Julia A. Rieve
     RN, BSHCM, CCM,
     CDAF,CPHQ, FNAHQ

     Biography

 

Ms. Rieve has over twenty five years combined clinical and management experience in ambulatory care, home care, acute care, managed care, and indemnity healthcare settings.  She has designed, implemented, and evaluated healthcare processes, focusing on Utilization, Quality, Case and Disease Management programs.

Ms. Rieve has extensive experience in the development of accreditation compliant Utilization, Quality, Case and Disease management programs.  As the first Pre-admission Coordinator for Kaiser Permanente, San Diego, Ms. Rieve implemented and managed a $31 million dollar Medicare preauthorization program.  She also served as a TQM facilitator for the hospital observation program.  As a Director of Utilization Management for the HealthTrust system, Ms. Rieve designed and implemented a JCAHO endorsed Case Management program.

While working as the Director of Quality and Care Management for CAREADVANTAGE Health Systems Inc., a Disease Management consulting firm, Ms. Rieve evaluated and developed innovative managed care concepts such as the adaptation of Milliman and Robertson guidelines for Blue Cross Blue Shield of Rhode Island and Maine.  Ms. Rieve designed and led the transition and training of BCBS of Rhode Island Utilization Review staff from telephonic Utilization Review to URAC compliant onsite Case Management and initiated the disease specific care management process.  Additionally, Ms. Rieve designed NCQA compliant quality management indicators in conjunction with disease specific carve-out populations managed by CAREADVANTAGE for BCBS of Maine.  She has conducted extensive operational redesign assessments for BCBS Plans of Michigan, New Jersey, Mississippi, ProAct E.A.P., Sutter/CHS, Santa Clara Valley Healthcare Systems, BayCare IPA, and Baxter Healthcare Corporation.

Ms. Rieve is a nationally known speaker and author for organizations such as Mosby on Managed Care, Case and Disease Management.  She is a contributing author for an American Hospital Association book on Disease Management and publishes numerous articles on Case and Disease Management.  Ms. Rieve is quoted frequently in medical journals and her work is referenced by others representing medical, employer and consumer groups.  She has been cited as a healthcare leader in "WHO’s WHO in American Healthcare, 1995" and received the 1996 NAHQ David L. Stumph Award for Excellence in Publication.  Ms. Rieve is the 1997-1998 National Communications Chair for CMSA and is a member of the 1997-1998 NAHQ Fellow Selection Committee.

She received her Bachelors of Science degree in Healthcare Management from Southern Illinois University and her nursing degree from Grossmont College, California.  Ms. Rieve carries certificates as a Certified Case Manager (CCM), a Certified Disability Analyst (CDAF) and Fellow, a Certified Professional in Healthcare Quality (CPHQ), and is a Fellow of the National Association for Healthcare Quality (FNAHQ).

Ms. Rieve is the founder and President of CQI, A Healthcare Management Services Company, located in San Diego, California.

CQI
A HEALTHCARE MANAGEMENT SERVICES COMPANY
Julia A. Rieve, RN, BSHCM, CCM, CDAF, CPHQ, FNAHQ
President
2726 Shelter Island Drive, Suite 316
San Diego, CA  92106
619-226-4141 VM & FAX
Send Inquiries & Comments to:  rieve@CQIhealthcare.com