Roberta Bocker, RN, BSN, CPHM Director of Operations - Westbury
As Director of Operations for the Westbury Office, Ms. Bocker is responsible for the overall administration and management of the full scope of review programs and activities offered and run in the Westbury Office. Ms. Bocker has over 35 years’ experience in
utilization review and quality assurance activities.
Ms. Bocker assists in developing and implementing organizational strategies, policies and procedures. She oversees the review activities of programs operated by the Foundation including the Medicaid retrospective and cost outlier review programs, the external appeal/dispute resolution review programs, and other special review projects and activities the Foundation is involved with. She monitors the performance
of Foundation staff through internal quality control reviews. Her extensive experience in clinical criteria (including MCG and Interqual) enable her to serve as an expert resource to the clinical staff performing reviews. She assists in pursuing new projects and in the short and long term planning activities. Ms. Bocker is responsible for the recruitment, hiring and training of new staff in the Westbury office.
Prior to her current position, Ms. Bocker served as the Area Program Coordinator for the Medicare PRO and was responsible for monitoring the PRO subcontractor performance, education and coordination of activities. She served as a Utilization/Quality Assurance Coordinator SUNY Stony Brook Hospital and Mid-Island Hospital, and was responsible for reviewing medical records to ensure proper utilization and
quality of care. She also served as a Utilization Review Analyst for Empire Blue Cross Blue Shield where she was responsible for the development and maintenance of education programs, and served as a liaison with Medicare providers serviced by Empire Blue Cross Blue Shield.
Ms. Bocker received her Bachelor of Science degree in Nursing from SUNY Stony Brook. She is a Certified Professional in Health Management (CPHM) for Interqual and received certification as a Care Guidelines Specialist (Utilization Management) for MCG Guidelines.