Janeace Voorhies
Madisonville
Summary
Senior Clinical Quality and Population Health leader with 14+ years of Managed Medicaid experience and deep expertise in HEDIS, NCQA accreditation, Performance Improvement Projects (PIPs), maternal health, provider education, and regulatory compliance. Proven ability to translate data into actionable strategies, lead cross-functional initiatives, and engage providers, executives, and state partners to improve quality outcomes. Known for clear communication, strong governance presence, and building trusted partnerships that advance population health.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Population Health Consultant / Community Liaison
UnitedHealth Group
Metairie, LA
09.2015 - Current
- Provide strategic quality oversight for 8 parishes in Southeast Louisiana, partnering with providers, facilities, and internal stakeholders to improve HEDIS and population health outcomes.
- Lead provider and staff education on HEDIS measures, documentation standards, billing codes, and gap-closure strategies.
- Manage the OB Notification of Pregnancy Incentive Program, analyzing billing data and performance metrics and presenting outcomes to executive leadership.
- Developed statewide OB Incentive training materials and delivered multi-state education via Webex to support program expansion.
- Created and maintain comprehensive OB, GYN, HPV, and Maternal/Infant Morbidity & Mortality toolkits, supporting provider performance and regulatory compliance.
- Serve as Quality liaison for Louisiana Women’s Hospital and partner with national and regional organizations on maternal health initiatives, including Babyscripts grant implementation to reduce maternal morbidity and mortality.
- Lead and present multiple Performance Improvement Projects, including:
- Prematurity (39-week delivery initiative)
- Cervical Cancer Screening (PIP Lead)
- Congenital Syphilis (PIP Co-Lead)
- COVID-19 Vaccination
- Conduct HEDIS abstraction, overreads, and medical record reviews, ensuring audit readiness and data integrity.
- Led development and implementation of the Medical Record Retrieval and Review end-to-end process, including staff training.
- Promoted to HEDIS Project Leader (2022); coordinated corporate partners, trained internal and contracted staff, led daily huddles, and resolved operational barriers.
- Facilitate NCQA-required plan committees, collaborative interdepartmental PIP meetings, and Joint Operating Committee presentations.
- Manage monthly PIP outreach and performance reports, ensuring regulatory compliance and timeliness.
- Conduct provider practice engagement, including chart reviews, gap reports, incentive optimization, and quality education.
- Represent Quality at provider expos, member outreach events, and state meetings, presenting when requested.
- Completed Institute for Healthcare Improvement (IHI) coursework in Quality and Population Health; maintain annual HEDIS certification.
Senior Clinical Quality Audit Analyst
Amerigroup Louisiana
Metairie, LA
12.2012 - 09.2015
- Provided enterprise-level Quality of Care oversight for the Louisiana plan, ensuring alignment with clinical governance, regulatory, and accreditation standards.
- Authored executive summaries of Quality-of-Care concerns, presenting findings and recommendations to the Senior Medical Director.
- Presented quality trends and risk analyses at Quality Management Committee (QMC) and Quality Improvement Committee (QIC) meetings.
- Directed the Louisiana grievance program, overseeing workflows, escalations, and regulatory reporting.
- Led preparation and submission of monthly, quarterly, and annual grievance reports to state agencies.
- Served as SME for HEDIS audits, abstraction, and medical record validation, supporting NCQA and EQRO readiness.
- Oversaw provider-focused audits and education for high-volume practices statewide.
- Supported NCQA accreditation and EQRO audits, contributing to successful outcomes.
- Trained in Medical Necessity Appeals, utilizing NextGen and PEGA systems.
High-Risk OB Case Manager
Amerigroup Louisiana
Metairie, LA
12.2011 - 12.2012
- Led care management for high-risk obstetrical members, ensuring coordinated, timely, and appropriate services.
- Authorized services using InterQual criteria and Aetna Clinical Policy Bulletins.
- Coordinated outpatient and home health services and collaborated with multidisciplinary teams.
- Participated in weekly interdisciplinary medical rounds, presenting complex cases as needed.
- Developed standardized OB Case Management workflows and processes, improving efficiency and care consistency.
- Utilized enterprise systems (MACESS, FACETS, Care Compass) for documentation and reporting.
- Promoted to Senior Clinical Quality Analyst based on performance and leadership.
Clinical Case Manager
Ameracare Home Health & Hospice
Covington, LA
04.2011 - 12.2011
- Managed comprehensive home health care for assigned patient panels.
- Oversaw interdisciplinary care teams (RNs, LPNs, aides) and therapy coordination.
- Completed ICD-9 coding, billing documentation, and payer authorizations.
- Coordinated Medicare, Medicaid, and private insurance requirements.
Perinatal Clinician
Alere Women’s & Children’s Health
New Orleans, LA
05.2009 - 04.2011
- Provided remote monitoring and clinical support for patients with preterm labor and high-risk pregnancies.
- Managed uterine monitoring, infusion therapies, IV/PICC troubleshooting, and patient education.
- Coordinated therapy initiation and referrals across multi-state regions.
- Served as liaison for Houston Amerigroup members and case management teams.
Registered Nurse – Women’s Services
East Jefferson General Hospital
Metairie, LA
10.2006 - 05.2009
- Provided care across Antepartum, Labor & Delivery, Nursery, and OB/GYN units.
- Served as Charge Nurse; precepted students and oriented new staff.
- Participated in Magnet preparation, quality initiatives, and monthly chart audits.
- Led training and implementation of new electronic clinical documentation systems.
- Maintained certifications in BLS, PALS, ACLS, NRP, and Fetal Monitoring.
Nurse / Patient Educator
I-Flow Corporation
California
02.2006 - 10.2006
- Educated patients, clinicians, and multidisciplinary teams on On-Q pain pump therapy.
- Delivered clinical presentations and supported surgical cases when needed.
Education
Bachelor of Science - Nursing
Our Lady of Holy Cross College
New Orleans, LASkills
- Clinical Quality & Performance Improvement
- Population Health Strategy
- HEDIS Abstraction, Validation & Education
- Maternal & Women’s Health Programs
- Regulatory Compliance (NCQA, EQRO, State)
- Provider Engagement & Education
- Executive Reporting & Committee Governance
- Medical Record Retrieval & Audits
- Care Management & Utilization Review
- Data Analysis & Performance Reporting
- Staff Training & Process Development
Certification
Six Sigma Green Belt – November 2022
Timeline
Population Health Consultant / Community Liaison
UnitedHealth Group
09.2015 - Current
Senior Clinical Quality Audit Analyst
Amerigroup Louisiana
12.2012 - 09.2015
High-Risk OB Case Manager
Amerigroup Louisiana
12.2011 - 12.2012
Clinical Case Manager
Ameracare Home Health & Hospice
04.2011 - 12.2011
Perinatal Clinician
Alere Women’s & Children’s Health
05.2009 - 04.2011
Registered Nurse – Women’s Services
East Jefferson General Hospital
10.2006 - 05.2009
Nurse / Patient Educator
I-Flow Corporation
02.2006 - 10.2006
Bachelor of Science - Nursing
Our Lady of Holy Cross College