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

Consultant

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).

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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!