Experience

CignaCigna ** yrs * mos** yrs * mos

Program Management AdvisorProgram Management Advisor Full-timeFull-timeJul 2017 – December 2023

Clinical Operations SupervisorClinical Operations Supervisor Sep 2010 - Jul 2017 · 6 yrs 11 mosSep 2010 - Jul 2017 · 6 yrs 11 mos

Ensure customer satisfaction through operational delivery of best in class case management services. Manages a national team of up to 24 Case Management staff and coach their performance to facilitate career growth with outcomes that contribute to meeting the needs of the customer, clients, business growth and quality standards.

As part of the leadership team, participates in accreditation audits with URAC and DMHC as well as client third party audits. Provided coaching to staff to prepare for successful audits. Supports strategic business growth through participation in projects requiring a non-disclosure agreement. Acts as liaison and collaborates with all matrix partners within the organization in addition to partners outside of the organization.

Lead the design and implementation of efficiencies resulting in $60K annual savings ongoing through streamlining processes focused on value add activities and improved data mining capability. Ongoing outcomes from this initiative include: Meet and exceed TAT for related medical necessity decisions, improved Health Care Providers satisfaction, increased frontline staff morale (Nurses, Medical Directors, non-clinical staff) & capacity for customer engagement that delivers the company’s mission to improve the well-being and sense of security of the customers we serve.

Successfully maintains staff morale throughout significant changes. In 2015, on-boarded 15 case managers new to the role.

Stays motivated with a strong focus on results and team building throughout multiple realignment and program transitions.

Supports the growth within localization, Collaborative Accountable Care, Population Health Management and Provider Network Collaboration including Delivery System Alliances.Ensure customer satisfaction through operational delivery of best in class case management services. Manages a national team of up to 24 Case Management staff and coach their performance to facilitate career growth with outcomes that contribute to meeting the needs of the customer, clients, business growth and quality standards. As part of the leadership team, participates in accreditation audits with URAC and DMHC as well as client third party audits. Provided coaching to staff to prepare for successful audits. Supports strategic business growth through participation in projects requiring a non-disclosure agreement. Acts as liaison and collaborates with all matrix partners within the organization in addition to partners outside of the organization. Lead the design and implementation of efficiencies resulting in $60K annual savings ongoing through streamlining processes focused on value add activities and improved data mining capability. Ongoing outcomes from this initiative include: Meet and exceed TAT for related medical necessity decisions, improved Health Care Providers satisfaction, increased frontline staff morale (Nurses, Medical Directors, non-clinical staff) & capacity for customer engagement that delivers the company’s mission to improve the well-being and sense of security of the customers we serve. Successfully maintains staff morale throughout significant changes. In 2015, on-boarded 15 case managers new to the role. Stays motivated with a strong focus on results and team building throughout multiple realignment and program transitions. Supports the growth within localization, Collaborative Accountable Care, Population Health Management and Provider Network Collaboration including Delivery System Alliances.

Case manager - Specialty OncologyCase manager - Specialty Oncology CignaCignaAug 2009 - Feb 2010 · 7 mosAug 2009 - Feb 2010 · 7 moswork at homework at home

Established a collaborative relationship with the client (plan participant), family, physician(s), and other providers to determine medical history and current status to assess the appropriate level of care and options for alternative care. Set a plan for short term and long term goals, time frames for follow-up, resources available (internal and community), involves all appropriate parties (client, physician, providers, employers, etc), and identifies anticipated case results/outcomes and criteria for case closure.

Implement, coordinate, monitor and evaluate the case management plan on an ongoing basis in collaboration with the client and treating providers and Oncology Medical Director as appropriate.Established a collaborative relationship with the client (plan participant), family, physician(s), and other providers to determine medical history and current status to assess the appropriate level of care and options for alternative care. Set a plan for short term and long term goals, time frames for follow-up, resources available (internal and community), involves all appropriate parties (client, physician, providers, employers, etc), and identifies anticipated case results/outcomes and criteria for case closure. Implement, coordinate, monitor and evaluate the case management plan on an ongoing basis in collaboration with the client and treating providers and Oncology Medical Director as appropriate.

Medical Aesthetic Nurse & Co-OwnerMedical Aesthetic Nurse & Co-Owner

Immaculè Medical Aesthetics

Immaculè Medical AestheticsSep 2006 - Aug 2009 · 3 yrsSep 2006 - Aug 2009 · 3 yrs

Under the supervision of Dr. Michael Lum, responsible for client assessment and administration of Injectable treatments for wrinkle reduction, Mesotherapy, Sclerotherapy, Medical-grade Microdermabrasion with Ultrasound and electrical stimulation, Intense Pulse Light therapy for pigment, hair reduction and acne, Laser resurfacing for acne scars and advanced wrinkles, and Medical-grade skin care. Responsible for performing client consultation and full spectrum management of medical aesthetics facility, protocols and clientele.Under the supervision of Dr. Michael Lum, responsible for client assessment and administration of Injectable treatments for wrinkle reduction, Mesotherapy, Sclerotherapy, Medical-grade Microdermabrasion with Ultrasound and electrical stimulation, Intense Pulse Light therapy for pigment, hair reduction and acne, Laser resurfacing for acne scars and advanced wrinkles, and Medical-grade skin care. Responsible for performing client consultation and full spectrum management of medical aesthetics facility, protocols and clientele.

