Teri Radogna-Linquist MM, BSN, RN, CCM is a Health Plan Services Consultant with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. A Registered Nurse with over 30 years of health care and managed care experience, Teri has over 10 years of experience with Medicare Advantage Health Plans including operations management, compliance, and delegation oversight.
Prior to joining BluePeak as a consultant, Teri has managed Utilization Management (UM) teams for Part C, managed oversight, and development of vendor delegations, performed mock audits for Part C Organization, Determinations, Appeals and Grievances, (ODAG), participated in CMS audits, remediation, and validation for ODAG conditions, and performed pre-delegation and annual delegation oversight audits for UM vendors. Additional health plan experience includes performing utilization management services for a large regional health plan in commercial and Medicaid lines of business during which time the plan achieved NCQA accreditation. Teri also has experience with developing a case management program for primary care physicians and implementing care management and other software platforms for medical group and health plan teams.
Prior to joining BluePeak, Teri served as the Director of Clinical Operations for a leading Utilization Management and Independent Review Organization (IRO) where she focused on development of auditing, monitoring, and training plans, development and oversight of new UM products, oversight of high performing clinical and support teams, compliance, quality, adaptation of Lean methodology tools and maintaining operational readiness for URAC accreditation activities.
Before her role with the IRO, Teri served as the Manager of Medical Management for a large regional Health Plan where she focused on oversight, management, and ongoing development of technical and clinical staff for medical prior authorizations, clinical claims review, and clinical appeals. Additional focus areas were assuring operational readiness for Medicare Advantage Part C, Medicaid, and Commercial regulatory and accreditation audits and plan medical policy development.
Teri received her MM, (Master’s in Management), from Southern Oregon University and holds a B.S. degree in Nursing from the University of San Francisco. She is a licensed registered nurse in Oregon and California and a Certified Case Manager (CCM).