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sallie shuskeySallie Shuskey, RN

Senior Consultant

Sallie Shuskey is a Senior Health Plan Services Consultant with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. A Registered Nurse with over 35 years of health care experience, Sallie has more than 15 years of experience with Medicare Advantage (MA) Health Plans in mid-level and senior leadership roles at local and national health plans.  Sallie has served in roles ranging from Health Services Director, front line Case Manager and Case Management leadership, Compliance, and Part D oversight.  Sallie provides BluePeak clients with operations and compliance support in all Part C areas, conducts mock program audits for ODAG and SNP and provides operational area support during CMS program and independent validation audits. In addition, Sallie provides consulting services for Case and Utilization Management, including pre-delegation audits and ongoing delegation oversight.

Prior to joining BluePeak, Sallie served as Manager of Case Management with a national MA Plan, where she focused on care coordination specific to readmission reduction and off-cycle Model of Care improvements to enhance the transition of care process. Sallie developed process enhancements, trained and led a team through the implementation, ultimately leading the team to achieve an 8% reduction in annual readmissions and increased member satisfaction which contributed to an increase in Part C Stars Ratings.

Prior to her leadership in Case Management, Sallie led a team through full implementation of an Institutional Special Needs Plan (I-SNP) in North Carolina and was accountable for ongoing senior level leadership to the clinical team. Sallie brings a wealth of experience in ISNP health plan management and can provide a unique perspective to ISNP plans as she previously served as a licensed nursing home administrator. In her role as Director of Health Services, Sallie developed and implemented performance improvement plans to prevent over utilization and improve health outcomes within contracted nursing facilities.  During her time with this I-SNP plan, Sallie and her team were able to decrease the medical loss ratio while increasing quality of care and member satisfaction.

Sallie received her bachelor’s degree in nursing from Chamberlain University School of Nursing and holds an Associate of Nursing degree from Randolph Community College. She is licensed as a Registered Nurse in North Carolina and a Certified Case Manager.

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Experienced Medicare staff: Ready when you are!

BluePeak knows how difficult it can be for Medicare Advantage plans and TPAs to find knowledgeable resources with experience in Medicare, especially when demands increase sharply given the Medicare annual cycle. BluePeak maintains a wide variety of experienced Medicare personnel to help you with seasonal projects, operational backlogs, compliance monitoring, remediation activities, and more.

Examples of projects that BluePeak has assisted plans in 2022 include:

  • Clinical chart review by licensed clinicians
  • Call center oversight, including listening to calls for accurate classification and calibration
  • Operational support to resolve grievance backlogs and provider directory compliance
  • Pharmacy support to resolve coverage determination backlogs
  • Program area specific operational and administrative responses to a corrective action (initiated internally or externally)
  • Compliance resources to support compliance program initiatives

Whether you need one resource or many, BluePeak can quickly staff any project, train resources, track results, and deliver success.

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