Patricia Jones is an NCQA consultant with The Mihalik Group, bringing more than 30 years of leadership experience in commercial and Medicaid health plans. She is widely recognized for her expertise in NCQA Accreditation standards and guidelines, specializing in quality management, improvement, credentialing, delegation, and utilization management.

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For over two decades, Ms. Jones has assisted healthcare organizations in preparing for NCQA accreditation. In addition to her consulting work, she serves as an NCQA surveyor, trainer, and Special Needs Plans (SNP) Early Reviewer, as well as an Interdisciplinary Team of Clinicians (IOC) reviewer—roles that underscore her depth of knowledge and influence within the accreditation process.

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Previously, Ms. Jones was Chief of Health Services at Community Health Plan of Washington, where she designed and managed statewide Medicaid and Medicare Advantage utilization and care management programs. She led the organization’s successful transition from externally vendored to internally managed services and resolved state corrective action findings through operational improvements and process redesign.

 

Earlier in her career, Ms. Jones was Principal and Healthcare Management Consultant at Milliman MedInsight, where she built and led a consulting team focused on analytics, population health interventions, and strategy.

She also held senior leadership roles at Cambia Health Plan, Solucient, and Blue Cross Blue Shield, contributing to provider profiling, contracting, marketing, behavioral health, and operational performance improvement.

 

Ms. Jones holds a Bachelor of Science in Nursing from Purdue University and an MBA from Boston University. Her strong clinical foundation, paired with extensive operational and strategic expertise, make her a trusted leader in healthcare quality and accreditation.