Management Quality

Name Nancy J. Borgstadt

Contact ***** ********* *****

Information Lone Tree, Colorado 80124

303-***-**** (home)

720-***-**** (cell)

**********@*****.***

Education MS, University of Colorado Health Sciences Center,

Denver, Colorado

BS, Nursing, University of Missouri, Columbia, Missouri

Training and Clinical Nurse Specialist, Community Health Education,

Relevant Denver, Colorado

Certifications Denver Community Leadership Forum, Denver, Colorado

Numerous educational courses in leadership: strategic

planning, change management, fiscal sustainability,

recruitment and talent management, and others.

Professional More than 35 years of experience in the healthcare

Summary industry, employed in a variety of senior management

roles in the following areas: quality improvement

organization, Medicare and Medicaid utilization

management, home health national trade association, and

inpatient and outpatient clinical settings. Expertise in

areas including utilization management, patient safety,

quality improvement, fiscal management, strategic

planning, program development, change management, and

regulatory issues.

During the past 15 years at CFMC, directed numerous

contracts, including TRICARE, Wyoming Medicaid, Colorado

Medicaid Acute Care and Long Term Care, Medicare

Beneficiary and Family Centered Care Program, Qualified

Independent Contracts for Medicare Part B and DME

Appeals, and private external review contracts, with

value of $5-$10 million annually.

Presentations include international, national, state,

and local conferences on topics such as Auto

Authorization: Streamlining the Authorization Process,

The Effect of Internal Quality Monitoring and Systematic

Selection of Physician Reviewers on the Case Review

Process, CFMC's Journey to Milliman Care Guidelines,

Utilization Management-Transitioning from Utilization

Review to Utilization Management, disease management

programs, strategies to improve fiscal accountability,

children's perception of death and dying and others.

Relevant Professional Experience and Qualifications

CFMC, Director of Review Services 1999- 2014

Overall leadership responsibility to develop, manage, and direct all staff

responsible for review services at CFMC, including more than 50 staff: five

managers, RN review coordinators, non-physician review coordinators and

administrative staff

. Provide oversight of CFMC's Medicaid Acute and Long-Term Care Utilization

Management programs, Medicare scope of work activities for beneficiary

and family-centered care, TRICARE quality management, Qualified

Independent Contracts for Medicare Part B and DME Appeals, private

utilization management contracts and independent external review

contracts

. Participate in strategic planning, quarterly management review process,

corrective/preventive action and improvement program, document control

process to ensure an effective organization-wide quality management

system

. Direct transition to the use of a nationally recognized, evidence based

screening criteria for utilization review activities

. Lead the organization-wide and review services department in the URAC

accreditation process for utilization management

. Instrumental in the implementation of the auto authorization program for

Medicaid prospective review activities

. Member of Cambridge Who's Who, 2006

HealthForce, Regional Director of Clinical Services 1997 - 1999

Clinical consultant to ten HealthForce offices in the western part of the

United States, ensuring compliance with regulatory and accrediting

agencies' guidelines

. Conduct clinical audits and provided educational programs to regional

home care offices

. Provide technical writing and editing for the HealthForce Policy and

Standard Procedure Manual

Visiting Nurse Association of America (VNAA), VP Clinical & Education

Development 1994 - 1997

Overall leadership responsibilities for clinical and educational services

at VNAA which represented nearly 200 VNAs across the country

. Develop strategic plan for clinical and educational services for the

national trade association (VNAA) to include goals, objectives, action

plan, and budget responsibilities

. Direct a multidisciplinary project team in the

development/implementation/marketing of disease management programs,

including Stroke/Brain Attack, Asthma, Diabetes, Heart Failure, and Wound

Management

. Provide technical writing and editing for the VNAA Nursing Procedure

Manual and managing editor for a marketing handbook entitled, Get ready-

Get Set-Go-Go-Go! A Marketing Primer for Home Health Care Professionals

. Participate in National Summit on Cancer Pain Control, Alzheimer's

Association's In-House Services Think Tank, AHA's Secondary Prevention

Project, and The Joint Commission's Professional Technical Advisory

Committee for Home Care

Caremark International, Inc., Program Manager of Nursing Science 1993 -

1994

Administrative and clinical management responsibilities of more than 20

nurse clinicians doing home infusion therapy in a three-state region

. Restructure nursing care system, resulting in decreased costs, increased

productivity, and increased customer satisfaction

. Maintain and develop accounts through inservices, resource information

for new programs, and conference exhibits

The Children's Hospital, Assisting Nursing Director 1978 - 1993

Administrative and clinical management for nurse clinicians and non-

nursing personnel providing patient care to pediatric

hematology/oncology/transplant patients

. Collaborate with the Medical Director and Administrative Coordinator for

overall departmental management of the outpatient program

. Participate in the design and development of an outcome management

system, including an outpatient acuity system that increased revenues by

nearly 50%

. Design and implement Home Care Chemotherapy, Home Care Transfusions, and

Bereavement Follow-up Programs

. Design and supervise facility construction for the Hematology/Oncology/

Outpatient Clinic

May 2014

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