Donna Simon, BSN, RN

Donna joined the team in 2024

Donna Simon is a highly experienced Registered Nurse with a career spanning over 28 years.

Her expertise encompasses a wide range of roles in health systems, payers, and consulting, with a strong focus on clinical program development, population health, and value-based care strategies.

Donna's expertise is in URAC/NCQA accreditation across multiple lines of business, HEDIS, ACOs, Medicare Stars, and Agile project management. In July 2024, Donna brought her wealth of experience to Managed Healthcare Resources (MHR) as an independent clinical Healthcare Consultant.

Before joining MHR, Donna provided consulting services to various organizations, guiding them in achieving NCQA Accreditation for Health Plan and Health Equity. As a clinical consultant, she worked closely with organizations to formulate and execute strategies for system technology enhancements, care management and utilization management operations, accreditation and regulatory efforts, and provider collaboration. 

Donna's professional journey has seen her take on senior leadership roles in managed care, ambulatory care management, and various hospital nursing positions. During her tenure as the Executive Director at Blue Cross Blue Shield of South Carolina Donna managed large teams and spearheaded initiatives to enhance clinical programs and healthcare outcomes.

She collaborated with data analytic teams to analyze data from multiple sources, gaining valuable insights on cost and utilization to drive improvements in healthcare outcomes. Donna played a pivotal role in developing population health management programs, integrating value- based care concepts, and implementing concierge case management for high-risk members.

Early in her career, Donna served as a registered nurse at Palmetto Health, Columbia, SC, where she administered care to patients in the emergency department and in senior care. Her outstanding work led to a promotion to Director of Post-Acute Care, where she successfully developed and implemented programs in ambulatory case management, medical neighborhood recognition, and quality incentive improvement for patients with complex issues or conditions.

Donna is licensed as a Registered Nurse in South Carolina and holds a Bachelor of Nursing degree from Western Governors University and a Bachelor of Science in Healthcare Administration, Leadership, and Management. Donna resides in South Carolina with her husband and finds joy in spending time with her college-bound daughter and her son, who is on active duty with the US Army. Their recent trip to Greece serves as just one example of how she enjoys her leisure time when not focused on NCQA consulting!