Nancy E. Erickson, BSN, MHA
Director
Nancy E. Erickson, BSN, MHA is currently Director, Health Plan Services with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. Nancy, a Registered Nurse, has been in the managed health care industry for 30 years with Medicare Advantage Health Plans including operations management, compliance, delegation oversight, and providing consulting services for government program plans and delegates.
Prior to joining BluePeak, Nancy worked with several large Medicare Advantage health plans accountable for operational areas, which included enrollment services, membership reconciliation, disease/care management, utilization management, credentialing, quality improvement, risk adjustment and delegation management areas. Nancy led a team in the implementation of Disease Management Programs in Ischemic Heart Disease, Congestive Heart Failure and Diabetes with a 50% decrease in emergency room visits and 25% decrease in hospital days. She also developed, implemented, and attained state HMO licensure in ninety days, and completed and secured a MAPD contract with CMS for 2006 for a new Special Needs Plan (SNP) and following go live, Nancy was Executive Director of the plan. During her tenure at a large plan, she led a team to National Committee for Quality Assurance, (NCQA) awarded an Excellent accreditation with 3 clinical “best practice” clinical studies in asthma, diabetes, and Pediatric immunization.
At BluePeak, Nancy serves as Director of Health Plan Services providing account management for multiple clients. Nancy provides consulting services in the areas of organization determinations, appeals and grievances (ODAG) for Medicare advantage plans operations (Part C), PACE plans clinical compliance, Special Needs Plans Care Coordination (SNPCC), including writing and review of the Model of Care (MOC), Medicare-Medicaid Plan (MMP) Service Authorization Requests, Appeals and Grievances (SARAG) and MMPCC. Nancy is on the guidance and audit committees and advises and trains other SMEs. Nancy also provides clients consulting support in all areas of Medicare policy and program management. Nancy supports plans in operational strategies for Stars Ratings, Risk Adjustment programs and annual bid review. Nancy also supports delegates who are contracted with Medicare Advantage plans. Medicaid support includes compliance with state audits, Medicaid validation audits, with focus on LTSS and MLTC. Qualified Health Plan (QHP) support includes compliance and access requirements.
Nancy holds a master’s degree in healthcare administration from Kennedy Western University and bachelor’s degree in nursing from the University of the Incarnate Word. She is a licensed, registered nurse in Texas.