Candace Gaddis, BSN, RN

Highly skilled Registered Nurse with over 20 plus years of experience in the realm of Utilization Management, Quality Improvement, Case Management and Disease Management, with her most recent role as Vice President of Medical Management & Quality. Experience includes Clinical Applications Consultant roles for multiple clients as well as experience in HEDIS, CAHPS, URAC and NCQA. Worked with a software vendor to develop a disease management and outcomes system. Proficient with implementation, configuration, design and training with systems including FACETS, AMISYS, Care Advance and Care Radius software. Possesses hospital experience related to the general medical surgical, intensive care and hospice patient.

Experience

  • Functioned as Vice President of Medical Management for a health plan
  • Supported as Systems Implementation Specialist Clinical Applications Consultant for a West Coast healthcare company
  • Worked as Manager of Quality & Care Management with management responsibilities of the following areas: Utilization Review, Case Management, Disease Management, Behavioral Health Case Management, Appeals, Quality Improvement and Clinical Editing. Development of Case Management Programs
  • Supported as a Utilization Review Nurse for medical necessity for large self-funded employer groups

Qualifications

  • NCQA & URAC Accreditation
  • QRS & STARS Programs

Education

  • Bachelors Degree of Nursing, Arkansas Tech University
  • Nursing Diploma, Baptist School of Nursing

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