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Serena Figueroa

@serenafigueroa

Senior healthcare quality leader with 15+ yrs driving regulatory strategy, value-based contracting, and multi-market performance improvement.

United States

Message

What I'm looking for

I'm looking to lead value-based contracting, population health, quality, and compliance initiatives where I can translate regulatory and clinical requirements into measurable improvements in care delivery, documentation integrity, cost trends, and outcomes.

I've led regulatory strategy, population-health performance, documentation integrity, and value-based care operations across Medicaid, Medicare, managed care, and behavioral health systems for more than 15 years.

At Telecare Corporation, I directed regulatory and compliance alignment across 80+ programs in the PNW, Northern California, and Bay Area. I translated CMS, DHCS, Medicaid, CARF, and CDPH requirements into operational and financial strategies supporting value-based care readiness.

Across Summit BHC, Santa Rosa Behavioral Health Hospital, and Sonoma Specialty Hospital, I built compliance, QAPI, documentation-governance, and chart-review programs. My work strengthened audit defensibility, risk adjustment, chronic-condition documentation, care transitions, health equity planning, and quality outcomes.

Earlier at i2i Population Health and Santa Rosa Memorial & Petaluma Valley Hospital, I supported HEDIS, UDS, HRSA, Medicaid, accreditation, and licensing requirements while redesigning workflows and training clinical teams. I bring a practical approach to connecting quality, compliance, provider education, cost drivers, and accountable care delivery.

Experience

Work history, roles, and key accomplishments

Regional Clinical Quality Director

Telecare Corporation

Jan 2025 - Dec 2026 (1 year 11 months)

Directed regulatory and compliance alignment across 80+ programs, ensuring adherence to CMS, DHCS, Medicaid, CARF, and CDPH requirements. Interpreted complex regulatory guidance and translated requirements into operational and financial strategies supporting value-based care readiness.

Regulatory Compliance CMS DHCS Medicaid CARF CDPH Value Based Care Documentation Accuracy Chart Reviews Risk Adjustments Provider Education Population Health

Recovery & Treatment Consultant

Summit BHC

Jan 2023 - Dec 2024 (1 year 11 months)

Directed compliance strategy across multisite behavioral health programs, collaborating with DOJ, legal teams, and state agencies. Enhanced EHR analytics to identify disparities, cost drivers, and compliance gaps, and built ASAM-aligned dashboards and regulatory reference tools per New Jersey NJAC recovery model standards.

Behavioral Health Compliance Strategy EHR Analytics ASAM Criteria Regulatory Compliance DOJ Data Analysis Dashboard Development

Director of Quality

Santa Rosa Behavioral Health Hospital

Jan 2021 - Dec 2023 (2 years 11 months)

Oversaw QAPI, risk management, incident reporting, and compliance with CMS, TJC, Title 22, and CDPH. Conducted audits, developed corrective action plans, and ensured survey readiness, while integrating health equity into compliance and corrective action planning.

QAPI Risk Management Incident Reporting CMS TJC Title 22 Compliance CDPH Audit Corrective Actions Health Equity

Director of Quality & Risk Management

Sonoma Specialty Hospital

Jan 2019 - Dec 2021 (2 years 11 months)

Led regulatory compliance, accreditation readiness, and QAPI. Improved continuity-of-care processes and DRG monitoring, and secured DHHS grants supporting access, equity, and quality initiatives.

Regulatory Compliance Accreditation QAPI DRG Monitoring DHHS Grants Documentation Accuracy Chart Reviews Provider Education

ERP Business Analyst Consultant

Manzana Products Company

Jan 2018 - Dec 2019 (1 year 11 months)

Performed data cleansing, validation, and configuration supporting accurate system implementation. Developed user training guides and dashboards improving visibility, reporting, and interface functionality.

Data Cleaning Data Validation System Configuration Training guides Dashboard Development ERP

Manager, Client Relations & Implementation Projects

i2i Population Health

Jan 2015 - Dec 2017 (2 years 11 months)

Supported compliance with HEDIS, UDS, HRSA, and Medicaid quality requirements, aligning with CMS Stars and quality measure integration. Delivered workflow redesign and compliance-aligned performance solutions, and provided consultative guidance on population health best practices.

HEDIS UDS HRSA Medicaid CMS Stars Workflow Redesign Population Health Consulting

Quality Assurance Coordinator

Santa Rosa Memorial & Petaluma Valley Hospital

Jan 2013 - Dec 2015 (2 years 11 months)

Conducted proactive audits, RCA meetings, and compliance steering committees. Supported accreditation and licensing verification processes for CMS, TJC, CDPH, and Title 22, and implemented policy and procedure monitoring systems.