Michelle Bolton, MBA, BSN, RN, RN-BC, CPHQ
Senior Consultant | BluePeak Advisors
Michelle Bolton, is a Senior Consultant with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. A Registered Nurse (RN) certified in nursing case management and healthcare quality, Michelle has 20+ years of healthcare experience with 10+ years of executive leadership, operations management, and quality improvement expertise in the Medicare Advantage and Medicaid space working with both national and local health plans, as well as providing clinical consultation services.
Michelle has led care management, quality improvement, appeals and grievance, and quality of care clinical teams in various health plans supporting all lines of business. She has facilitated HEDIS strategy and operations as well as NCQA accreditation projects resulting in successful completion of the accreditation process and HEDIS improvement in targeted measures. Prior to joining BluePeak Advisors, Michelle worked as a Senior Director of Medicare Appeals at a managed care company where she was responsible for the strategic direction of the clinical and non-clinical appeals programs and initiatives. In this role, she successfully completed Medicare audits (program, timeliness, transition, and desk audits) and achieved operational improvement related to Stars performance for timeliness and decision making of appeals.
At BluePeak, Michelle serves as a subject matter expert (SME) for Medicare Advantage, commercial, and Medicaid plans. Michelle supports multiple clients of varying sizes in mock ODAG, SNP, and MMP audits, with a particular focus on Part C operational related issues. Michelle also supports clients with operational and system implementations and quality-related issues (e.g., HEDIS, Stars, CAHPS, and quality improvement projects).
Michelle received her Master of Business Administration with Health Care Concentration from Ohio University and her Bachelor of Science in Nursing from the University of Missouri – Kansas City. Michelle maintains certifications from the American Nurses Credentialing Center (Nursing Case Management) and the National Association for Healthcare Quality (Certified Professional in Healthcare Quality). Michelle holds a multistate license as a Registered Nurse in states participating in the Nurse Licensure Compact.