Consultant Bios
Our highly experienced URAC and NCQA consultants can help your organization reach successful accreditation or re-accreditation.
Peggy Powers Thomas, RN, MS, brings more than 30 years of experience in health care to PSN with more than 20 years specifically in managed care. Peggy spent four years as a URAC reviewer and participated on a URAC National Advisory Committee. She contributed to the development of many URAC standards, performance measurement tools and to the URAC Program Guides used extensively by URAC applicants.
Peggy has given many seminars on accreditation and participated in some of URAC's research in medical management. Her experience has made her an expert in quality assurance, regulatory compliance, home health, utilization, case management, and her time at URAC made her one of the country's premier experts in workers' compensation. Peggy, Senior Consultant for Accreditation Services since 2000, has been an independent consultant, managed a utilization review department for a national PPO, and has been a case manager, director of a Home Health Program and a Public Health Nurse. She received her Master of Science degree from Georgetown University and her Bachelor of Science in Nursing from Boston College.
Ellen Pauley, RN, MS, has prior experience as Assistant Director of Accreditation Operations/ Surveyor at NCQA’s office in Washington, DC. Through her hands-on and personable approach, Ellen has successfully guided many organizations towards successful NCQA Accreditation. She is a healthcare executive with more than 18 years of diversified experience in developing, training, implementing, supporting, and promoting health services strategies. Ellen’s past experience includes development and monitoring of strategic business plans; project management; policy and standards development; budget development and accountability; and regulatory and accreditation compliance.
As Director of Utilization Management with a national health plan, Ellen actively participated in medical management, quality management, sales and marketing services to facilitate appropriate healthcare utilization, and to improve the quality of the healthcare program for 350,000 members. She re-engineered unit processes to exceed targeted organizational compliance goals and numerous service levels and medical costs to within standard.
Judy A. Ashley, LCSW-C, MBA, brings diverse health care industry knowledge and experience, strong leadership skills, and demonstrated business acumen to her role as a consultant. She is particularly skilled in managed care operations, quality improvement, analytic studies, program development and evaluation, and project management. Her expertise extends to both private and public sector clients.
As a consultant Judy has assisted health plans and specialty managed care organizations in successfully submitting applications for NCQA and URAC accreditation, implementing new accounts and clinical programs, creating tools to enhance Quality Management programs, and developing promotional and educational materials for members and providers. Most recently, Judy completed a study for a large health system on regional access to behavioral health services that resulted in a major policy change at the state level. Judy also conducts systems performance reviews of managed care organizations providing services in Medicaid waiver states and jurisdictions. She has provided extensive training and individual consultation on performance improvement projects and compliance requirements. In addition, she served as a project manager for a CMS study focused on validating performance measures for Medicare Advantage organizations.
Prior to her current role, Judy held positions of increasing responsibility within both the provider and payer sectors. She began her career as a social worker at University of Maryland Medical Systems where she assisted with the development of a center of excellence for rehabilitation. Subsequently, Judy accepted a position with CareFirst BCBS where she served as Director of Marketing Research and Product Development and later as director of a strategic business unit with responsibility for sales, underwriting, customer service, claims processing, account installation, enrollment, billing and collections. Among her accomplishments was the development of a behavioral health subsidiary that was later sold for $53 million. Judy was president of a regional subsidiary of Magellan Behavioral Health, which was the first in the nation to achieve full NCQA accreditation under new industry criteria.
Jessica Cox, RN is a registered nurse with extensive leadership and consulting experience in corporate business, medical management organizations, managed care program development and regulatory compliance activities. Her experience in healthcare and managed care encompasses the acute care hospital setting, hospital management, physician group practice management, corporate business medical management activities, corporate regulatory affairs and medical management consulting on a national basis.
Kathleen Ward Douglas, RN, MPA, CCM, is a seasoned consultant providing client-specific solutions for Case and Disease Management. She is an accomplished healthcare executive with over two decades of experience working in profit and non-profit nationally recognized medical/healthcare management organizations. Her past positions include such experience as Executive Director Case/Disease Management SHPS Healthcare Services/Health International, Director of Medical Management WellPoint Health Networks/UNICARE and Assistant Vice President Medical Care Management for MassMutual Life Insurance Company.
She is a member of the Academy of Certified Case Managers Leadership Council (ACCM), and Case Management Society of America (CMSA)/Academy of Certified Case Managers (CMLC) Leadership Coalition representing leaders who are cutting-edge, innovators in the field of Case Management. She is a member of the Editorial Board for Lippincott’s Case Management Journal. She has held the position of Chair for the American Accreditation HealthCare Commission (URAC) for the Case Management Advisory Committee and is a current member of DMAA (Disease Management Association of America) Patient Satisfaction Workgroup. Kathleen has been a member of the URAC Disease Management and Patient Safety Advisory Groups as well as appointed to the URAC Standards Advisory Committee. She is highly sought after as both a consultant and public speaker.
Anne Llewellyn, RN.C, BHSA, CCM, CRRN has been a leader in the healthcare field for over 30 years as a critical care nurse, catastrophic case manager and educator. Llewellyn serves as an Accreditation Consultant for URAC. She performs Case Management, Health Utilization Management, and Web Site Reviews and is part of the team for Health Plan, Health Network and Medicare Advantage Reviews. Prior to becoming a reviewer, she served as a member of the Accreditation Committee. Anne currently is Editor in Chief of Case in Point magazine.
Anne has written and lectured both nationally and internationally on topics related to continuing medical education, patient safety, quality of care and medical management. She is past president of the Case Management Society of America (CMSA) and continues to be an active member of her local chapter. She is also a member of the American Nurses Association and the Emergency Nurse Association. Anne was a founding member of The Center for Practical Health Reform. In addition to these professional organizations, Anne is a member of Quota International of Plantation, an organization dedicated to providing service to deaf, hard-of-hearing, and speech-impaired individuals and disadvantaged women and children.
Patricia (Pat) Trefny Ford, RN, BS, CPHQ, CCM has 20 years of experience in medical management program development, as well as15 years in the clinical setting specializing in medical surgical and intensive care nursing. She has worked extensively in Quality Improvement, Utilization Management, Case Management, and Credentialing program design and implementation. She has been responsible for directing and coordinating both the URAC survey process (Core, Health UM, Case Management, Health Network, Independent Review Organizations, and Disease Management) and the NCQA survey process. Pat is active in the National Association for HealthCare Quality (NAHQ) and the Washington State Association for HealthCare Quality (WSAHQ) where she has served as President, and is a member of the Case Management Society of America (CMSA), and the Washington Medical Case Management Association (WMCMA). Pat has been a featured speaker on managed care and accreditation issues. She is a Registered Nurse with a Bachelor’s degree in Health Care Administration. In addition, she holds current certification in Quality Improvement (CPHQ) and Case Management (CCM).