Project Manager Registered Nurse
Resume:
CARLIN OSBORN
Malcom, Iowa ****7
Phone: 515-***-****
Email: **********@*****.***
PROFESSIONAL ● MOTIVATED ● POSITIVE ● ENERGETIC
SUMMARY OF QUALIFICATIONS
• A skilled and experienced Healthcare Professional with a consistent record of success
• Strong production, financial, administrative, sales and relationship management skills
• Change agent, reliable, results oriented and self motivated, demonstrated proficiency in multiple software applications,
Electronic Medical Records and Health Information Management systems
• An effective communicator and manager with demonstrated success as a leader, team member and collaborator for
process improvement
• Quality oriented; able to plan and prioritize to meet deadlines, quality goals and bottom line objectives
CAREER ACHIEVEMENTS
Served as Project Manager for $4M software implementation (McKesson) completed on time and within budget
•
constraints while maintaining daily operations of the Care Coordination Unit.
Developed Utilization Management department for Meridian Health Plan of Iowa, an HMO serving the Medicaid
•
population of Iowa beginning in March 2012.
Met with providers across the State of Iowa to introduce Meridian Health Plan and support the contracting process as
•
well as the enrollment process in Iowa. Successfully contracted with the largest Health System in Iowa serving 8 metro
regions and increased enrollment from 800 to 16,000+ in one year.
Implemented an admission counseling program at United Healthcare that resulted in reduced lengths of stay for non
•
emergent admissions.
Reorganized Medical Management Division of Wellmark combining medical and behavioral health case management
•
resulting in a holistic approach to health care management. Our success with this approach was validated by our
members (through satisfaction survey results indicating 95% of members surveyed were "totally satisfied"), by metrics
demonstrating a decrease in readmission rates after this process change and also by a URAC onsite auditor who cited
our program as " Best Practice".
Managed budget of $7M annually, consistently managing within or under budget at year end while implementing new
•
practice techniques, staff training and relocation.
Instituted Quality requirement that all case managers be certified in Case Management within two years of hire.
•
PROFESSIONAL EXPERIENCE
DIRECTOR OF UTILIZATION MANAGEMENT 2012–2013
MERIDIAN HEALTH PLAN OF IOWA Des Moines, IA
Responsible for the strategic development and implementation of the utilization and case management programs for
•
Medicaid business in the State of Iowa; overcoming unique challenges with this population due to low member
resources
Completed Health Risk Assessments on every member, with additional focus on the Maternity population to reduce risk
•
of preterm delivery. Established goal for elective C section no sooner than 39 weeks gestation
Developed strategies to support the improvement of quality and utilization management through promotion of wellness
•
initiatives (HEDIS), timely discharge planning and innovation within Meridian Health Plan. As an example, created
incentives for members to obtain well child exams and immunization at recommended age
Designed programs to ensure compliance with NCQA /URAC standards
•
Developed, recommended and implemented effective and efficient standards, protocols and processes; submitted
•
quarterly analysis outlining benchmarks achieved, opportunities and stretch goals
INPATIENT CARE MANAGER/ADMISSION COUNSELING PROGRAM 2008 2012
UNITED HEALTHCARE Urbandale, IA
Implemented an admission counseling program for members scheduled for elective surgery. The results demonstrated
•
a reduction in inpatient length of stays and readmissions. Because of the positive impact from both a financial as well
as patient quality perspective, the program was expanded nationally.
Nominated for the 2011 SAGE award for “consistent demonstration of excellence in care management, coaching and
•
professional leadership.”
Performed discharge planning for members receiving inpatient services for all United Healthcare members including
•
managed Medicare members.
Collaborated with providers as well as the member’s support system to identify and remove barriers to a positive
•
clinical outcome.
DIRECTOR OF QUALITY AND PROGRAM DEVELOPMENT 2008
Panora, IA
HINES AND ASSOCIATES
Developed and implemented Quality Metrics for Case and Utilization Management, resulting in consistent
•
identification of candidates who could benefit by proven case management activities.
Results indicated substantial savings in corporate revenue and improved quality care for client members.
•
GROUP LEADER/DIRECTOR CARE COORDINATION UNIT 1992 2007
WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA Des Moines, IA
15 years of progressive leadership positions within the Health Management Division
•
Assured compliance with all accreditation standards (URAC, NCQA) and local and state regulations in relationship to
•
health management programs through ongoing monitoring of workflow processes.
Applied process management (including LEAN, Six Sigma, and DMAIC), leadership techniques and Basic Principles in
•
daily work activities.
Supported the physician patient relationship by providing tools, information and resources which led to improved health
•
outcomes for Wellmark customers.
SENIOR PROJECT MANAGER
WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA Des Moines, IA
Led and managed corporate cross functional project teams to take project from inception through completion;
•
Identified project goals and requirements, mapped and designed new processes; implemented, monitored and
•
measured; managed project costs effectively to remain in budget; facilitated timeline and schedules for project
completion.
Met with group customers to promote ideas and initiatives.
•
Additional roles at Wellmark Blue Cross and Blue Shield:
TEAM LEADER/TRIAGE UNIT (call center)
CASE MANAGER/SPECIAL SERVICES
UTILIZATION MANAGEMENT ONSITE REVIEW NURSE
EDUCATION AND TRAINING
BACHELOR OF SCIENCE HEALTH ARTS
UNIVERSITY OF ST. FRANCIS Joliet, IL
GPA: 4.0
DIPLOMA REGISTERED NURSE
ST. JOSEPH MERCY SCHOOL OF NURSING Sioux City, IA
LICENSURES/CERTIFICATIONS
• Certified Case Manager – Commission for Case Manager Certification
Accredited by the National Commission for Certifying Agencies
• Managed Healthcare Professional – MHP, Health Insurance Association of America
America’s Health Insurance Plans – AHIP
• Licensed Registered Nurse – Iowa
PROFESSIONAL ASSOCIATIONS/AWARDS
• Member of the American College of Healthcare Executives (ACHE)
• Case Management Society of America, Iowa Chapter – President 2001
• Case Management Society of America, Iowa Chapter – Board Member and Secretary
• Case Management Society of America, Iowa Chapter – National Member
• Urbandale Optimist Club – Charter Member
• Recipient of Iowa National Guard “Employer Support of the Guard and Reserve Recognition Award” for outstanding
support of employees of the Iowa National Guard called to duty in 2003, now known as the
“Freedom Award”
Contact this candidate