Experience

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  Jeff anderson regional medical center

  Mar 2004 - Jan 2009

  Student nurse and staff nurse in the Emergency Department / ICU. Student nurse in the ER.

  • Registered Nurse

    Mar 2007 - Jan 2009

  • Student Nurse

    Mar 2004 - Mar 2007
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  Carondelet health network

  Mar 2007 - May 2012

  Registered nurse

  Staff Nurse, Charge Nurse

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  Rtg medical

  Oct 2012 - Jul 2013

  Staff nurse
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  Banner health

  Jun 2013 - Aug 2015

  Clinic manager

  During this time, I oversaw the clinic's day-to-day operations, including 22 nursing and ancillary health care staff, to ensure quality and efficient provision of services. I created policies and processes while maintaining compliance with regulatory, accrediting, and clinic policy for personnel management, quality services, and environmental safety. I also managed the integration of services and oversaw education programs, including competency assessment, orientation, and in-service training for all clinic sections. A few key achievements in this tenure include: • Accelerated patient satisfaction CAHPS scores to above 92nd percentile by alleviating operational challenges and enhancing the quality of care.• Reduced clinic wait times from 3.5 hours to 15 minutes.• Expanded clinic revenue by 30% through recruitment of two provider services. Show less

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  Humana

  Aug 2015 - Jan 2017

  Quality initiatives nurse

  Throughout my term in the position, I administered quality and appropriate care delivery by educating healthcare team to improve patient outcomes following HEDIS, NCQA, and CMS standards. I collaborated with the case and utilization management department to promote individual health and HEDIS compliance. I also facilitated health professional and new staff training on data systems and processes for analyzing the progress of quality care initiatives. In addition, I served as a quality consultant in identifying and prioritizing opportunities for quality enhancement within the organization, as well as in planning and conducting action plans. A few key achievements in this tenure include: • "North Star" Award recipient for increasing a contracted practice STARS rating from 2.5 to 4.5 in less than eight months.• Amplified overall plan rating of 3.5 STARS across all contracted practices by training new team members to achieve quality, patient-focused outcomes.• Championed a new system, CareBook, to optimize reporting efficiency, saving an average of 15 minutes per practice report. Show less

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  Unitedhealthcare

  Jan 2017 - Sept 2018

  Clinical practice consultant

  As a Clinical Practice Consultant, I improved targeted HEDIS measures, compliance, and STARS scores through working collaboratively with health professionals and all medical quality staff to progress reporting and value-based care models. I developed a standardized reporting and documentation system for electronic medical records to convey quality reporting and initiatives to contracted state, community, and Medicare providers. I have also contributed to delivering advanced experience, quality, and value of care by formulating innovative processes and identifying organizational impediments to achieving desired program results. A few key achievements in this tenure include: • Directed efforts to increase HEDIS performance by 35% in less than six months.• Raised the STARS rating of primary contracted practices from 2.5 to 4.0 by driving the transformation of interdisciplinary practices.• Optimized performance and communication of five rural contractual practices that demonstrated a 20% advancement in HEDIS performance within one year. Show less

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  Kaplan

  Sept 2017 - now

  Instructor

  At Kaplan Inc., I provide competency-based education to newly graduated nursing students, which aligns with the Kaplan model of curriculum and style of system distribution. My daily duties include modifying instructional resources to meet the needs of students with varying backgrounds and learning styles. A few key achievements in this tenure include: • Earned a 90% teacher satisfaction rate from all classes taught by maintaining a high energy level and aptitude to help students succeed on the National Clinical Licensure Exam (NCLEx). Show less

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  Banner health

  Sept 2018 - now

  Associate director of centralized denials management

  In my most recent role, I evaluate clinical practice and outcomes, perform quality assessments of files, and implement new processes to increase the quality of claim denial workflows and communication with payers. I lead and empower a team of 32 staff nurse, auditors, and coder reviewers on Utilization Management claim denials from various payer plans. I also elevate claims production and accuracy by developing concurrent and post-billing review processes and policies for the department and setting KPIs for the team. A few key achievements in this tenure include: • Recognized and commended as a top 10 leader for effective management of all aspects of the claims handling processes and outcomes.• Managed hiring and performance-based training of new employees, minimizing account write-offs by more than 20% and raising the denial overturn rate to more than 75%.• Significantly reduced inactive inventory in denial accounts receivable by 30%. Show less