temporary/Contractor
Healthcare Support-Centene
01.2026 - 04.2026
- Performed clinical data abstraction for HEDIS hybrid measures, ensuring compliance with State requirements and NCQA criteria
- Apply structured auditing criteria to medical records to determine compliance
- Maintained quality rating above 98%
Overreader, Temporary/Contractor
BCFORWARD-Elevance Health
10.2024 - 04.2025
- Achieved a quality rating above 98% through rigorous review processes
- Overread medical records for accuracy in HEDIS Supplemental Data Collection project, ensuring data integrity for reporting
- Overread HEDIS hybrid measure abstractions for quality assurance, validating data accuracy and compliance during annual medical record review
Executive Director Health Equity and Community Engagement
The MetroHealth System
02.2024 - 10.2024
- Supports MetroHealth’s health equity strategy by developing and managing health equity operational plans and implementing coordinated initiatives that target health improvement, health equity, and the clinical, social, economic, and environmental drivers of health.
- Initiates, develops, and sustains strategic partnerships with cross-sector partners, healthcare providers, consumers, patients, and neighborhood groups, and alliances, philanthropies, nonprofit community service agencies, businesses, housing authorities, school districts, colleges and universities, municipalities, professional organizations, and trade associations for the purposes of advancing community health equity.
- Convenes members at MetroHealth and external stakeholders for shared health equity education, community outreach, and support for various initiatives that advance total population health, including existing hospital-led efforts in support of the Multicultural Health Equity Centers of Excellence.
- Supports the analysis of state and federal policies and initiatives that impact health equity, the development of MetroHealth’s health equity strategy, and participation in innovation opportunities, including philanthropic and other private sector opportunities.
- Identified and developed innovative health equity policies at MetroHealth, local, state, and national levels to advance health equity objectives.
- Oversaw health equity-centered MetroHealth and community health improvement projects and strategies, including direct supervision of project staff dedicated to the MetroHealth Multicultural Health Equity Centers of Excellence.
- Integrates health equity strategies with clinical quality initiatives to address disparities impacting HEDIS and Stars performance
Director HEDIS Clinical Quality and Health Equity Improvement
Elevance Health
09.2022 - 08.2023
- Directed enterprise HEDIS and Stars improvement strategy, aligning clinical quality, vendor operations, and health equity initiatives across multiple markets
- Led $30M portfolio of vendor programs supporting gap closure, medical record retrieval, and supplemental data capture
- Drove performance initiatives to close care gaps and enhance measure-level outcomes across multiple markets
- Partnered with analytics teams to identify performance gaps by measure, region, and provider, translating insights into targeted intervention strategies
- Established vendor performance governance, including SLAs, KPIs, and escalation pathways, to enhance operational accountability and delivery consistency
- Supported NCQA and state audit readiness, ensuring accuracy and compliance in HEDIS data collection and reporting processes
Clinical Quality Admin promoted to Manager, Strategic Vendor Management – Clinical Quality Health Equity Improvement
Anthem Inc.
09.2021 - 09.2022
- Oversaw Clinical Quality Health Equity Improvement activities/projects, implementing clinical interventions that improved quality of care for members.
- Aligned practice guidelines and care standards with corporate quality improvement work plans.
- Integrated quality improvement frameworks into enterprise business processes, conducting gap assessments and implementing corrective actions to enhance quality and technology workflows.
- Overread HEDIS medical record abstractions for all HEDIS hybrid measures
Senior STARS Improvement Professional– Clinical Quality
Humana, Inc.
05.2020 - 05.2021
- Created alignment between care team population health activities and STARS/HEDIS and CAHPS/HOS Strategy
- Executed training and implemented clinical programs and modifications to enhance member experience with STARS/HEDIS and CAHPS/HOS initiatives.
- Developed and coordinated clinical programs with the interdisciplinary team and physicians based on analytics to improve member outcomes.
- Monitored and analyzed data to identify interventions that supported physicians in improving member outcomes.
- Monitored clinical programs for efficiency and effectiveness.
- Managed vendor relationships for eye care, lab, and pharmacy to ensure compliance with STARS/HEDIS goals, collaborating with providers and health plan initiatives.
Product Manager
CIOX Health, Inc.
01.2019 - 08.2019
- Lead HEDIS product development by establishing priorities and managing the project roadmap.
- Managed all phases of CIOX Quality product management, leading organizational developmental initiatives to achieve strategic goals.
- Built coalition and alignment through collaboration with customers, internal stakeholders, consultants, and third-party vendors to drive project success.
- Collaborated with clients, cross-functional teams, and healthcare network professionals to achieve set goals.
- Designed and evaluated process improvement plans, implementing continuous quality improvement (CQI) methodology to enhance operational efficiency.
Program Manager
Anthem, Inc.
10.2014 - 12.2018
- Managed end-to-end HEDIS program operations, overseeing vendors, data collection, and quality assurance to ensure program effectiveness.
