Dr. Tonia M. Richardson, DM, LPC, LSSGB, CPHQ

Accomplished Quality Manager with 10+ years of experience and extensive expertise in behavioral health, Employee Assistance Programs (EAP), managed care and quality management. Demonstrates a robust track record of achieving results through strategic planning, clinical programming and interventions, program evaluation, and data analysis. Highly skilled in facilitating internal and external collaboration, navigating NCQA and CARF accreditation processes, and managing complex projects. Expert in performance improvement, policy and procedure development, and staff coaching, training, and evaluation. Adept at delivering professional presentations and fostering team development to achieve strategic objectives. Known for a collaborative approach to problem-solving and decision-making, with a proven ability to lead teams and develop comprehensive programs that meet and exceed organizational goals. An effective communicator dedicated to maintaining high standards and driving continuous improvement.

AREAS OF EXPERTISE

PROFESSIONAL EXPERIENCE

Director of Quality Management |DECEMBER 2024 – PRESENT

Operation PAR – A Substance Use Disorders Treatment Facility | Pinellas Park. FL

Designed and maintain program-specific clinical audit tools across MAPS, Residential, Outpatient, and Peer Review programs, leveraging Microsoft Forms, Excel, and SharePoint to standardize performance measurement and drive corrective action tracking.
Facilitate execution and ongoing monitoring of the organization’s strategic plan, while developing manager communication infrastructure to ensure alignment and transparency across all levels of leadership
Oversee comprehensive quality management operations across a multi-program behavioral health organization, encompassing internal and external clinical audit oversight, CARF accreditation compliance, risk and safety management, and organization-wide quality improvement initiatives
Implemented new accreditation readiness process resulting in three-year CARF reaccreditation for all programs
Implemented standardized quality improvement framework including Trilogy documents and QI committees
Collaborated with program directors and data analysist to develop standard quality indicators

Clinical Quality Program Director | APRIL 2023 – JANUARY 2024

Carelon – A Behavioral Health Managed Care Organization| Remote

Continuously evaluated and refined behavioral health clinical policies to stay abreast of evolving regulations and best practices.
Orchestrated the seamless integration of behavioral health clinical policies across diverse departments, driving operational efficiency.
Collaborated closely with interdisciplinary teams to ensure the smooth assimilation of new clinical policies into existing systems and workflows.
Engaged in strategic collaboration with executive leadership to align clinical policy initiatives seamlessly with the organization’s overarching strategic objectives and goals.

Accreditation Manager | APRIL 2021 TO MARCH 2023

Anthem – A Managed Care Organization | Remote

Offered expert guidance as a Quality Consultant, navigating NCQA standards and ensuring strict compliance with regulatory requirements.
Established and maintained robust reporting systems, meticulously tracking accreditation status and compliance metrics ensuring 100% on-time report delivery.
Delved into comprehensive data analysis, uncovering trends and pinpointing areas ripe for improvement, catalyzing a significant boost in overall quality performance.
Presented detailed reports and engaging presentations to senior management, distilling accreditation readiness and highlighting key areas requiring attention.
Fostered collaboration across cross-functional teams to conceptualize and implement process enhancements, propelling the efficiency and efficacy of accreditation-related tasks to new heights.
Leveraged accreditation data to identify deficiencies and proactively recommend corrective actions, effectively curtailing non-compliance issues.
Facilitated impactful quality assurance projects aimed at elevating accreditation standards and surpassing industry benchmarks.

Clinical Quality Program Manager | OCTOBER 2019 TO MARCH 2021

Amerigroup – A Managed Care Organization| Atlanta, GA

Managed the intricacies of the quality management system, ensuring compliance with healthcare regulations and NCQA standards, culminating in a commendable 15% enhancement in regulatory audit outcomes.
Delved into comprehensive CAHPS and HEDIS data analysis, uncovering nuanced patterns and trends in clinical performance, thus providing invaluable insights for strategic decision-making and propelling quality improvements forward.
Crafted and delivered comprehensive reports on the intricacies of quality improvement activities to senior leadership and stakeholders, underpinning informed decision-making and strategic planning efforts.
Fostered collaborative partnerships with cross-functional teams, orchestrating the design and execution of impactful quality improvement projects, ultimately resulting in tangible enhancements in patient outcomes and satisfaction levels.
Leveraged detailed clinical data analysis to meticulously evaluate the efficacy of interventions and pinpoint areas ripe for improvement, thus catalyzing more targeted and successful quality initiatives.

Quality Evaluator Lead | AUGUST 2015 TO OCTOBER 2019

Amerigroup – A Managed Care Organization | Atlanta, GA

Managed quality management processes, ensuring adherence to industry standards and regulatory requirements, resulting in a 20% improvement in compliance rates.
Conducted in-depth data analysis to identify trends and patterns in CAHPS, HEDIS, encounter and enrollment data, informing strategic decision-making and driving a 15% improvement in quality metrics.
Prepared detailed reports summarizing quality evaluation findings and recommendations for improvement.
Conducted regular audits to assess compliance with quality standards and identify areas for enhancement.
Fostered teamwork and collaboration among quality evaluation team members, promoting a culture of continuous improvement and knowledge sharing.
Facilitated PIPs focused on behavioral health HEDIS measures resulting in improved processes, outcomes and scores
Collaborated with cross-functional teams to integrate quality evaluation processes into organizational workflows and systems.

EDUCATION

Master of Science, Healthcare Quality Management | George Washington University

Doctor of Management, Organizational Leadership | University of Phoenix

Master of Education, Counseling and Personnel Services | University of Maryland

Master of Arts, Psychology | Wayne State University

Bachelor of Arts, Psychology | Clark College

CERTIFICATIONS

Certified Professional in Healthcare Quality | Healthcare Quality Certification Commission

Lean Six Sigma Green Belt | J. Mack Robinson School of Business

Licensed Professional Counselor | Georgia Professional Licensing Board License #LPC004931