Elaine C.

Experience

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  UPMC

  Aug 2002 - Apr 2005

  I was responsible for comprehensive patient care on a step-down cardiothoracic transplant unit, as part of a collaborative health care team working to advance transplant medicine to a new level.My duties included assessing the patient, administering medications, assisting doctors with procedures, working as a patient advocate, educating patients on new medications, procedures, etc. I have unique transplant experience including experience with bi-ventricular assist devices, left ventricular assist devices, transplant medications, and a solid knowledge of infection versus rejection relating to transplant medicine. Other experience I gained on this unit includes trachs, central lines, titration of drips including nitroglycerin, dobutamine, and dopamine, chest tubes, bi-pap, C-pap, telemetry, insulin protocols, and anti-coagulant therapies such as lovenox, heparin, argatroban. I also responded and initiated emergency protocol as needed in code situations. Show less

  • Admission Team Professional Staff Nurse

    Jun 2004 - Apr 2005

  • Cardiothoracic Transplant Professional Staff Nurse

    Aug 2002 - Jun 2004
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  Penn Commercial Business/Technical School

  Jan 2011 - Apr 2011

  Instructor

  I was responsible for instructing medical students (coding and billing) in medical terminology and anatomy and physiology. I taught to give students a working knowledge of medical terms. I taught to give these students an understanding of the origin of the terms in order to apply this knowledge in their careers. I taught anatomy and physiology to give an understanding of the human body. We also examined how certain pathologies affect the body. In addition to the aforementioned responsibilities, I also kept an accurate grade book, assisted students having difficulty with material, and maintained a positive classroom environment. Show less

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  Children's Hospital of Pittsburgh

  Sept 2014 - May 2016

  Registered Nurse

  Responsible for comprehensive patient care in an Express Care Setting often filling charge nurse responsibilities. Routine, urgent, and emergent care provided as indicated. Duties included facilitating patient flow, rooming, triage, medication administration, referrals, following up on abnormal patient results, lab testing, urgent/emergent patient transfers coordinated with CHP and WHS emergency departments as necessary, working closely with physicians and other staff members. I really loved this job! It's great to be part of helping little ones get better!! Show less

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  UPMC Health Plan

  May 2016 - Oct 2019

  Promoted to project manager to support a new effort at UPMC working with our largest volume Pay For Performance providers from a quality perspective. I worked to use my HEDIS experience to facilitate gap closure, identify opportunities, and to assist the sites reaching their targets. Responsible for implementation of new strategy, assessment and dissemination of education for providers relating to health plan support, efforts, reporting etc. Worked to build successful relationships with essential leadership in order to facilitate implementation of our program. Show less Worked in Quality Improvement to support our 4 star, NCQA accredited health plan. I worked in-depth with many of the HEDIS measures on a daily basis. As a HEDIS coordinator, I helped to coordinate the clinical and administrative functions that support HEDIS. Some of my responsibilities included: Utilize NCQA guidelines and detailed work strategies for each clinical HEDIS measure to validate clinical inclusions and exclusions for specified measures, review and approve the clinical documentation submitted via ProHEDIS, act as a practice liaison for shared savings practices with regard to HEDIS inquiries, as well as work as clinical abstractor during HEDIS season. It was and will remain very rewarding to positively affect the care of our members with better outcomes through quality improvement measures! Show less

  • Clinical Case Manager

    May 2019 - Oct 2019

  • Project Manager Quality Improvement

    May 2018 - May 2019

  • HEDIS Coordinator

    May 2016 - May 2018
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  Allegheny Health Network

  Oct 2019 - May 2022

  Pay For Value Practice Specialist

  I worked to support several practices in regards to all-payor Pay for Value programs including Highmark, Aetna, United, Gateway, etc. I worked to share program updates with each site supported. I provided insight for improvement in all 3 arenas essential to success working these programs including quality, cost and utilization. I provided support ensuring AHN initiatives relating to quality, cost, and utilization were disseminated to my sites and that supports were provided as needed for successful implementation. I also performed Medicare Shared Savings program chart reviews in this role as well as worked with suspected conditions and hierarchial condition category documentation and assisted with strategy for MSSP success. My favorite part of this job was the opportunity I had to mentor teammates and new hires. I was also responsible for organizing new hire orientation. I also supported local advisory councils which were physician led to organize meaningful progress and change within our organization. I believe great quality is the basis of great care!! Show less

• 

  Highmark Inc.

  May 2022 - now

  I worked to support our Gold Card Program efforts here at Highmark, working as the Gold Card program manager for Pennsylvania, Delaware, and West Virginia. I was proud to be part of the team to expand this effort to fold in New York as well! I have lead efforts to kick off our anchor partner pilots, initiate auditing across 3 arenas for the program, expand our 2023 program, increase and define KPI’s, and so much more. This is such a great effort to benefit patients and providers, and I was grateful to be involved! Show less

  • Medicare Advantage Quality Consultant

    Apr 2024 - now

  • Clinical Services Engagement Manager

    May 2022 - Apr 2024