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Board Member Admissions Manager

Location:
Tuscaloosa, AL
Salary:
110,000
Posted:
April 23, 2022

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Resume:

Roger Vann Wilhite

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

Tuscaloosa, AL 35406

(H) 205-***-****

(C) 205-***-****

EDUCATION:

Bachelor of Science in Nursing

Capstone College of Nursing, University of Alabama, Tuscaloosa Alabama

Graduated BS

Master of Science in Nursing Health Services Administration

University of Alabama at Birmingham, Birmingham Alabama

Graduated MSN

Jurist Doctorate

Birmingham School of Law

Graduated JD

Bar Eligible

LICENSED/CERTIFICATIONS:

Registered Nurse

Current 1/1/2019-12/31/2020

Certified Six Sigma Green Belt (2008)

Prior Certification McKesson/InterQual CPUR (2010) and IQRS (2008)

COHC Certified (2008)

EXPERIENCE:

2/19 to Present, State of Alabama, Taylor Hardin Secure Medical Facility, Tuscaloosa, AL

Promoted to Director of Nursing

Promoted to Senior Registered Nurse, Unit Manager

Hired as Registered Nurse I

• Supervise up to 10 staff members on an Acute Psychiatric Unit.

• Lead and direct daily patient care needs.

• Plan, coordinate services and programs for patients.

• Consults with various other disciplines.

• Insure patients attend groups

• Follow-up with medical clinic for referrals

• Admit patients to facility.

• Participate with Treatment Team Planning Conference.

• Complete Nursing Plan of Care for individualized treatment plans.

• Follow and incorporate JCAH regulations in daily work load.

• Document for Medicare, Medicaid, and JCAH requirements.

• Work with staff members to share and document for treatment plan.

(Reason seeking to leave: seeking promotion of employment where I can use my education and experience to help a facility prosper. I am willing to relocate.)

4/16 to Present, R&V Hospitality Recruiters, Inc., Tuscaloosa, AL

President/Owner-Manager, Regional Developer

• Supervise recruiters at my local office for making job placements.

• Advertise to obtain top talent for job placements.

• Market for leads with clients that need jobs filled.

• Be involved and create a presence in the local community.

• Develop offices in Louisiana, Mississippi and Arkansas.

• Vertical integration with businesses to bring jobs to the area.

(Reason seeking to leave: seeking permanent employment that challenges my knowledge and skills as a Leader.)

08/17 to 10/18, DCH System, assigned to Northport Medical Center, in less than 6 months

Promoted to Leadership/Management position for a Progressive Inpatient Physical Rehab Unit

Hired as Staff RN

• This is a very successful and highly-rated IRF-approved and JCO-certified provider, which maximizes reimbursements

• Supervised 3 lead Case Managers, 8 professional staff, and collaborated with Ancillary Staff

• Performed very good care to inpatient clients and rated in the 98th percent for patient satisfaction

• Provided management and complete oversight to all patient care as the • Team Leader, followed the Plan of Care, participated in team conferences

• Maintained the utmost HIPAA and confidentiality measures to protect PHI

• Completed other duties assigned by the Director

(Reason for leaving: looking for an environment in a permanent corporate, public or private setting with advancement opportunities in a similar c-level position where I worked before for 20+ years so that I can use my special skills, extensive experience and knowledge. Willing to work with a medical or non-medical employer, and will consider relocating within states contiguous to Alabama, but will consider other locations given the job.)

09/99 to 3/16, Walter Energy / Jim Walter Resources, Inc., Tuscaloosa, AL

Promoted to JVP, Corporate Matters/Administrator of Medical Benefits

Promoted to Director

Hired as Manager

• Managed staff for medical claims management of third-party administration for appropriate medical care based on McKesson guidelines.

