Lisa B. Barker MBA, BSN, RN, CCM
Executive Consultant of Clinical Ops and Quality
Lisa B. Barker is the Executive Consultant of Clinical Ops and Quality with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. A Registered Nurse (RN) and Certified Case Manager with over 26 years of health care experience, Lisa has more than 15 years of experience with Medicare Advantage Health Plans including operations management, compliance, delegation oversight, and providing consulting services.
Prior to joining BluePeak, Lisa managed Utilization Management (UM) teams for Part C, developed UM vendor oversight programs, conducted risk assessments, performed mock audits, participated in CMS audit remediation and validation for Coverage Determinations Appeals and Grievances, (CDAG) and Part C Organization, Determinations, Appeal and Grievances, (ODAG), and performed pre-delegation, annual delegation oversight and validation audits for UM vendors. Lisa has extensive experience with an Institutional Special Needs Plan (I-SNP) where she conducted reviews for eligibility, analyzed and communicated performance monitoring results to key stakeholders and developed and implemented performance improvement plans to eliminate unnecessary utilization while maximizing care coordination and improving health outcomes. Additional health plan experience includes performing utilization and care management services for a national health plan in commercial and Medicaid lines of business, during which time the plan achieved URAC accreditation for Case Management and NCQA accreditation.
At BluePeak, Lisa serves as the Part C lead over Medicare, commercial, Medicaid, PACE, exchange, and self-funded plan issues. Lisa is the primary account manager and contact for multiple clients of varying sizes, and her focus is on ODAG, PACE clinical compliance, Special Needs Plans and the operational and clinical implications of the Model of Care (MOC). Lisa is BluePeak’s primary subject matter expert (SME) for CMS audit support for Part C clients in ODAG, SNP and Medicare-Medicaid Plan (MMP) Care Coordination. Lisa is part of the BluePeak guidance and audit committees and advises and trains other SMEs. Lisa also supports Part C operational gap analysis, clinical quality reviews, SNP assessments, and SNP MOC reviews for clients. Lisa has assisted with plan remediation of conditions post-audit and reduced audit conditions to observations with her expertise in Part C clinical and operational requirements. Lisa also leads consultant support to plans regarding Medicare business operations, Medicare policy, and program management, including delegation oversight.
Lisa holds a master’s in business administration and a certificate in Health Care Management from East Carolina University College of Business. Lisa holds a bachelor’s degree in nursing from the University of North Carolina at Greensboro. Lisa also maintains a Registered Nurse license in North Carolina and is a Certified Case Manager (CCM).