- Led cross-functional initiatives to improve clinical quality metrics and HEDIS performance
- Collaborated with HEDIS vendors and cross-functional teams to address community gaps in care and enhance clinical outcomes.
- Identified and addressed gaps in care through data analysis and provider collaboration
- Oversaw HEDIS vendor management initiatives, monitoring service levels and compliance while identifying and implementing process improvements.
- Served as SME on HEDIS measures, supporting internal teams and external partners
- Ensured compliance with NCQA standards and supported audit readiness activities
- Ensured both organizational objectives and vendor initiatives were implemented. Set operational priorities
Regional Clinical Quality Manager
United Healthcare
12.2013 - 10.2014
- Subject Matter Expert (SME) related to HEDIS technical specifications; supported teams and drove seamless operations.
- Trained and managed staff to ensure operational readiness and performance effectiveness throughout HEDIS data collection cycles
- Monitored quality goals and metrics outcomes using complex healthcare database tools and reports.
- Identified issues, compiled data, and offered solutions that improved practices and enriched health plan quality.
- Investigated and resolved vendor and organizational issues, advocating for regulatory compliance and setting a standard for the team.
- Monitored vendor contracts and ensured compliance with established requirements.
Clinical Analyst/HEDIS Program Manager
Independence Blue Cross
01.2013 - 12.2013
- Led risk adjustment operations with 35 direct reports, achieving performance targets and regulatory compliance within strict deadlines
- Oversaw and evaluated HEDIS collection/reporting vendor performance throughout the HEDIS season.
- Closed gaps in care through targeted research and analysis, leading to improved patient care and outcomes.
- Subject Matter Expert (SME) related to HEDIS technical specification; supported teams and drove seamless operations
- Performed complex clinical quality audits such as risk adjustment, fraud, waste, and abuse.
- Monitored contracts and audited vendor performance, ensuring compliance with contract requirements and enhancing service delivery.
- Hired, trained, coached, and evaluated direct reports, fostering a high-performance team culture.
- Established and enriched client and vendor relationships and served as a key resource for daily operational directives.
- Performed clinical coding, ICD9 /ICD 10 and HCC, QA, and data and clinical analysis of In-house charts for RADV (and Mock RADV) Audit, In-Home Assessment QA & Review, Retrospective Chart Review QA, Perspective QA, and the HCC Surveillance Program QA.
HEDIS Research Nurse
Independence Blue Cross
03.2008 - 12.2012
- Led HEDIS and STARS project management, coordinating NCQA, CMS, and additional accreditation reporting.
- Developed and implemented an effective project plan for the assigned HEDIS and STARs region.
- Performed quality assurance checks via expert trend and pattern analysis; presented findings to physicians for care gap closure.
- Assessed and advised providers on strategies to enhance STARS/HEDIS rates and CAHPS/HOS survey outcomes.
- Trained and supported providers and office staff on medical records documentation and clinical standard guidelines.
Education
Master of Business Administration - Healthcare Administration -
Western Governors University
12-2026
Bachelor of Science - Nursing
Western Governors University
01-2015
Associate of Science - Nursing
Community College of Philadelphia
01-2007
Skills
Medicare Stars Strategy HEDIS Performance Optimization Gap Closure Strategy
Clinical Quality Improvement Data-Driven Decision Making Provider Engagement
Vendor Strategy & Oversight Health Equity Integration Risk Adjustment (HCC)
Measure-Level Performance Management NCQA/CMS Audit Readiness
Cross-Functional Leadership Program & Portfolio Management
Certification
- Registered Nurse Pennsylvania
- Registered Nurse Ohio
- Registered Nurse Illinois
Timeline
Abstractor, Temporary/Contractor
Healthcare Support-Centene
01.2026 - 04.2026
Overreader, Temporary/Contractor
BCFORWARD-Elevance Health
10.2024 - 04.2025
Executive Director Health Equity and Community Engagement
The MetroHealth System
02.2024 - 10.2024
Director HEDIS Clinical Quality and Health Equity Improvement
Elevance Health
09.2022 - 08.2023
Clinical Quality Admin promoted to Manager, Strategic Vendor Management – Clinical Quality Health Equity Improvement
Anthem Inc.
09.2021 - 09.2022
Senior STARS Improvement Professional– Clinical Quality
Humana, Inc.
05.2020 - 05.2021
Product Manager
CIOX Health, Inc.
01.2019 - 08.2019
Program Manager
Anthem, Inc.
10.2014 - 12.2018
Regional Clinical Quality Manager
United Healthcare
12.2013 - 10.2014
Clinical Analyst/HEDIS Program Manager
Independence Blue Cross
01.2013 - 12.2013
HEDIS Research Nurse
Independence Blue Cross
03.2008 - 12.2012
Master of Business Administration - Healthcare Administration -
Western Governors University
Bachelor of Science - Nursing
Western Governors University
Associate of Science - Nursing
Community College of Philadelphia