• Successfully lead teams of Internal and External Case Managers through ongoing changes with appropriate and safe plans of care until the Discharge Plan was met

• Involved with Prospective and Concurrent Utilization Reviews, Precertification, and Screening Reviews

• Familiar with CMS Guidelines for Admissions and Discharge, UB/HCFA and HCPCS Coding for maximized reimbursement

• Evaluated and realigned nation-wide of PPO’s for participation

• Maintain familiarity with current guidelines for ERISA, COBRA, HIPAA, LTD, S&A Plans, Social Security, Pensions and employee Medical Plans

• Review and recommended changes to work environments and Wellness Plans

• Provided Multi-state management for Active and Discontinued Operations

• Additional Responsibilities: First Responder

Help plan Health Fairs and Flu Clinics

Member of the Joint Insurance Committee

(Reason for leaving: the Company went through Chapter 7 Bankruptcy and closed.)

1/04 to 2/07, (Extra job on Weekends only) DCH Regional Medical Center, Tuscaloosa, AL

Staff Nurse, Clinical Resource Team

• Primary case nurse for selected patients

• Supervise other licensed staff

• Cross-trained for multiple nursing units

4/97 to 9/99, Integrated Health Services, Birmingham, AL

850 9th Street NW, Alabaster, Alabama 35007, 205-***-****

Acting DON

Promoted to Director of Complex Medical Services

Hired as Case Management/Admissions Manager

• Turned around a non-profitable area to reach a profit with 75 staff and 4 Managers in areas of Sub-acute and Skilled Nursing Facility Care

• Interacted with 20 External Case Managers, Social Workers, and Discharge Planners of managed care organizations, hospitals, and insurance companies for referrals and appropriate placement at 3 facilities

• Performed weekly Concurrent Utilization Reviews for 43 patients

• Team Leader for 2 Case Mangers, 2 MDS Coordinators, and 2 Social Workers

• Calculated patient cost and reimbursement financial ratios on facility patients for revenue performance for Commercial Carriers

• Interviewed and recommend employees for employment

• Investigated and administered disciplinary action to employees

• Resolved patient complaints

• Represented the facility at health fairs and educational seminars

• Additional Responsibilities: Infection Control Committee, Chairperson

Infection Control Officer

Employee Health Coordinator

(Reason for leaving: recruited by Walter Energy /formerly Jim Walter Resources, Inc.)

ADDITIONAL WORK EXPERIENCE:

9/96 to 3/97, (6 Month Contract Position) University Orthopedic Clinic, Tuscaloosa, AL

Occupational Health Services Consultant

• Interacted with other physicians to enhance clinic referrals

• Contracted with businesses and employers to market clinic services

• Served as resource person to improve business’s workman’s compensation programs

• Promoted clinic at health fairs and educational seminars

• Represented clinic at Safety Leaders of Tuscaloosa committee meetings

4/96 to 7/96, DCH Center For Occupational Health, Tuscaloosa, AL

Case Manager

• Interacted with businesses which utilized the occupational health clinic

• Tracked company employee's dispositions

• Performed drug testing

• Performed needs analysis

3/95 to 4/96, DCH Center For Occupational Health, Tuscaloosa, AL

On Contract to Jim Walter Resources, Inc.

Occupational Health Services Coordinator

• Reduced Jim Walter Resources Mining Operations Worker’s Compensation expenses by $1.2 million by implementing an integrated healthcare delivery system

• Member of Safety Leaders Committee

• Negotiated provider contracts

• Interfaced with physicians regarding usual and reasonable medical treatment

• Identified cost effective providers

• Recommended Worker’s Compensation program changes

• Resolved/Adjudicated claims

10/94 to 3/95, DCH Regional Medical Center, Tuscaloosa, AL

Administrative Resident

• Worked on a project with hospital Vice President to identify the "Top Ten Revenue Producing Procedures" for the Outpatient Surgical Care Unit

• Presented this project to the Medical and Clinical staff of the Ambulatory Outpatient Medical Facility