Great-West HealthcareGreat-West Healthcare

5 yrs 1 mo5 yrs 1 mo

Quality Assurance NurseQuality Assurance Nurse

Aug 2006 - Sep 2006 · 2 mosAug 2006 - Sep 2006 · 2 mos

Performs Case Management staff quality case evaluations and telephone evaluations. Track and trend staff performance to ensure regional success and compliance with corporate initiatives.Performs Case Management staff quality case evaluations and telephone evaluations. Track and trend staff performance to ensure regional success and compliance with corporate initiatives.

Director, Knowledge ManagementDirector, Knowledge Management

May 2003 - Aug 2006 · 3 yrs 4 mosMay 2003 - Aug 2006 · 3 yrs 4 mos Glendale, CaliforniaGlendale, California

Co-manage the Medical Outreach Department which consists of 19 clinical and 8 non-clinical personnel as part of the regional leadership team. Responsible for full spectrum, day-to-day management of medical outreach programs. Develop regional strategies to meet corporate goals. Responsible for training and staff development, including quality evaluations. Work in partnership with the Director, Care Management and co-develop workflows to assure regional compliance to Regulatory standards such as URAC, DMHC and other state and federal mandates. Participate in the Peer-Review, Quality Management, and national committees. Participate in hiring, supervising and counseling staff as needed. Work in collaboration with matrix partners to ensure service delivery is consistent with company initiatives and partnerships.Co-manage the Medical Outreach Department which consists of 19 clinical and 8 non-clinical personnel as part of the regional leadership team. Responsible for full spectrum, day-to-day management of medical outreach programs. Develop regional strategies to meet corporate goals. Responsible for training and staff development, including quality evaluations. Work in partnership with the Director, Care Management and co-develop workflows to assure regional compliance to Regulatory standards such as URAC, DMHC and other state and federal mandates. Participate in the Peer-Review, Quality Management, and national committees. Participate in hiring, supervising and counseling staff as needed. Work in collaboration with matrix partners to ensure service delivery is consistent with company initiatives and partnerships.

Manager, Utilization ManagementManager, Utilization Management

Jul 2002 - May 2003 · 11 mosJul 2002 - May 2003 · 11 mosGlendale, CaliforniaGlendale, California

Assist the Director of Episodic Care Management in supervising a staff of 8 clinical and 2 non-clinical personnel. Responsible for Delegation Oversight, Audits and Joint Operation Meetings for delegated groups for Utilization Management on the HMO business in California. Re-vamped the Company’s audit tool to reflect 2003 NCQA standards and URAC 4.2 standards. Created the DOFR Matrix to allow for a better management of our company dollar and resources. The DOFR availability has been useful in other departments such as Provider Relations, Customer Service and Claims.Assist the Director of Episodic Care Management in supervising a staff of 8 clinical and 2 non-clinical personnel. Responsible for Delegation Oversight, Audits and Joint Operation Meetings for delegated groups for Utilization Management on the HMO business in California. Re-vamped the Company’s audit tool to reflect 2003 NCQA standards and URAC 4.2 standards. Created the DOFR Matrix to allow for a better management of our company dollar and resources. The DOFR availability has been useful in other departments such as Provider Relations, Customer Service and Claims.

Case ManagerCase Manager

Sep 2001 - Jul 2002 · 11 mosSep 2001 - Jul 2002 · 11 mosGlendale, CaliforniaGlendale, California

Great Beginnings Program, Hi-Risk Maternity Program, and Breast Care Program.

Additional Contributions as a staff include effectively organizing and coordination of the initial CCMS training with the Director of Episodic Case Management. National representative for Clinical Case Management System production support. Lead nurses on the implementation and integration of CCMS workflows between Service Operations and Medical Management. Nominated for the Fanatic Award and the President’s Award.Great Beginnings Program, Hi-Risk Maternity Program, and Breast Care Program. Additional Contributions as a staff include effectively organizing and coordination of the initial CCMS training with the Director of Episodic Case Management. National representative for Clinical Case Management System production support. Lead nurses on the implementation and integration of CCMS workflows between Service Operations and Medical Management. Nominated for the Fanatic Award and the President’s Award.

Case ManagerCase Manager

Network Medical Management - Allied PhysiciansNetwork Medical Management - Allied PhysiciansJun 2000 - Sep 2001 · 1 yr 4 mosJun 2000 - Sep 2001 · 1 yr 4 mosAlhambra, CaliforniaAlhambra, California

Case Manager for several IPAs averaging 50,000 lives. Worked closely with our Medical Director, functioned as the Lead case manager, assisted in selecting oncoming RNs and facilitated new employee training.

Streamlined systems and documentation tools for the case management department with supporting Policy and Procedures.

