Registered Nurse Management

Ellen Freedman

Email: **********@********.***

Address: *** ****** ***

City: Bloomfield

State: CT

Zip: 06002

Country: USA

Phone: 732-***-****

Skill Level: Management

Salary Range: $100,000

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

Ellen S. Freedman

180 Oliver Way Bloomfield, CT 06002 732-***-**** *************@*******.***

Value Proposition

Seasoned executive with extensive cross functional healthcare organizational experience driving key initiatives in a timely and cost-effective manner within care management, claim processing and informatics realms

Provided executive-level client consultation to achieve entity objectives and mission deliverables for national, multi-state health insurers, state governments, large Taft Hartley plans and large employers

Experience

Collaborative Health Innovations -NJ

Freelance Consultant June to November, 2012

Mission included the definition of data infrastructure, risk categorization schema and innovative utilization and quality measure action-oriented tools/reports enabling optimization of primary care practice care delivery.

Initiated risk-adjusted solution development in response to a collaborative integrative approach between private payers and government entities in response to Centers for Medicare & Medicaid Innovations (CMS/CMMI) Comprehensive Primary Care Initiative (CPCI)

Directed IS staff as to tool content; represented client at all collaborative meetings in four geographic markets

CareAdvantage, Inc. Iselin, NJ

Director of Client Solutions (result of company downsize, mission and restructure) January 2002 to May 2012

Vice President of Marketing and Product Development April 1998 to December 2002

Vice President of Care Management July 1996 to March 1998

Position mandates included restructuring and refinement of care management operations inclusive of developing quality management and reporting infrastructure according to plan and budget. Directed 100+ utilization review/case management. Mandate segued to providing market analysis and leading definition/development of new, market-driven care management products, key to redefining the company in order to meet emerging business trends. Oversaw execution of and continued innovation within the firms analytics and consulting engagements.

Achievements:

Developed new quality/network management, underwriting/actuarial and sales strategies and solutions included within CAI ASP software offerings, serving multiple clients and encompassing more than 5MM lives. Includes addressing Accountable Care Act requirements, inclusive of care continuity, NCQA, URAC and quality initiatives

Defined program/product constructs into tangible analytic approaches, specifications/logic, collaboratively with clinical and technical teams including (but not limited to): chronic disease cohort analysis; over sixty chronic disease and procedure-related severity-adjusted OLAP cube-based episodes; utilized by a large state government All Payer Claim Database and other clients for policy and contracting/reimbursement purposes

Analyzed market options/advocated for selection of predictive algorithms, identifying members most at risk for chronic disease and key events, measuring network/physician quality and cost effectiveness.

Managed the development of and to market strategy associated with RightPath Specialty Case/Disease Management comprised of 46 interchangeable chronic disease specific modules used by several large health plans for patient management

Beacon Corporate Benefit Services, Blue Cross Blue Shield of Connecticut - Shelton, CT

Director of Processing Support March 1989 to Dec. 1995

Mandate included the development of claim, customer service, client and underwriting processes and infrastructure for a full service third party health care benefits administrator serving the National Account client market

Directed multiple analysts in the development of, and ongoing management of cross-functional support services for claim processing/coding quality audit programs/procedures, underwriting/actuarial and employer reporting, Also created, managed and negotiated participating Blue Cross plan service and discount arrangements.

Worked with external entities/vendors to expand/integrate additional business lines into product offerings including pharmacy, life, short- and long-term disability coverage, and claim unbundling services

Education

MBA Strategic Management Stern School of Business

New York University - New York, NY

MPA Policy and Planning Wagner School of Public Administration

New York University - New York, NY

BS Nursing Hunter College - Bellevue School of Nursing

Hunter College - New York, NY

Additional Course Work

New Product Development Workshop, Executive Education Certificate: The Wharton School of Business, University of Pennsylvania Executive Education Program

New Developments in Hospital Information Systems, Executive Education Certificate: Harvard School of Public Health

Awards and Licensure

Marchal Award for General Excellence in Nursing: Hunter College Bellevue School of Nursing

Medical Surgical Nursing Award: Hunter College Bellevue School of Nursing

Inducted into Sigma Theta Tau, National Honor Fraternity; Alpha Phi Chapter

New York State Registered Nurse Licensure RN242224

Connecticut State Provisional Licensure obtained; awaiting final licensure

Other Proficiencies

Microsoft Word, Excel, PowerPoint and Visio

OLAP Cubes

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