JUDITH LYNN (HALE) FORNIA
Chief Consultant, Paradigm Development,Inc.
Specializing in Health Care Quality
Assurance, Utilization Management and Medical Review
7118 NE Fairway Avenue
Vancouver, WA 98662
(360) 254-3706 (telephone)
(360) 604-7811 (fax)
(800) 916-1377 (voicemail/pager)
Judith L. Fornia, R.N., M.H.A., has over 15 years experience in Utilization Review and Quality
Management in acute care, long-term care, and home care settings, including monitoring care and
DRGs for Medicare and Medicaid patients. She has developed and implemented Utilization Review
and Quality Assurance Programs in Georgia, Tennessee, and Oregon. She has also performed
Utilization Review and Quality Assurance review for the local Professional Review Organization,
monitoring hospital care of Medicare and Medicaid patients, and also for IntraCorp, a private
review organization, as well as Portland based managed care organizations.
Judith has experience in clinical teaching, public health, and nursing administration. She
received her B.S. in Nursing from the University of Washington, and a Masters Degree in Health
Administration from Portland State University. She is Board Certified in Quality Assurance and
Utilization Review, and is a Diplomat of the American Board of Quality Assurance and
Utilization Review Physicians, a 1996 and 1997 Examiner for the Malcolm Baldrige National
Quality Award, a 1996 and 1997 Examiner for Oregon's Quality Award Program, a 1996 Sr. Examiner
for Washington State's Quality Award Program, listed on InterQual's ISD Registry, and a member
of the American College of HealthCare Executives.
ACCOMPLISHMENTS INCLUDE:
Developed and implemented internal policies, procedures, and procedure manuals and
documentation templates for Utilization Management Programs, including pre-admission and
admission review, continued stay authorizations, second surgical opinion, and discharge
planning. Created and implemented Utilization and Quality Management Programs, and Case
Management screening tools and protocols to be utilized during review process.
Recruited and trained panels of Physician Advisors and Second Opinion Consultants. Assisted in
training Chief Medical Officer and Associate Medical Directors.
Developed database formats, position descriptions, performance evaluation tools, and monthly
productivity/outcome reports. Developed audit tools for internal process quality control,
performed audits and presented recommendations.
Developed an integrated HMO-PPO Mental Health Triage/Referral System, and a Shorter Length
of Stay OB Program, focused on quality of care through pre-authorization and post-discharge
Home Health visits, resulting in a benefit to cost ratio of 10:1. Developed protocols for
integration of Utilization Review activity and claims.
Taught basic Healthcare Utilization and Quality Management principles, techniques, and skills
at Portland Community College; guest speaker for Case Management course at PCC focusing on
application of utilization management principles and techniques to case management. Speaker
at NW Occupational Health Conference demonstrating using Baldrige criteria to assess program
effectiveness relative to strategic directions.
QUALIFICATIONS:
*Masters Degree in Health Administration, Portland State University
*B.S. in Nursing, University of Washington
*Diplomat of the American Board of Quality Assurance and Utilization Review Physicians
*Examiner:
Malcolm Baldrige National Quality Award, 1996, 1997
Oregon Quality Award, 1996, 1997
Sr. Examiner for Washington State Quality Award Program, 1996
*15 years experience in Utilization Review and Quality Assurance in acute care and
long-term care settings, including monitoring care and DRGs for Medicare and
Medicaid patients
(10 years experience in administration and management)
*Performed Utilization Review in acute care and long-term settings, and for the local
Professional Review Organization, monitoring hospital care of Medicare and Medicaid
patients, and also for IntraCorp, a private review organization
*Developed and implemented Utilization Review and Quality Assurance Programs in
Georgia, Tennessee, and Oregon
*Experience in clinical teaching, public health, and nursing administration; community
college instructor for utilization and quality management principles, techniques,
and skills, including application to case management processes
EMPLOYMENT HISTORY:
10/94 - Paradigm Development Inc., Principal Consultant; focusing on improving
healthcare systems; contract and project work
5/94-3/95 Sisters of Providence, Portland, Oregon
"On-call" for Providence Home Services, Physician Services,
and Medical Group
1/93-4/94 Providence Home Services, Portland, Oregon
Quality Management and Education Coordinator
Develop and integrate Division Quality Management Program, encompassing
Home Health/Hospice, Medical Equipment and Oxygen, and Home Infusion;
provide education to transition from QA to Quality Improvement; develop
data base and coordinate reporting; monitor JCAHO compliance; develop,
integrate Division education and new employee Orientation.
1/89-1/93 Providence Health Plans, Portland, Oregon
Manager, Utilization & Quality Management
Plan and organize HMO-PPO Utilization & Quality Management functions,
including program evaluation and direction; facilitate provider groups
to develop strategies; assist with marketing and provider relations;
develop and implement reporting of effectiveness and efficiency; plan
budget and resource allocation, policy and procedure implementation;
identify/research problem areas, resolution.
10/86-1/89 Managed HealthCare Northwest, Portland, Oregon
Utilization Review Manager
Develop and administer Utilization Review Program, manage and
facilitate Utilization Review Committee activities; develop and
redefine medical screening criteria; supervise and train new staff;
conduct prospective, concurrent, and retrospective review of
services for medical necessity; assist with marketing of
Utilization Review Program.
10/85-10/86 IntraCorp, Portland, Oregon
Supervisor, Concurrent Medical Review
Develop, administer preadmit/continued stay certification,
discharge planning, second opinion programs; recruit/establish
Physician Advisor contracts; marketing; develop training materials.
10/83-12/85 Oregon Medical Professional Review Organization (OMPRO),
Portland, Oregon
Reviewer - PPS
Retrospective reviews for Medicare program, evaluating admissions,
procedures, quality.
Long Term Care Review Coordinator
Performed level of care reviews in long-term care facilities for
Medicare/Medicaid clients; monitor quality assurance.
3/82-8/83 Parkway Hospital (HCA Corp.), Jackson, TN
Quality Assurance Coordinator
Integrated and monitored decentralized Quality Assurance Program;
monitored compliance with JCAHO Standards and coordinated preparations
for survey; coordinated Physician Quality Assurance Committee;
Utilization Review RN.
12/80-10/81 St. Mary's Hospital, Athens, Georgia
Utilization Review R.N.
Performed utilization review on inpatient admissions and continued stays.
OTHER WORK EXPERIENCE
Assistant Director of Nursing: developed and administered in-service
education programs; facilitated communication between physicians and nursing staff;
Certified CPR Instructor.
Developed and implemented adult rehabilitation clients' health assessments system;
on-staff EMT for adult sheltered workshop.
Public Health Nurse: expanded role of R.N.; performed health physical screenings and
monitorings; utilized established protocols to treat health problems; provided school
education; health teaching and monitoring for residents and schools.
ORGANIZATIONS:
American Board of Quality Assurance and Utilization Review Physicians - Diplomat
InterQual ISD Registry
American College of HealthCare Executives
Northwest Healthcare Roundtable - Treasurer
University of Washington Nursing Alumni
Changes last made on: Sun Dec 28, 1997
Paradigm Development, Inc.