6/94 to 10/94, DCH Regional Medical Center, Tuscaloosa, AL

Associate Nurse, Cancer Treatment Center

• Administered chemical agents to combat cancer-producing cells

• Interacted with patients regarding side effects

• Performed medical records reviews

4/86 to 6/94, DCH Rehabilitation Pavilion, Tuscaloosa, AL

Charge Nurse, Physical Rehabilitation Unit

• Primary case manager for assigned patients

• Supervised other licensed staff

• Cross-trained for Acute Long-term Care Unit

• Member of Clinical Pathway Committee

8/85 to 4/86, State of Alabama, Taylor Hardin Secure Medical Facility, Tuscaloosa, AL

Relief Supervisor

• Responsibilities included scheduling, assigning, and supervising staff

• Member of Safety Committee

• Member of Medical Staff Committee

• Member of Quality Improvement Committee

2/85 to 8/85, Bessemer Carraway Medical Center, Bessemer, AL

Staff Nurse

• Team Leader for Intensive Care Unit

• Cross-trained for Surgical Intensive Care Unit

CONSULTING ROLES:

10/16 to 04/17, Burns Healthcare, Inc. DBA Always Best Care, Birmingham, AL

Consultant / Director of Nursing

Worked with the business owner to Certify the Business which allowed for additional reimbursement sources like commercial and government insurance programs, i.e. BCBS of Alabama, Aetna, Travelers Insurance, and Medicare.

Developed an Education Program for staff for 12 hours of annual CEUs to comply with Certification.

Wrote Policies & Procedures mandated by Certification.

Created a contacts list to market to at insurance companies, social groups and associations, hospitals and physicians’ offices, and for profit companies

Completed other duties as assigned by the Franchise Owner

Reference: Jennifer Mancuso, Owner at 205-***-****

04/16 to 10/16, Alabama Self-Insured Guaranty Fund; Decatur, AL

Consultant / Establish Run-off Procedures

Worked with the Executive Director for the Alabama Self-Insured Fund in Decatur, AL and York Risk Management in Birmingham, AL to setup an effective program to transition JWR / Walter Energy run-off claims.

Created case management reference files / injury management plans for high-cost run-off claims.

Established a cost-effective fee for service-based reimbursement plan.

Provided $2-million excess carrier reimbursements

Completed other duties assigned by the VP at York or Exec. Director at the Fund

References: Charlie Hough, Executive Director at the Fund, 256-***-****; Pam Roberts, VP at York, 205-***-****.

OTHER CERTIFICATIONS, GROUP AFFILIATIONS, VOLUNTEERING AND HONORS:

Vice President, The Britni Leigh Wilhite Memorial Foundation

Board Member, IMPACT Ministry

Member, Tuscaloosa Ballroom Dance Club

Six Sigma Training for White Belt Certification, Two Projects Completed

Certification, Council for Accreditation in Occupational Hearing Conservation; COHC

Certification, McKesson - InterQual Review Criteria; CPUR

Appointment, State of Alabama, Board Member Alabama Workers’ Compensation Self-Insurer’s Guaranty Association

Board Member, Alabama Self-Insured Association (ASIA) and COMPAC Committee

Board Member, Workers’ Comp. Advisory for Birmingham Neurosurgery & Spine Group, PC

Committee Member, State of Alabama, Utilization Management/Bill Screening

Member, Alabama Self-Insured Association (ASIA)

Member, Alabama Workers’ Compensation Organization (AWCO)

Member, Workers Compensation Communications Committee to UOC

Member, Indian Lake Baptist Church;

Past Committees Involvement: Budget & Finance Committee

Constitution & Bylaws Committee

Personnel Committee

Building & Grounds Committee

Member Usher Committee/Greeters

Past Member, Industrial Advisory Board to Work Wise

Past Registry, InterQual Review Criteria; IQRS

Past Licensure, Alabama Department of Insurance; Life, Health and Disability Underwriter

Past Member, Board of Directors for the Workers’ Comp. Assoc. of West Alabama (WCAWA)

