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Medical Management

Location:
Albuquerque, New Mexico, United States
Posted:
November 03, 2018

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Resume:

Janet Nelson

MBA, MS, CCC-SLP, MA

ac7ljz@r.postjobfree.com

Albuquerque, NM

505-***-****

SUMMARY

Dynamic hands-on healthcare leader of 10 years with broad skill set. High-performing and results oriented. Works with passion, drive, integrity, innovation and commitment to program goals. Excels under pressure. Licensed Speech Pathologist. Lean Six Sigma Green Belt.

SKILLS

Hospital Operations

Budget and Financials

Physician Relations

Patient Engagement

Multi-Site Management

Post-Acute Operations

Business Development

Recruitment/Onboarding

Leadership

Rehab Therapy

Licensed Clinician

Quality Improvement

Strategic Planning

Contracts

Telemedicine

Care Management

Training

Project Management

EHRs

Credentialing/Privileging

Instructional Design

Process Improvement

Compliance

Health Care Delivery

PROFESSIONAL EXPERIENCE

ADMINISTRATIVE DIRECTOR of HOSPITAL OPERATIONS - HOSPITAL MEDICINE PROGRAM

LOVELACE MEDICAL GROUP – Albuquerque, NM 7/2016-7/2018

Developed and launched an inpatient hospital medicine program at 4 acute hospitals.

Executed day-to-day operations of 36 hospitalist physicians at multiple acute hospital sites.

Built out program to 100% full employment in less than 2 years w/ embedded Medical Director, MD leads.

90% locum coverage in 8/2016 reduced to 0-1% in less than 2 years.

Budget neutral within 1.5 years.

90% improvement in removing silos and building collaboration among hospitalists and emergency department, nursing staff, case management, hospital and professional coders, and specialists.

50% improvement in patient throughput on piloted bedside rounding project.

18% in ambulatory/OP referrals s/p acute stay.

Provided strategic direction and planning to attain quality, strategic, and operational short- and long-term financial and clinical goals.

Collaborated with nursing, ED, case management, ICU, medical director, CMO, hospitalist leads to develop and implement an organized approach to interdepartmental communication for improved teamwork and workflow.

Monitored program revenue cycle including charge capture, coding, billing.

Directed the investigation and resolution of inquiries, problems, patient/provider grievances, emergencies.

Hired and delegated non-clinical staff to support system-wide program goals.

Built and maintained effective working relationship with C-suite and key clinical leadership at each hospital.

Partnered with HR to recruit, negotiate contracts, on board, evaluate, and retain providers and admin staff.

Developed, implemented, and revised guidelines that define and support the hospital medicine program.

Designed solutions to improve quality scores for hospitalist and hospital metrics.

Collaborated in development of telemedicine coverage for 24/7 stroke coverage.

DIRECTOR of POST ACUTE OPERATIONS and BUSINESS DEVELOPMENT

TEAMHEALTH/IPC HEALTHCARE – Tucson, AZ 6/2015-6/2016

●Executed operations and practice management for 30 providers and 5 administrative staff in post-acute practice setting.

●Implemented BPCI bundled program contract practice protocols in acute and post-acute settings to reduce hospital readmissions, reduce length of stay, and maximum gain sharing opportunities.

●Established strong relationships with national insurance contract administrators, medical directors, acute and post-acute hospital administration, and IPC providers.

●Assembled and embedded a post-acute transitional care management team, first in company, January 2016 go live, in two acute hospitals to secure IPC service is initiated at next level of post-acute care upon discharge.

●Executed performance metrics within Optum, United Community and State, and Mercy Care contracts.

●Built a pilot program for participation Medicare’s BPCI 3-midnight waiver rule in two acute hospitals.

●Constructed pilot protocols for participation in Bayada home health care national contract for preferred provider program.

●Implemented a provider communication process to replace antiquated system to facilitate speed, accountability, improved patient care and positive financial practice impact. Educate providers on use of new system.

●Collaborated with recruiting team to ensure new providers in pipeline, meet with potential candidates, onboard new staff members. Facilitate provider credentialing, compliance training, onboarding, and facility orientation.

●Constructed a transitional care pilot project between Banner Health and IPC to direct and monitor patient SNF discharges and readmission rates with two IPC post-acute facilities.

●Established JOC’s in all SNF’s to improve partner relationships toward meeting performance metrics and securing a strong IPC service line.

