Heather Riggle

Experience

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  Aetna, a CVS Health Company

  Oct 2012 - Feb 2017

  Utilization Review Nurse

   Partnered within a team of multidisciplinary professionals to deliver care and treatment to post-acute patients.  Provided education on medical issues and illnesses to guide patients toward heath.  Collected patient information and applied clinical judgement to render coverage for post-acute admissions.  Used Interqual and Milliman criteria to determine the level of care consistent with facility contracts aligning to patient specified needs.  Referred members to other opportunities integrating other product lines, clinical services, and clinical programs. Show less

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  Allegheny Health Network

  Feb 2018 - Mar 2023

  Director Clinical Operations

   Facilitate operations in support of 30 clinicians and 200+ non-clinicians.  Build relationships with all key internal and external stakeholders including patients, families, and associates attending to the holistic needs and rehabilitation of patients.  Provide nursing and holistic health education to inform patients of overall health in terms of physical, emotional, and psychological reaching a point of optimal health, wellbeing, and quality of life.  Serve attentively listening to patients’ pain points and driving the changes needed to recover from specific illnesses.  Engineered team workflow alignment ensuring patient safety when scheduling. Complied with all internal and governing agency policies and procedures.  Champion the success of staff and team performance through coaching, performance reviews, and training when required.  Oversaw the telephonic care of patients offering additional support and resources to enhance their care experiences.  Triaged patients ensuring the proper routing to appropriate levels of care concerning symptoms and disease management reducing unnecessary hospitalizations.  Organized centralized scheduling for abnormal mammograms, lung screening programs, infusions, PET scans and Genetics including all locations. Noteworthy Career Achievements: Spearheaded efforts to centralize Covid-19 testing and vaccine administration for the entire Allegheny Health Network including Highmark.  Launched and supported multiple clinically focused pilot programs within the call center. Show less

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  CenterWell Home Health

  Jan 2023 - now

  Director of Clinical Operations