Committee Involvement: Membership Committee

Education Committee

Corporate Sponsor Committee

Past President 2002-2003, 2003-2004, and 2004-2005

Past Vice-President 2000-2001, and 2001-2002

Past Member, Case Management Society of America (CMSA)

Past Member, American Professions in Infection Control

Past Member, Alabama Nurses Auxiliary

Past Member, American College of Healthcare Executives

Recipient, DCH Regional Medical Center Scholarship for Continuing Education

Recipient, National Traineeship Scholarship, University of Alabama at Birmingham

Recipient, Mary Harmon Bryant Scholarship

SPECIALIZED CORE COMPETENCIES/SKILLS:

25+ Thriving Years of Progression-Experience in Healthcare Operations with a Respected Knowledge Base

Always provided confident, commendable leadership and senior management skills with the ability to inspire and lead global teams

Consistently demonstrated success in leading operational functions and assigning responsibilities within senior/executive management teams

Provided excellent problem-solving skills and ability to make difficult judgment calls within a sphere of responsibility to Shareholders and Board Members, and maintain a superior customer organization for a positive customer service experience

Demonstrated advanced negotiating, influencing and motivating skills, with the ability to identify and resolve issues at a senior level within Quintiles Ratings for top 20 costly contracts and 5 top member cost areas among 15 plans to reduce total cost 25%

Consistently demonstrates professionalism and is a respected ambassador for the Regulatory Business Unit, remaining effective in difficult, stressful and/or highly sensitive situations when others may be overtly anxious

Ability to communicate effectively at all levels in the organization, consistently demonstrating confidence and authority within remitter and composure

In depth knowledge of global clinical development regulatory requirements and project financial tracking and accounting methods under SEC requirements (2006, 2007 and 2008 training)

Six Sigma Trained and adopted W. Edward Deming Total Quality Management Principles

Successfully setup networks for Behavioral Health, Home IV administration, Case Management and Pharmacy Compounding

Directed Senior Management from BOD-approved Company-set Goals

Effective in Performance Management with 5+ Disciplines

Strong Background in Consulting for Private Business, PPO’s and State Organizations

Exemplary Record for Identifying, Recruiting and Training Qualified Personnel

Commendable Management of Clinical Trials in the area of Cancer Chemotherapy

Emphasis Placed on Forward, Strategic-thinking and Highly-successful Goal Setting with 98% Return on these Goals

Successful at Forecasting Cost Projections for 10 years and always within 5% of Forecasted Goal for each year for $550-million in health plans

Effectively Worked with Self-administered, Self-funded and Insured Arrangements Specializing in Full-cycle Employee Benefit Plans in Company-provided and Volunteer-election with 15 different TPA Offerings

Productively Managed 7 Hospital Arrangements, 20+ IPO’s, 5 Ambulatory Surg. Centers, 3 Preferred DME Companies, 1 Exclusive-national Case Management Firm, 1 Exclusive-national PT Company and Helped Identify 5 Locations for Profitable PT Clinics

Contracted, Benchmarked and Grew ASO Plans, PPO’s and Multiple IPA Groups by 30%

Developed Health Insurance Plans from Labor Groups Contracts and Employer Preferred Plans, and Wrote-in Provisions for Cost-savings with UMWA Leadership and Company Approval

Negotiated with DME, Free-standing Ambulatory Care Centers, and additional IPA’s

Streamlined Service Agreements and Combined Plans for Efficiency for 67% Savings under 3 Disability Health Plans with prior Annually Costs of $12-million

Established HMO-style Management for Workers’ Compensation and other Disability Programs

Created a Wellness Program and Employee Health Surveillance Plan for Jim Walter Resources that saw 10% Savings to the Group Plans of UMWA and Salaried Employees

Streamlined COB from Multi-payor Sources including Medicare ESRD to Reduce Plan Costs

Increased Retention Rates from 15% to 75% as a Productive Team Builder and Matched Employee/Job Placement Based on Employee’s Strengths

Served as Director on 3 Different Governing Boards

January 2022



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