Management Manager

LISA M. SMITH

**** ************ ***** ****-423-***-****

Chattanooga, TN 37405 *************@**.***

EMPLOYMENT:

DST Health Solutions 333 W. 11th St., Kansas City, MO 64105

Director Care Management Solutions, May 2014 – Present

Supports the companies long term growth by driving improvements to the Care Management System

Engages internal stakeholders and customers to elaborate business requirements.

Collaborates and delivers an exceptional customer experience with high quality products and services; focuses energy on discovering, understanding, and meeting the needs of the customer; develops and sustains productive relationships that are built on trust and fosters customer loyalty.

Develops solutions, drive enhancements, release packages and establish effective working relationships while providing team direction for all areas that support the Care Management System, ex: Development (both on and off shore), Implementation, Customer Support and Documentation.

BlueCross BlueShield of Tennessee, 1 Cameron Hill, Chattanooga, TN 37402

Manager, Enterprise Clinical systems - February 2008 – May 2014

Matrix project management with multiple areas of organization to establish process improvements for the core clinical programs UM/CM/DM. Subject matter expert of cost effective improvements for clinical systems.

Coordinator of corporate initiatives to create strategic clinical roadmaps and government program improvements, i.e. DSNP, LTSS, CMS, Pharmacy. Collaborate with organizational areas to determine business requirements that ensure functional system specifications.

Strong understanding of analytics, reporting, government state/federal requirements and systems utilized in the Health Care Industry.

Close collaboration with software vendors, information technology and reporting areas with a focus on system enhancements, defects and upgrades.

CareAdvance Chairperson, 2011/2012 – Co-Chair 2013/2014. Responsible for driving the direction, for the software vendor and the user community of the healthcare solutions platform CareAdvance clinical system.

Ensure state/federal regulatory compliance, and contractual requirements are met within the clinical systems.

Restructured the Enterprise Clinical System area of Business Engineering to support the incoming system enhancement request. Achieving overall, annually, 100% of goals.

Supervisor Clinical Risk Management Department/Credentialing – July 2004 – February 2008

Reorganized the Clinical Risk Management Department to reduce the backlog of member complaints and obtained timely turnaround review, within 6 months, of physicians with adverse clinical outcomes.

Coordinated the Clinical Risk Management Committee, charter and program description.

LISA M. SMITH

Cell:423-***-****

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

Created policy and procedures within the credentialing area to ensure all staff were meeting regulatory guidelines for URAC, NCQA and EQRO.

Initiated collaborative activities with the Special Investigations Unit and Provider Audit.

Unum Provident/Genex Services, 1 Fountain Square, Chattanooga, TN 37402

Supervisor Integrated Disability Management / IDM - September 2002 – July 2004

Supervised a group of clinical staff performing the clinical case review of long /short, FMLA and workers compensation claims.

IDM subject matter expert and national account liaison for selling the integrated disability product.

East Ridge/Parkridge Hospital, 941 Spring Creek Road, 2333 McCallie Chattanooga, TN 37412

Charge Nurse Emergency Room/Occupational Health Clinic Nurse - September 1991 – July 2002

RN Charge Nurse for Occupational Health Clinic and the Emergency Room Department.

Evaluated and performed patient care based on acuity level assisting physicians on clinical procedures

Instructed and educated patients and families on discharge planning, preventative treatment for acute and chronic illness.

Shaw Industries, 1 Manufacturers Road, Ringgold, GA 30736

Plant Safety Coordinator/Occupational Health Nurse/Workers Compensation Case Manager - September 1994 - September 1998

Developed, implemented and maintained the Safety and Wellness Program for 6 Shaw facilities.

Conducted detailed analytical research on work related injuries. Focused safety initiatives to decrease workers compensation incidents from 11% to less than 1% in one year.

Case managed medical and workers compensation cases.

Performed on-site new-hire physicals, annual screenings, and training for CPR/First Responders.

EDUCATION:

1998- 2002 - Covenant College, 14049 Scenic Hwy, Lookout Mountain, GA, 30750

Bachelor of Science – Business/Organizational Management

1989 - 1991 - Cleveland State Community College, 3535 Adkisson Dr. NW, Cleveland, TN 37312

Associate Degree in Science – Nursing - Licensed in TN

Project/Methodology Training - Yellow Belt in Six Sigma Methodology/28 hours towards Project Management Certification

Certification – CareAdvance Clinical System, Facets Claims Payment System

REFERENCES:

Available upon requests

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