Case Management Project Manager

About

My vision is high quality patient centered care through strategic and systematic processes amidst continuous change & healthcare delivery evolution.

My work reflects the continuous quest for patient safety, quality improvement, staff development and patient satisfaction. I utilize teamwork, interdisciplinary and intercommunity resources as my tools in achieving the provision of patient centered healthcare in the appropriate setting. Through process analysis and outcomes measurement, I leverage opportunities for efficiency to facilitate organizational improvement in the departments that I have worked in. It has been my experience that planning for resources considered for healthcare almost always results in cost containment for all involved: patient, employer groups, healthcare provider, healthcare organizations in both private and public sectors.

As an experienced program/project manager, entrepreneur and healthcare professional with working knowledge of clinical nursing and case management in multiple settings, I am comfortable thinking outside the box with efficiency and CQI as my thinking hats. I’m looking for opportunities to utilize my skills in clinical program & project management.

Experience

Calibrated healthcare 1 yr 1 mos

Senior Director Utilization Management/Extended Care Management

June 2024-June 2025

Responsible for UM teams offshore and ECM/Community support teams onshore. Stood up the company’s first Extended Care Management program meeting contractual milestones despite resource restraints

Navenhealth. 1 yr 3 mos

Per Diem Infusion Nurse – Home health

April 2024-June2025

Cigna 13 yrs 7 mos

Clinical Program Manager 6 yrs 9 mos Jul 2017 – Mar 2024

Reviewed and prioritized upcoming business strategies to be implemented across Clinical Operations. As the Vendor Relations Manager for Omada, ensured the Hypertension and Pre-Diabetes Programs are synchronized for seamless delivery of services by Omada. Daily review of accounts and programs active for the clientele is performed through a cross matrix analysis of information from multiple internal systems as aligned with the information Omada has throughout their systems. Teams are responsible for collaborating with all externally facing partners to transform the way health care is delivered, ensuring best-in-class care for all members.

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

Ensured customer satisfaction through operational delivery of best-in-class case management services. Managed a national team of up to 24 Case Management staff and coached 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.

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

Supported the growth within localization, Collaborative Accountable Care, Population Health Management and Provider Network Collaboration including Delivery System Alliances.

Case manager - Specialty Oncology 7 mos Aug 2009 - Feb 2010

Established a collaborative relationship with the client (plan participant), family, physician(s), and other providers to determine medical history and 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 & CEO 3 yrs

Immaculè Medical Aesthetics 3 yrs Sep 2006 - Aug 2009

Responsible for client assessment and administration of injectable treatments for wrinkle reduction, volume enhancement, 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 Healthcare 5 yrs 1 mo

Quality Assurance Nurse 2 mos Aug 2006 - Sep 2006

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 Management 3 yrs 4 mos May 2003 - Aug 2006

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 Management 11 mos Jul 2002 - May 2003

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 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 Manager 11 mos Sep 2001 - Jul 2002

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

Additional Contributions as a member of 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.

Network Medical Management - Allied Physicians 1 yr 4 mos Jun 2000 - Sep 2001

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 2 yrs 10 mos Sep 1997 - Jun 2000

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 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.

Sisters of Providence, Holy Cross Medical Center 1 yr 1 mo Feb 1997 - Feb 1998

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.

Sisters of Providence - St. Joseph Medical Center 2 yrs Mar 1995 - Feb 1997

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

Queen of Angels-Hollywood Presbyterian 4 mos Dec 1994 - Mar 1995

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

Huntington Memorial Hospital 5 mos Nov 1994 - Mar 1995

Clinical Nurse. 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 Phoenix

Master of Business Administration (M.B.A.), Health/Health Care Administration/Management 2004 - 2018

Grade: 3.97

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

Six Sigma Yellow-Belt Certified 2012

University of Phoenix

Bachelor of Science (BS), Registered Nursing/Registered Nurse 1995 – 1997

Pasadena City College

Associate of Arts (AA), Nursing Science 1992 - 1994

Dean's Honors

Pasadena City College

Associate of Science (AS), Registered Nursing/Registered Nurse 1992 – 1994

Dean's Honors

Certifications

Commission for Case Manager Certification

oCertificate Number: 0008457

oIssued July 2005

American Association of Managed Care Nursing

oCertificate Number: 12-0947

oIssued January 2012

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