Carolyn (Kris) Gipson

MSN, RN, CCM, CPHQ, CCP

Address:

*** ***** ******,

Lavaca, AR 72941

Cell:

479-***-****

Email:

adgrls@r.postjobfree.com

Health plan, home health, home infusion and hospital leadership, hospital case management, hospital quality management and presentation. LTAC, home health, home infusion, medical and cardiac ICU. Understanding of NCQA HEDIS and PQA quality measures, gap closure, promotion of positive member experience and member and provider engagement.

EMPLOYMENT DETAILS

Arkansas Blue Cross Blue Shield

Job Title: Manager Medicare Advantage Case Mgmt.

Job Title: Supervisor Medicare Advantage Case Mgmt.

Job Title: Medicare Advantage Case Manager

Job Title: Regional Case Manager for all LOB

2018-Current

2017-2018

2013-2017

2007-2013

Manager Medicare Advantage case management team.

Work collaboratively with Medicare Advantage administrative, operations, medical management, and MA partners.

Seek to promote admission avoidance, emergency department utilization mitigation, member/provider engagement.

Seek to support MA STAR ratings, gap closure, and positive member experience.

Quality Management and Medicare Chronic Care Improvement Plan (CCIP) development, implementation, and submission, ensuring all URAC standards and measures are met for Medicare Case Management outreach and documentation.

Responsible for assisting in developing and managing the implementation of clinical protocols and programs.

Quality improvement of case management and clinical operation effectiveness.

Provide leadership in the development of new pilots and initiatives to improve care or lower cost of care.

Manage team responsible for coordinating member service, access, care management to ensure cost effective utilization of services.

Oversee program compliance, identify opportunities, develop, and implement strategies to improve customer service and quality outcomes.

Develop and implement quality initiatives and activities to promote adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS requirements and Pharmacy Quality Alliance (PQA) measures and requirements.

Hire, train, coach, counsel and evaluate performance of direct reports.

Motivational coaching and team member education including strategic SMART goal setting aligned with organizational mission, vision, and goals.

Mercy Hospital Fort Smith

Job Title: Case Manager

2005-2007

Case management for oncology/hematology population.

Identified and addressed psychosocial issues and social determinant barriers to care and disease management.

Coordination with patient/family, internal and external providers and resources for post discharge follow up care, with provision of motivational interviewing and education to promote successful transitions of care.

Collaborative benefit review and coordination of care with health plans, providers, staff, local resources, patients, and patient caregivers for successful transitions of care.

Select Specialty Hospital (LTAC)

Job Title: Director of Quality Management

2003-2005

Developed, implemented, promoted, and monitored quality improvement and quality outcomes for 32 bed long term acute care hospital utilizing PDCA methodology.

Developed, maintained, and presented quality, safety, risk, and infection control program dashboards, charts, and graphs for facility leadership and staff.

Presented in a meaningful way the quality, safety, risk and infection control programs and outcomes to facility Board of Directors, Quality, Risk, Compliance, Safety and Infection Control committees and leadership quarterly.

Program Manager for Onboarding and annual quality, compliance, infection control, safety, and risk management education for all facility employees.

Program Manager for Hospital infection control and risk management.

Conducted risk cause analysis and developed policy and procedure changes to improve patient and staff safety.

Program Manager for performance Improvement and quality outcomes.

Responsible for understanding Joint Commission standards with facility policy development and implementation to meet those standards.

Responsible for quality onsite audit preparation, assistance, and participation with Joint Commission auditor and follow up outcome presentation for staff and leadership.

Baptist Home Infusion (Formerly American Home Patient)

Job Title: Director of Nursing

1995-2003

Hiring, development, supervision of clinical and non-clinical staff for home infusion organization.

Worked closely with onsite pharmacist, providers, payors, and patients to ensure successful coordination of services.

Educational presentations to home health organizations and providers.

Marketing and presentation to and for local providers.

Quality Program Management and Performance Improvement.

Provision of educational courses to local home health agencies and the University of Arkansas – Fort Smith Nursing Program under supervision of clinical instructor Nancy Vernon.

Direct patient, family, care provider education.

Direct patient care, education and training for access and central line care for variety of access sites.

Certified and successful with Mid-line and PICC line placement, maintenance.

Earned Certified Registered Nurse Infusion (CRNI) through Intravenous Nurses Society and deemed Infusion Specialist.

Provision, management, and oversight for safe home administration of various chemotherapeutic agents, pain management, IVIG, TPN, lipids, antibiotics/ antifungals, steroids, iron, anti-rejection medications, diuretics, cardiac medications, etc.

Responsible for quality onsite audit preparation, assistance, and participation with Joint Commission auditor and follow up outcome presentation for staff and leadership.

Kindred at Home (Formerly Kimberly Quality Care)

Job Title: Director of Professional and Clinical Services

1993-1995

Conducted human resource responsibilities including interviewing, hiring, onboarding and development of nursing, professional and support staff; planning, assigning, and directing work; performance evaluations and disciplinary action.

Directly supervise and manage 50+ interdisciplinary clinical licensed and auxiliary staff.

Collaborative benefit review, negotiation, and coordination of care with health plans, providers, staff, patients, and patient caregivers for successful transitions of care.

Clinical documentation audit and review for Quality Management and Performance Improvement program management.

Quality onsite audit assistance and participation with Medicare auditor.

Responsible for quality onsite audit preparation, assistance, and participation with Arkansas State Health Department auditor and follow up outcome presentation for staff and leadership.

Diligent management and oversight of patient care equipment, sterile and non-sterile supplies ordering, storage, and dispersion.

Baptist Fort Smith (Formally Sparks Regional Medical Center)

Job Title: Medical/Cardiac ICU Staff Nurse

1990-1993

Medical/Cardiac ICU staff nurse.

Coordination of nursing care, direct patient care, education, and transitions of care.

Planning, implementing, evaluating, and communicating all phase of nursing care for patients.

Direct nursing care of patients post cardiac procedures including coronary artery bypass graft, femoral popliteal bypass graft, heart valve replacement, med/surg trauma, cardiac catherization, telemetry interpretation, emergency cardiopulmonary resuscitation code coverage for unit and units throughout facility.

Provision of Registered Nurse ICU preceptorship.

Night shift team lead.

ACADEMIC BACKGROUND

Master of Science in Nursing-Nursing Administration

University of Texas-Arlington

Year Completed: 2020 GPA 3.72

Sigma Theta Tau Honor Society of Nursing

Bachelor of Science in Nursing

University of Texas-Arlington

Year Completed: 2017 GPA 3.88

Magna Cum Laude

Associate Degree of Nursing Science

University of Arkansas-Fort Smith

Year Completed: 1990 GPA 3.27

LICENSE / CERTIFICATIONS

Registered Nurse – R036055

9/11/1990-12/31/2020

Arkansas State Board of Nursing

Certified Professional Health Care Quality (CPHQ) 114816

National Association of Health Care Quality

4/17/2019-12/31/2021

Certified Case Manager (CCM) 00032333

Commission for Case Manager Certification

6/1/2017-5/31/2022

Chronic Care Professional Health Coach (CCP)

9/10/2020-9/10/2023

HealthSciences Institute

https://healthcoachregistry.org/registered-health-coach-locator

Certified Registered Nurse Infusion Specialist (CRNI)

Infusion Nurses Certification Corporation

1997-2001

PROFESSIONAL MEMBERSHIPS

Case Management Society of America (CMSA) CHAPTER AR2 - Member 52514

National Association for Healthcare Quality (NAHQ) - Member 114816

Contact this candidate