Over fifteen years of experience as a manager in the medical field. Strong abilities to develop and direct corporate strategies. Extensive experience with budgets, outcomes management, analytical and statistical skills, and healthcare reorganization with a focus on quality and cost efficiency. Proficient in Windows XP/2000/NT/98/95, HTML, MS Office, MS Project, Visio, MS Access, MS Powerpoint, and Project WorkBench. Experienced with SIX SIGMA methodologies and Productivity Management. Licensed as a Registered Nurse (RN) in States of New York, Florida and California.
• Master of Science in Administration, Health Services Administration, Central Michigan University, Mt Pleasant, MI 1999
• Bachelor of Science in Nursing, Syracuse University, Syracuse, NY 1996
• Course and Certificate of Completion, Productivity Management, Keane,Inc., Danbury, CT 2002
• Certificate of Completion, Clinical Documentation Management Program, Cap Gemini, Ernst and Young, Hartford, CT 2001
• Course and school, Officer Basic Course, AMEDD Center and School, US Army, San Antonio, TX 1996
Associate Vice President, Healthcare Services and Quality Management 01/07- Present
Altamed Heath Services Corporation, Los Angeles, CA
Served as the senior nurse for Southern California’s largest Federally Qualified Health Center (FQHC) that includes 32 primary care clinics, adult day health centers, an IPA and two PACE sites servicing over 85,000 lives throughout the Los Angeles and Orange Counties. Responsible for developing and implementing the organization’s nursing, quality, utilization, infectious control, case management and disease management, plans and programs. Created, monitored and maintained compliance with policies and procedures for JCAHO, NCQA, and the Department of Managed Healthcare. Recruited, educated, and mentored nursing staff. Directed a staff of 65 nurses and 85 support staff. Doubled the identification rate of California Children Services (CCS) for the organization thus increasing organization savings in excess of $1,000,000/yr. Implemented Interqual (CERMe) clinical care guidelines, and EZCAP managed care system thus increasing utilization efficiencies while decreasing expenses and improving quality outcomes.
Regional Network Clinical Manager, CIGNA Healthcare, Tampa, FL 09/04- 01/07
Served as the liaison to internal and external customers by analyzing, aggregating, coordinating, and communicating CIGNA’s quality and efficiency data, methodologies, and transparencies, that included, but not limited to, HEDIS, NCQA, LeapFrog, CIGNA's Centers of Excellence (COE), P4P, and Episode Treatment Groups (ETG) and Episode Risk Groups (ERG) methodologies. Planned, conducted, projected profit/ loss analyses, reporting, and revenue management for CIGNA Networks throughout the U.S. Served as a project manager for Market level projects on the east coast US involving high performance networks, benefit tiering, fee for service, facility and provider quality and efficiency, and hospitalist utilization activities and programs. Monitored, assessed, evaluated, forecasted, and made market recommendations regarding CIGNA’s High Performance Networks (HPN), CIGNA Care Networks and Florida SELECT Networks based on impacts from cost, efficiency, qualitative, contractual, legal and a regulatory standpoint. Responsible for analyzing and providing recommendations on market financial performance to meet and exceed revenue goals. Prepared and provided estimates of cost savings for existing and new markets based on financial trending and market organization. Supported and made recommendations to the east coast Senior Market Medical Executives, General Managers, clinical case management, Utilization Management, Contracting, and other internal customers in optimizing network performance for quality and cost utilization.
Principal Consultant, Keane, Inc., Rocky Hill, CT,
State of Connecticut, Department of Social Services and Department of Information Technology 09/01- 09/04
Served as the conduit and PMO at University of Connecticut Health Center (UCHC) and the Department of Social Services (DSS) for HIPAA compliance. Assessed and analyzed risks and gaps to HIPAA for 12 State of Connecticut (SOC) government covered entities and provided feedback to all levels of the organization. Developed, designed, wrote and managed multiple project plans to meet HIPAA compliance for privacy, security and transaction and code sets. Developed and conducted training for all State of Connecticut agency covered entities on HIPAA awareness and requirements, and content for HIPAA Privacy policies and procedures. Developed, audited, monitored and oversaw expenses associated to budgets in excess of $5,000,000 for two government covered entities. Served as the DSS Privacy Officer. Developed databases and auditing tools to monitor and maintain ongoing compliance with agency’s policies.
Regulatory Manager/ Privacy Officer, Information Management, Hartford Hospital, Hartford, CT 02/01-09/01
Served as the Privacy Officer for Connecticut Health Systems and Hartford Hospital. Provided guidance and expertise to the clinical and corporate quality improvement committees in improving quality of patient care and corporate compliance issues. Chairman and Lead for the Connecticut Health Systems, and Hartford Hospital’s Information Security Committees. Maintained accountability for funds in excess of $2,000,000 by approving and allotting allocations. Maintained compliance with HIPAA, JCAHO, HFCA (CMS), State of Connecticut, and Federal Statutes and Regulations. Directed and supervised 34 staff members.
Documentation Manager, Information Management, Hartford Hospital, Hartford, CT 08/00-02/01
Facilitated the development of hospital-wide documentation standards to assure quality documentation within the inpatient, outpatient, and specialty service areas. Served as the project manager for implementing Electronic Signature within the Connecticut Healthcare System. Served as the liaison between the clinical healthcare providers (including physicians, nurses, etc.) and the Health Information Management staff. Chaired the Information Management JCAHO Standards Committee. Implemented a process to change medical record reviews from retrospective to concurrent reviews. Ensured compliance with JCAHO standards, federal and state laws. Directed and supervised 34 staff members, developed budgets and oversaw budgets in excess of $2,000,000.
Hospital Administrator, U.S. Army, 121 General Hospital, Seoul, Korea 10/99-08/00
Served as Public Affairs Officer for the hospital. Coordinated events to promote international relations with host country. Served as the Chief Project Officer for the Hospital, designed and implemented 8 major projects. Served as the Assistant Transition Officer for a six-year hospital renewal project by coordinating hospital sections transitions, speeches and serving as the spokesman to the hospital and community. Developed and implemented quality improvement plans for entire healthcare network of US military care in Asia for military personnel, US military contractors and dependents of such persons. Served as committee chair for Joint Commission on Accreditation of Healthcare Organizations on Information Committee. In addition to hospital based personal, oversaw services for 64 clinicians in 14 clinics throughout South Korea.
Nursing experience, U.S. Army, 05/96-08/00
Assistant Director PACU, Pre-Op, Conscious Sedation Suites , U.S. Army, 121 General Hospital, Seoul, Korea 03/99-10/99
PACU Nurse, U.S. Army, Walter Reed Army Medical Center, D.C. 09/98-03/99
Transplant Unit Nurse Manager/ Assistant Head Nurse, U.S. Army, Walter Reed Army Medical Center, D.C. 03/98-09/98
Surgical Nurse, U.S. Army, Walter Reed Army Medical Center, Washington, D.C. 05/96-03/98
Extensive nursing experience in multiple clinical settings and management levels in the following clinical settings: Med-surgical, transplant, PACU, SICU, MICU, and PICU. Served as a resource for peers and subordinates. Participated in unit and organizational level process improvement, staff development, and continuing education activities. Received an award while serving as the Nurse Manager to the PACU by bringing the conscious sedation units up to meet JCAHO standards. Assured JCAHO compliance with Nursing and Information Management Standards by serving on the Information Management and Nursing Education Committees.
American College of Healthcare Executives (ACHE)- affiliate American Nurses Association- member
Amateur Radio Operator- General Class License Lambda Chi Alpha Fraternity- Alumnus