Chantelle McMurrian

Developed and implemented a Delegation Oversight Audit Program for Medicare Advantage and Medicaid delegated entities to ensure CMS, DHCS, NCQA, contractual, and regulatory compliance. Leads delegation oversight activities including pre-delegation assessments, audits, corrective action plans, ongoing monitoring, and vendor performance evaluations.

Created an oversight program for commercial, Medicare, and Medicaid delegated UM/CM services. Collaborates with stakeholders to develop RFPs within budget and supports contract development, integration, and vendor negotiations.

Develops and monitors corrective actions and communicates performance outcomes and gaps to internal and external stakeholders, escalating high-risk findings as needed. Acts as a liaison to support regulatory compliance for vendor delegated services, including participation as a speaker during mock and regulator audits.

Oversaw delegation oversight activities for assigned vendors, setting goals and performance expectations with a focus on quality. Participated in RFP and vendor contracting activities to support new business deals and ongoing delegated services.

Weekend supervisor/trainer for adult and pediatric home healthcare, supporting nursing operations and training activities. Provided registered nurse coverage in home healthcare settings.

Participated in research, development, and implementation of clinical programs aligned to corporate and divisional goals, using a clinical perspective to identify process gaps and limitations. Provided clinical consultation based on analysis of key drivers of results and supported RFP-related collaboration with stakeholders.

Responsible for overseeing utilization management operations for Affordable Care Act initiatives, directing and evaluating utilization management activities. Managed policies and best practices, led and grew staff, handled budget management and strategic planning, and ensured compliance with accreditation and state/federal regulatory guidelines.

Managed utilization management clinical operations, including staffing schedules, workflow management, hiring, training, and performance reviews. Ensured compliance with HEDIS indicators, maintained documentation and reporting, and led quality improvement initiatives within budget guidelines.

Provided care management for members with complex and chronic needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans across the care continuum. Facilitated interdisciplinary approaches, monitored staff performance, and supported care plan activities for member optimization.

Coordinated NICU utilization management and case management by overseeing and managing care for NICU members to support appropriate and cost-effective care. Assessed treatment needs, monitored outcomes, facilitated weekly interdisciplinary meetings, and communicated progress and obstacles to the therapeutic team and family.

Worked as an extended registered nurse case role as an in-house travel nurse. Supported specialty hospital case coverage in RN capacity.

Served as RN charge nurse and quality coordinator, with responsibility for quality-focused coordination activities. Provided leadership as part of nursing operations while supporting quality initiatives.

Doctor of Business Administration program at Capella University, with an expected graduation year of 2027 and start date of 12/2024.

Master of Business Administration program at Capella University, beginning 9/2024.

Bachelor of Science in Nursing from Capella University, beginning 2/2007.

Registered Nurse education at Baptist Health College in Little Rock, Arkansas, associated with 5/1999.

Practical nursing education at SOWELA Technical Community College in Oakdale, Louisiana.