Carole Graham, RN, MBA

Director of Operations & Talent Management

Professional

Carole Graham applies both her nursing background and data analysis skills in helping health services organizations improve clinical care management and operations. She has a broad perspective on these subjects, having worked in operations on both the provider and payer sides of managed care.

Carole’s experience includes:

  • Developing and analyzing RVU and AWP-based fee schedules
  • Acting as liaison between providers and payers on fee matters
  • Reviewing and advising on contract language related to physician fees
  • Serving as a third party in measuring performance and determining incentive payments actually received by physicians under a co-management agreement incentive plan
  • Identifying programs needed to improve community health care and guiding clients in developing and implementing those programs
  • Advising clients on medical management program development and implementation

 

Before joining Veralon, Carole developed medical management programs covering over 200,000 risk lives, as Vice President of the Allegheny Health, Education, and Research Foundation. She also managed quality improvement and claims analysis for Keystone Health Plan East.

Carole holds an MBA in Health Administration from Temple University and a BS in Nursing from West Chester University.

Personal

First job: Nursing Assistant
Favorite food: Filet Mignon
Favorite drink: Margaritas
Something you are passionate about: Time at the beach
One bucket list item: Sail the Caribbean for four weeks
Go-to pastime/hobby/non work related activity you enjoy: Painting ceramics
What I’d tell my 20 year-old self: Start saving more for retirement and a great annual vacation
Most used app: FaceBook
Nonprofit you support: Gift of Life

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