Created a departmental orientation syllabus, as well as a departmental case management reference distributed to all case managers.Case Manager for several IPAs averaging 50,000 lives. Worked closely with our Medical Director, functioned as the Lead case manager, assisted in selecting oncoming RNs and facilitated new employee training. Streamlined systems and documentation tools for the case management department with supporting Policy and Procedures. Created a departmental orientation syllabus, as well as a departmental case management reference distributed to all case managers.

Glendale Memorial Hospital and Health Center logo

Case ManagerCase Manager

Glendale Memorial Hospital and Health CenterGlendale Memorial Hospital and Health CenterSep 1997 - Jun 2000 · 2 yrs 10 mosSep 1997 - Jun 2000 · 2 yrs 10 mosGlendale, CaliforniaGlendale, California

Case Manager for Women’s Health and Neonatal Intensive Care areas. Functions as a float, covering Critical Care, Medical-Surgical, telemetry, oncology and pre-admitting areas.

Program Manager for DRG assurance program (1998). Successfully structured the program to fit organizational needs. Provided interdepartmental outcomes reports and updates. Supervised a case management staff of 13 during implementation and created the departmental competency.

Streamlined documentation through developing an improved Discharge Assessment and Planning tool consistent with JCAHO requirements.

Developed Policy and Procedure with guidelines for the aboveCase Manager for Women’s Health and Neonatal Intensive Care areas. Functions as a float, covering Critical Care, Medical-Surgical, telemetry, oncology and pre-admitting areas. Program Manager for DRG assurance program (1998). Successfully structured the program to fit organizational needs. Provided interdepartmental outcomes reports and updates. Supervised a case management staff of 13 during implementation and created the departmental competency. Streamlined documentation through developing an improved Discharge Assessment and Planning tool consistent with JCAHO requirements. Developed Policy and Procedure with guidelines for the above

Case ManagerCase Manager

Sisters of Providence, Holy Cross Medical CenterSisters of Providence, Holy Cross Medical CenterFeb 1997 - Feb 1998 · 1 yr 1 moFeb 1997 - Feb 1998 · 1 yr 1 mo

Headed weekly interdisciplinary case conferences. Systemized process for clinical case conference, developed documentation tool and implemented the documentation process consistent with JCAHO requirements. Influenced other units to utilize the same process. Result: Increased time efficiency for the interdisciplinary team members.Headed weekly interdisciplinary case conferences. Systemized process for clinical case conference, developed documentation tool and implemented the documentation process consistent with JCAHO requirements. Influenced other units to utilize the same process. Result: Increased time efficiency for the interdisciplinary team members.

Clinical Nurse IClinical Nurse I

Sisters of Providence - St. Joseph Medical CenterSisters of Providence - St. Joseph Medical CenterMar 1995 - Feb 1997 · 2 yrsMar 1995 - Feb 1997 · 2 yrs

Medical-Surgical/Vascular unit. Functioned as a relief charge nurse. Supported departmental goals by functioning as a communication team leader.Medical-Surgical/Vascular unit. Functioned as a relief charge nurse. Supported departmental goals by functioning as a communication team leader.

Clinical Nurse IClinical Nurse I

Queen of Angels-Hollywood Presbyterian Medical CenterQueen of Angels-Hollywood Presbyterian Medical CenterDec 1994 - Mar 1995 · 4 mosDec 1994 - Mar 1995 · 4 mos

Medical-Surgical/Oncology unit. Highly motivated in a demanding floor with high acuity patients.Medical-Surgical/Oncology unit. Highly motivated in a demanding floor with high acuity patients.

Clinical Nurse IClinical Nurse I

Huntington Memorial HospitalHuntington Memorial HospitalNov 1994 - Mar 1995 · 5 mosNov 1994 - Mar 1995 · 5 mos

Progressive experience as a new graduate in a renal-diabetic ward. Supported organizational requirements assisting in staffing needs by alternating work schedule of day and night shifts.

Education

University of PhoenixUniversity of Phoenix

Master of Business Administration (M.B.A.), Health/Health Care Administration/ManagementMaster of Business Administration (M.B.A.), Health/Health Care Administration/Management2004 - 20182004 - 2018

oGrade: 3.97

o

Started in 2004-2005, put on hold & resumed in 2016. Completed 2018.Started in 2004-2005, put on hold & resumed in 2016. Completed 2018.

CorePowerCorePower

200 RYT, Movement and Mind-Body Therapies and Education200 RYT, Movement and Mind-Body Therapies and Education2015 – 2016

2016: Completed 200hr Teacher Training. Grateful member of the Studio Experience Team.2016: Completed 200hr Teacher Training. Grateful member of the Studio Experience Team.

University of PhoenixUniversity of Phoenix

Bachelor of Science (BS), Registered Nursing/Registered NurseBachelor of Science (BS), Registered Nursing/Registered Nurse1995 – 1997

Pasadena City CollegePasadena City College

Associate of Arts (AA), Nursing ScienceAssociate of Arts (AA), Nursing Science1992 - 19941992 - 1994

Dean's Honors

Pasadena City CollegePasadena City College

Associate of Science (AS), Registered Nursing/Registered NurseAssociate of Science (AS), Registered Nursing/Registered Nurse1992 – 1994

Dean's Honors

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