Experience

• 

  Hardin memorial hospital

  Jun 1991 - Nov 1992

  Staff rn

  Medical Surgical Unit. Bedside patient care. Maintained patient safety. Shift assessments on patients, gave medications, called the doctor as needed for patient care orders. Responsible for 10 through 12 patients.

• 

  Jewish hospital

  Nov 1992 - Dec 1994

  Critical care rn

  Critical care (TMU - telemetry monitoring unit). Bedside patient care. Maintain patient safety. Shift assessments on patients, gave medications, called the doctor is needed for patient orders. Responsible for 4 to 6 patients.

• 

  Louisville primary care center, psc

  Dec 1994 - Dec 2007

  Office management duties including credentialing. Office inspection maintenance. Maintained all logs, and protocols/procedures for inspection. Office activities – planned quarterly activities for the office and their families. Staff motivational activities. Helped develop protocols for our physicians home visits program. Negotiated medical equipment purchases. Wrote and reviewed contacts. Multispecialty practice that required numerous contracts. Helped with the development of marketing material. Managed clinical staff, HCI ( Healthcare Information – medical records). Quality improvement program including utilization review, chart audits, and case management. Made hospital rounds on patients with the medical director and went on home visits with physician on homebound patients. Development of the patient education department. Coordinator of patient teaching.

  • Clinical Administrator

    Dec 1994 - Dec 2007

  • Nurse Manager

    Apr 1995 - Mar 1997

  • Patient Education

    Dec 1994 - Dec 1995
• 

  Louisville patient centered medical home, psc

  Feb 2008 - Oct 2015

  Practice & team outcomes manager

  Job responsibilities include office management, and all aspects of human resources. Coordinated benefits, hiring and training. Instrumental in the office recognition as a Patient Centered Medical Home (PCMH) and the Diabetes Recognition program (DRP) certification. Trained in coding and billing, patient registration and medical records. Other responsibilities include, HIPAA & corporate compliance, hospital (TCM) follow-up, CLIA, ACO, HEDIS Measures, and all aspects of practices management. Show less

• 

  Evolent health

  Oct 2015 - May 2017

  Medicare Dual Special Needs Plan (DSNP) clinical and non-clinical protocol adherence, Medicaid, Model of Care (MOC) compliance, utilization management (UM)/ care management (CM), matrix responsibilities to Care Coordination, UM, and Quality Improvement, monitor and grow relationships with internal and external business partners, achievement of improved clinical quality outcomes and processes. Coordinated with FDR (vendor) on reports and processes regarding care coordination. Troubleshoot internal issues. Worked closely with internal departments and all levels of management. Show less

  • Manager, Clinical Operations

    Dec 2016 - May 2017

  • Quality Improvement / Case Manager

    Oct 2015 - Nov 2016
• 

  Anthem, inc.

  Jun 2017 - May 2018

  Population health transformation consultant (care consultant, sr.)

  Focused on clinical processes, efficiency, and the quality of care provided by medical practices. Served as the point of contact, subject matter expert, and liaison with Anthem Care Management. Collaborated with program stakeholders to meet provider and practice service needs. Medicare Advantage department supporting population health management. Facilitated meetings with an Independent Physician Association (IPA) for Medicare site work. Provided resources to help providers increase AV (annual visits), HEDIS measures, and PCV (persistent condition validation). Educated and supported workflows, report analysis. Leveraged monthly reports, including practice performance and member lists for improvement. Assigned practice increased from 2% to 9% as compared to the previous year. Internally tracked quality measures and checked for outcomes. PowerPoint presentations were presented and educated for improved performance. Provider value-based medicine consultation, including data sharing and shared savings incentive strategies. Project Management – organized and managed clinical quality program resources. Work plan maintenance and completion. Show less

• 

  Anthem, inc.

  Jul 2018 - Sept 2019

  Clinical program consultant

   Knowledge Library Project, which included standardization of procedures across the enterprise. Assisted the director with department responsibilities. Oversight of the AUMSI audit process, NCQA (National Committee for Quality Assurance) accreditation, and regulation report scrub and submission. Responsible for monitoring department compliance. NCQA TAT (turnaround time) improvement by initiating and facilitating meetings, reporting out, and following up on action items. Increased manager compliance from 25% to 75% success rate in the period working on compliance issues. Completing quality PDSA (Plan, Do, Study, Act) projects after assessing the root cause of internal issues. Monitored department internal correction action plans, with initiation, development, and distribution of a monthly report for upper leadership. Developed internal audit process. Managed a project helping to develop a software program with a business analyst moving away from a manual worksheet. Worked with the director and CMOS to develop system requirements for NCQA TAT measurements. Show less

• 

  Michrn coach collective

  Jul 2021 - now

  Small business owner

  Health and wellness RN coach empowering, educating, and coaching individuals to be powerful, and positive healthcare advocates for themselves. Health / Wellness coaching emphasizing the patient as the expert of themselves. Consulting and empowered individual healthcare advocacy. Biometric review implementing actions for improvements as needed. Medical office pre-/post-visit review with education for newly diagnosed conditions Customer service, leadership, sales and marketing Show less

• 

  Elevance health

  Aug 2021 - Mar 2023

  Practice consultant

  HEDIS chart review. Trained and pulled STAR/HEDIS measures from medical records/data abstraction Worked on a production system of pulling medical records for accountability. Gave feedback on improvements noted when pulling medical records as needed.