Susan Stern, RN, CCM, MHA

Interim Director of Care Management / Senior Clinical Consultant at Quality

Susan Stern, RN, CCM, MHA has over 20 years of experience in the healthcare industry. Susan began their career in 1996 as the Corporate Director of Clinical Medicare Programs at Harvard Pilgrim Health Care. Susan then moved to HCA Network Management Services / Florida Group as the Director of Medical Management. In 1998, they became the Director of Business Development at Opnet, where they were responsible for new business development and contracts with managed care organizations. In 1999, Susan moved to Aetna as the Director of Medical Management at Maryland Physicians Care, managing five departments and direct reports. From 2000 to 2007, they worked as an independent contractor in healthcare, performing home health, medical practice Hedis quality audits, Joint Commission preparation and hospital based denial management audits. In 2007, they joined TriZetto Corporation as a Senior Nurse Clinical Consultant. In 2009, Susan became a Senior Business Development Executive and Business Development Executive for Accreditations & Vendor Certifications at URAC Accreditation. Since 2016, Susan has been working at Quality Healthcare Partners as an Interim Director of Care Management / Senior Clinical Consultant. In this role, they and their team of consultants specialize in CM, UM, Quality, Nursing Leadership, Transition of Care, Revenue Cycle Integrity, HIM and assist hospital leaders attain their goals for team and patient engagement. Susan has also been involved in NCQA Accreditation Gap Analysis, developing Discharge Planning Program Education, preparing Children's Hospital Clinically Integrated Network for Clinical Integration Accreditation, and most recently, building a team of expert consultants and participating in review & quality control of clinical consultant proposals and statement of work.

Susan Stern, RN, CCM, MHA received their RN Diploma from The Brooklyn Hospital School of Nursing in 1968, their BS in Health Science from Hunter College in 1971, and their Master’s Degree in Health Care Administration from Loma Linda University in 1988. In 2018, they obtained their CCM certification from the Commission for Case Manager Certification (CCMC).

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  • Interim Director of Care Management / Senior Clinical Consultant

    March, 2016 - present

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