Care Manager Case
Resume:
REBECCA WINGSTER
adopyr@r.postjobfree.com
Proactive, ambitious, enthusiastic, and successful individual with a proven ability to establish a professional and service-oriented environment. Highly skilled at leading teams to success. A collaborative team player and leader – equally effective at working on self-managed projects. Extremely proficient at cultivating positive internal and external partnerships. Talented Registered Nurse with 20+ years’ experience in various disciplines of the healthcare industry EXPERIENCE
JUNE 2020 – PRESENT
DIRECTOR OF OPERATIONS, KLW LOGISTICS
Support customer service and delivery activities by coordinating and directing teams with enhanced focus on order fulfillment and supply chain coordination, as well as personnel management. Provide for overall performance and efficiency by developing and monitoring KPI’s throughout shipping and receiving. Management of day-to-day duties, onboarding of new hires and setting goals of company expectations as well as employee performance to ensure that team runs efficiently while providing guidance and support Customer/client driven to ensure a high level of customer service Ensure that team members comply with company policies and maintain a high level of safety including that teams understand expectations and consistently meet or exceed key performance indicators (KPIs). AUGUST 2019 – JUNE 2020
RN NURSE MANAGER, PRIMARY CARE CLINICS, VETERANS HOSPITAL Provided exceptional leadership by advocating for patients, nurses and the nursing profession. Supervised Primary Care Clinic and Women’s Clinic with approximately 40 staff members and two assistant managers. Responsible for policy writing and implementation, nurse audits, nurse reviews, quality assurance, and the development of care-plans for patient documentation platform to facilitate quality of service. Promotes shared decision making and professional autonomy by providing department input into executive level decisions while providing transparency to staff members. Facilitates collaborative problem solving among interdepartmental disciplines. Diligently works with physicians at the department level to achieve operational and service goals. MARCH 2018 – AUGUST 2019
RN FINANCIAL NURSE AUDITOR, STEWARD HEALTH
Audits patient charts to determine charting accuracy for billing purposes, review claims, correspondence with medical and financial team to ensure claims are submitted without error. Write appeals and compile chart documentation to support procedures and capture revenue. Knowledgeable in insurance processes including Medicare, Medicaid and Workers Comp.
SEPTEMBER 2017 – MARCH 2018
RN CARE MANAGER, HUMANA AT HOME
2
Navigates members through the utilization of healthcare services, by providing information about benefits, resources, and gap closures. Expert in healthcare benefits, with an in depth understanding of Medicare policies and guidelines. OCTOBER 2014 – SEPTEMBER 2017
RN CASE MANAGER, OPTUM HEALTH
Assisted in the development of the new Med-Advantage sector and implementation of documentation requirements for the case management team. Procured relationships with facilities to facilitate transition to Optum Utah. Educated facilities on proper documentation to capture ICD-10 codes. Educated new hires on Care Management and processes. Assisted in the development of processes to support and educate the high utilizer population of patients on proper utilization of services. Site visits to ensure quality of care delivery to members.
JULY 2013 – JUNE 2014
RN SUPERVISOR, PALOMAR HEALTH
Delivered exceptional leadership to the women’s services team of 35 team members. Responsible for; conducting interviews, employee reviews, budgeting, scheduling, processing payroll, managing patient flows, quality of care. EDUCATION
MASTER OF HEALTH ADMINISTRATION, WALDEN UNIVERSITY GRADUATED
BACHELORS OF IHEALTH ADMINISTRATION, WEBER STATE UNIVERSITY GRADUATED
ASSOCIATE DEGREE IN NURSING, WEBER STATE UNIVERSITY GRADUATED
CERTIFIED LICENSED PRACTICAL NURSE, SALT LAKE COMMUNITY COLLEGE SKILLS
Proven Leadership skills in hospitals, clinics,
and offices
Promotes positive environment for
team/staff members
Experience in Quality Management
Enhanced organization, time management
skills with attention to detail
Proficient in creating policy & procedures
and SOP’s
Knowledgeable of Medicare, Medicaid and
Med advantage
Education of staff
Execution of purchasing equipment and
supplies
Fosters an environment of
professionalism and employee
engagement
Responsible for recruitment,
retention, and employee
satisfaction
Competent with Commercial
insurance processes
Experience with McMillian &
McKesson InterQual
Knowledge of Workers Comp
opportunities for staff
Skilled with acute care of
patients
Skillful with internal and external
customers
3
AND
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