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Sonya L. Hughes, BSN, RN, CCM

Consultant

Sonya L. Hughes BSN, RN, CCM is a Health Plan Services Consultant with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. A Registered Nurse with over 28 years of health care experience, Sonya has more than 10 years of experience with Medicare Advantage Health Plans. In addition to providing consulting services for “all things Part C”, Sonya has extensive leadership experience in plan operations, compliance, and utilization review.

Prior to joining BluePeak, Sonya has managed Utilization Management (UM) teams for Part C, provided consulting services for Medicare Advantage Plan on developing a Health Risk Assessment Program, provided education to providers for coding and documentation related to Risk Adjustment Factor (RAF) scores, and development of case management program policy and procedures. Sonya also has extensive experience with Medicare Institutionalized Special Needs Plan implementation, claims, sales, referrals and account management.

Sonya received her BSN from Winston-Salem State University and certification in case management from the Commission for Case Managers.  She holds a license as a registered nurse in North Carolina.

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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.

Contact us today!