Patricia Tierney BSN, MHA, RNGERO-

B C, CCM

Nurse Case Manager

Utilization License Review

Board Certified Geriatric Registered Nurse

Contact

* ********* ****

Waltham, Ma 02452

Cell 781-***-****

Email

ad1uwz@r.postjobfree.com

Summary

Skilled and effective leader with 32 years of home health experience. 20 years of experience in a utilization and care management. Laser focused result driver team leader with a goal to exceed the company goals and values. Operational excellence with the skills to increase staff performance and execute real time improvements needed by using the model of Agile Management. Expert knowledge in National Coverage Determination

(NCD), Local Coverage Determination (LCD), Medicaid coverage in multiple states and commercial products. Great leadership skills with team motivation and collaboration. Operational excellence in quality of decisions and filling the member’s medical needs within the boundaries of the benefit. Assurance of quality within the measurements of the industry; timeliness of decision, standardization of staff decision and regulations. Work

Experience

2018-2023 COMMONWEALTH CARE ALLIANCE

Services and Utilization Services Clinical Manager 2016-2018 MASSGENERAL BRIGHAM HEALTH CARE

Utilization Services Clinical Manager

2011 -2018 SELF-EMPLOYED Independent Home Care Consultant advisor for certified home healthcare start-up

2011-2016 TUFTS HEALTH PLAN

Commercial Utilization Services Team Manager

2001-2016 DELTA PROJECTS, INC.

Nurse Consultant

2009 -2011 MULTICULTURAL CARE

Clinical District Director for 3 Offices

2002-2009 HARVARD PILGRIM HEALTH CARE

On-Site Utilization Review Manager

2007-2008 LIFE PLANS, INC.

Director of Clinical Services

2006-2007 MEDICAL RESOURCES HOME HEALTH CARE CORPORATION Director of Living Well

2002-2006 TUFTS HEALTH PLAN

Clinical Services Training Manager

Specialty Case Manager/Training Specialist

2000-2002 GENTIVA HEALTH SERVICES

Home Health Trainer/Clinical Director

Key Skills

• CMS Regulations

• Staff Development

• Team Leadership

• Communication

Responsible • Healthcare Operations and Process Improvement Oversight of daily operations, management of staff, ensure compliance with CMS regulations. Provide exceptional customer accuracy services and develop to the membership strategies to and improve the vendors. the department’s Also, responsible performance to analyze the data for timeliness and Education

FRAMINGHAM STATE COLLEGE UNIVERSITY, Framingham, Massachusetts, M.H.A., 1987 NORTHEASTERN UNIVERSITY, Boston, Massachusetts, B.S., Nursing, 1980 Professional Certifications

Certified Case Manager, The Commission for Case Manager Certification, 2004 Board Certified for Gerontological Nursing Practice, The American Nurses Credentialing Center, 1998 Massachusetts Certified Medication Administration Program Trainer, 2000 Professional

Registered Nurse in Massachusetts (since1980)

New Hampshire (since 2009)

Computer Skills

Microsoft Office Suite including TEAMS Microsoft Project Lotus Notes Change Health Care Management InterQual Criteria SunGard EXP Macess Diamond Cobalt Database G Suite QNXT MedHOC Altrutrista- Guiding Care Softphone systesm Remdeia Looker Trizetto OS operating systems Android operating systems

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