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Dhara Shah

@dharashah2

Quality Improvement Facilitator II at Inland Empire Health Plan, advancing maternal, pediatric, and behavioral health pathways.

United States

Message

At Inland Empire Health Plan, I lead quality improvement projects across the Maternal & Pediatric Pathway and Behavioral Health Pathway, using root cause analysis and other QI methods to guide improvement efforts. I measure outcomes, analyze data, and share recommendations through executive report-outs and quality audits.

Previously, I worked on compliance and process improvement at Inland Empire Health Plan, including policy reviews and cross-functional projects. At Prime Healthcare Management Inc., I supported behavioral health utilization review and denial management across 27 hospitals, contributing to an $8 million revenue increase in six months and a 15% reduction in denial rates.

Experience

Work history, roles, and key accomplishments

Current

Quality Improvement Facilitator II

Current

Inland Empire Health Plan

Feb 2026 - Present (8 months)

Led quality improvement projects from planning to execution under the Maternal & Pediatric Pathway and Behavioral Health Pathway. Partnered with leaders and external stakeholders to advance strategic priorities and applied QI methodologies such as cause-and-effect analysis and root cause analysis.

Quality Improvement Project Management Root Cause Analysis Data Analysis Executive Reporting Quality Audits Medical Covered California Portal

Compliance Analyst II

Inland Empire Health Plan

Jul 2024 - Feb 2026 (1 year 7 months)

Managed cross-functional projects supporting regulatory compliance, system enhancements, and process improvements. Reviewed and updated internal and provider policies to ensure compliance with regulatory and accreditation requirements.

Compliance Policy Management Regulatory Affairs Gap Analysis Project Management Risk Identification Accreditation

Process Improvement Facilitator

Inland Empire Health Plan

Jan 2023 - Jul 2024 (1 year 6 months)

Consulted owners, leaders, and teams using Lean process improvement tools and methodologies. Led care management improvement projects and supported the development of Lean best practices and infrastructure.

Lean methodologies Process Improvement Project Management Stakeholder Communication HEDIS CAHPS MCAS Stars Quality

Utilization Review Supervisor

Prime Healthcare Management Inc.

Jun 2020 - Dec 2022 (2 years 6 months)

Spearheaded Behavioral Health Utilization Review and Denial Management across 27 hospitals, increasing revenue by $8 million in 6 months. Developed reports using pivot tables and VLOOKUP and analyzed workflows to reduce denial rates by 15%.

Utilization Review Denial Management Behavioral Health Data Analysis Pivot Tables V Lookups Six Sigma Compliance 42 CFR

Quality Assurance Auditor

Keck Medicine of USC

May 2019 - May 2020 (1 year)

Assisted in developing and executing a quality assurance program for the Access and Transfer Center. Performed audits, analyzed data, and presented weekly KPI reports, improving performance by 25% in 3 months.

Quality Assurance Audit Data Analysis KPI Reporting Training Regulatory Compliance

Graduate Resident Intern

America's Physician Group

May 2019 - Dec 2019 (7 months)

Produced data interpretation on the annual and quarterly compliance record of risk-bearing organizations from 2006-2019. Compiled CAP summaries and quality score reports, presenting findings at the DMHC Federal committee meeting.

Data Analysis Compliance Reporting Financial Viability Corrective Action Plans Presentation Skills

Research Assistant

Keck Medicine of USC

Feb 2019 - Aug 2019 (6 months)

Worked with the Data Coordinating Centre on data collection, maintenance, and cleaning for a lung cancer screening study with over 10,000 participants. Maintained study files and communicated with participants for follow-ups.

Data Collection Data Cleaning Data Analysis Study Management Communication Skills