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Skills

  • Business Planning
  • Admissions review process optimization
  • Strategic planning
  • Team management
  • Evidence-based medicine (EBM)
  • Policy and procedure development
  • Business analysis
  • Operational improvement
  • Clinical chart review
  • Financial Management

Work Experiences

  • Achieved resolution within a 7-month timeframe.
  • Used forecasting to figure out what changes needed to be made in the supply chain.
  • Led an overhaul of the company's best practices, which resulted in significantly higher employee retention rates and a top-ranking as an industry leader.
  • Enhanced and redefined organizational structure to maintain the company's competitive edge across territories.
  • Oversaw a group of 16 system associates who dealt with the department's daily and complex requirements.
  • Devised, implemented, and tracked processes to improve long-term business success and profit margins by 9%.
  • Welcomed new members and established and updated memberships in Lakeside Partners framework programs.
  • Created program and system reports on a regular basis to evaluate performance, adjust strategies, and keep operations agile and sustainable.
  • Assessed employee performance over a two years period and provided constructive feedback to help them improve.
  • Achieved 4 consecutive deficiency-free audits.

Summaries

  • Mentoring and challenging team members to meet and exceed company goals is something I'm passionate about.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Multi-tasking manager with a reputation for fostering a positive work environment and high-performing teams.
  • Utilization Review Manager who is proactive and meticulous, with over 7 years of experience in the metric industry.
  • Optimize long-term success by effectively balancing targets with resources.
  • Achieved President's Club for best compliance practices.
  • Utilization Review Manager with 5 years of successful team leadership and performance reporting experience.
  • Strategic planning, client relations, and risk assessment are all well-trained.
  • Forward-thinking manager with 5 years of manufacturing project management experience.
  • Expertise in technology and product development.

Accomplishments

  • Collaborated with nursing and medical teams to ensure adherence to clinical guidelines, driving improved patient outcomes and savings of $4.
  • Introduced technology solutions for tracking utilization benchmarks, helping the organization optimize resource use and save $6 annually.
  • Resolved product issue through consumer testing.
  • Established care coordination protocols across multiple sites, leading to significant cost efficiencies, saving an average of $12 per patient.
  • Optimized the management of high-cost patient cases, lowering readmission rates through data-driven interventions by 72%.
  • Improved interdepartmental communication regarding patient care plans, leading to a 66% uplift in efficiency and continuity of care.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Led a team of 9 clinical staff in revising utilization review processes, reducing variances in care, and improving quality outcomes by 84%.
  • Collaborated with interdisciplinary teams to streamline care transitions, lowering patient readmission rates by 46% across 2 facilities.
  • Established guidelines for outlier case management, resulting in a 66% reduction in outlier cases and improved overall compliance with payer requirements.

Affiliations

  • American College of Healthcare Executives (ACHE)
  • Project Management Institute
  • National Committee for Quality Assurance (NCQA)
  • Association of Information Technology Professionals
  • Council for Affordable Quality Healthcare (CAQH)
  • National Association for Healthcare Quality (NAHQ)
  • American Case Management Association (ACMA)
  • Centers for Medicare and Medicaid Services (CMS) - Regulatory Committee
  • American Hospital Association (AHA)
  • Case Management Society of America (CMSA)

Certifications

  • Certified Medical Audit Specialist (CMAS)
  • Salesforce
  • ServSafe
  • Certified Healthcare Access Manager (CHAM)
  • Cisco Certified Network Associate (CCNA)
  • Certified in Health Care Compliance (CHC)
  • Project Management Professional (PMP)
  • URAC Case Management Accreditation
  • Microsoft Certified Systems Engineer (MCSE)
  • Medicare Specialist Certification (2016)

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