DIRECTOR of OPERATIONS – CASE MANAGEMENT, CLINICAL MARKETING, QUALITY, ADMISSIONS, TRANSPORTATION

LOVELACE HEALTH SYSTEM - ALBUQUERQUE, NM 4/2014-6/2015

Built and maintained dedicated case management, marketing, admissions, quality, and transport teams to execute strategic plan for exemplary patient care outcomes, budgeted patient volumes, highest level of satisfaction with services, and the most efficient use of resources for a 68-bed inpatient rehabilitation hospital.

●Implemented initiatives to achieve improvements in clinical care processes, team engagement, patient experience, volume, and financial performance.

●Partnered with physicians, nursing leadership, and clinical staff to develop an interdisciplinary, evidence-based process of care; coordinated resources to ensure effective management of patients among inpatient, outpatient, and acute settings.

●Collaborated with managed care payers to ensure authorizations for care timely, services rendered were appropriate and negotiated with payers if a claim/stay denied.

●Directed disease-specific CARF protocols in 6 accreditation areas to meet volume, profitability, quality and service standards.

●Collaborated with CEO to jointly assess organizational effectiveness and implement strategies for continued improvement in the administrative and business areas. CFO to assist in the development and implementation of finance, revenue cycle, and budgetary objectives. CNO and medical director to foster quality processes for optimum patient care.

●Recognized as “Employee of the Quarter,” 12/2014.

DIRECTOR of PRACTICE MANAGEMENT and BUSINESS DEVELOPMENT

IPC HEALTHCARE at LOVELACE HEART HOSPITAL, ALBUQUERQUE, NM 4/2012-3/2014

Built relationships with administration, physician and medical groups, case management, information systems, quality, medical records, contracts, health plans.

●Collaborated with hospital leadership to implement policies and procedures related to patient throughput, length of stay, readmissions and discharge processes, billing and documentation requirements, provider staffing and scheduling, HCAHPS, patient and provider satisfaction.

●Managed and scheduled 25 permanent and temporary providers.

●Facilitated implementation of new acquisition in acute heart hospital.

●Recruited and educated new providers on hospital EMR and CPOE programs.

●Participated in hospital-established work groups to solve problems and developed new processes toward improved patient experiences and outcomes.

DIRECTOR OF MARKETING OPERATIONS and ADMISSIONS

HEALTHSOUTH REHABILITATION HOSPITAL, ALBUQUERQUE, NM 6/2010-4/2012

●Exceeded weekly, monthly annual volume goals for 87-bed acute rehab hospital – 90% of months, by minimum of 5% of budget per month.

●Managed team of 12 members – marketing liaisons and non-clinical staff.

●Directed all department operations – recruiting, hiring, training, retaining, payroll, and staff education.

●Analyzed volume, case mix growth, CMS percentage, payer mix, functional patient outcomes, and EBITDA.

●Worked within reimbursement system as it related to volume impact, appropriate utilization of resources and patient length of stay.

●Generated media coverage and planned community healthcare events.

CLINICAL LIAISON

SUNBRIDGE HEALTHCARE, ALBUQUERQUE, NM 4/2009-6/2010

Generated referrals to exceed volume budgets for two, 120-bed rehabilitation/long-term care centers considering case mix and payer sources.

Educated referral sources, including case management and physicians within acute hospitals on SNF level of care.

Conducted comprehensive clinical evaluations via chart reviews and patient interviews to determine appropriate admissions.

LICENSED SPEECH LANGUAGE PATHOLOGIST

REHAB CARE, INC, ALBUQUERQUE, NM 1/2008-4/2009

●Evaluated, diagnosed, and treated swallowing and cognitive/communication disorders in adult population.

●Collaborated with an interdisciplinary team of physicians, nurses, physical and occupational therapists.

LICENSED SPEECH LANGUAGE PATHOLOGIST PRN

PRESBYTERIAN HOSPITAL, ALBUQUEQUE, NM 2009-2010

●Evaluated, diagnosed, and treated swallowing and cognitive/communication disorders in adult population.

●Collaborated with an interdisciplinary team of physicians, nurses, physical and occupational therapists.

EDUCATION

SPEECH LANGUAGE PATHOLOGIST - MS, CCC-SLP

University of New Mexico, Albuquerque, NM

ORGANIZATIONAL LEARNING AND INSTRUCTIONAL DESIGN - MA

University of New Mexico, Albuquerque, NM

HUMAN RESOURCE MANAGEMENT - MBA

Golden Gate University, San Francisco, CA

COMMUNICATIONS & MARKETING - BA

State University of New York, Plattsburgh, NY



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