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Teri Radogna-LinquistTeri Radogna-Linquist, MM, BSN, RN, CCM

Senior Consultant

Teri Radogna-Linquist 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 more than 10 years of experience with Medicare Advantage Health Plans including operations management, compliance, and delegation oversight.

Prior to joining BluePeak, Teri served as the Director of Clinical Operations for a leading Utilization Management (UM) and Independent Review Organization (IRO). In that role she focused on development and oversight of UM products, auditing, training high performing clinical teams, compliance, quality, adaptation of Lean methodology tools and maintaining operational readiness for URAC accreditation activities. Her broad experience includes leading and developing Utilization Management (UM) teams and programs for MA-PD, Medicaid, and Commercial lines of business for a large regional health plan. Leadership activities include medical policy development, performing mock audits for Part C Organization, Determinations, Appeals and Grievances, (ODAG), participating in CMS audits, remediation, and validation for ODAG conditions, performing pre-delegation and annual delegation oversight audits for UM vendors and achieving and maintaining readiness for NCQA accreditation and State and Federal regulatory requirements. Teri also has experience with developing and managing case management programs for primary care physicians and implementing care management and other software platforms for hospital delivery systems, medical groups, and health plan teams.

At BluePeak, Teri serves as a subject matter expert (SME) on Part C Medicare in the areas of ODAG, and Medicare-Medicaid Plan (MMP) Service Authorization Requests, Appeals and Grievances (SARAG). Teri is the primary account manager and contact for multiple clients of varying sizes, and her focus is on Part C and ODAG related operational and benefit management related issues. Teri serves as primary SME for CMS audit support for Part C clients in Organization Determinations, Appeals and Grievances (ODAG). Teri also supports clients with Medicare operational implementations, Medicare policy and program management, and Medicare post audit remediation and validation.

Teri holds a master’s degree in management from Southern Oregon University and a bachelor’s degree in nursing from the University of San Francisco. She is a licensed, registered nurse in Oregon and California and is a Certified Case Manager (CCM).

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