• Responsible for the successful completion of assigned contract deliverables accordingto each IRO contract requirement• Developed and monitored timelines and work-plans relevant to assigned tasks• Input data accurately and timely into the designed MPRO IRO system and department data base for each IRO contract• Managed and processed incoming and outgoing IRO Case Reviews, third party independent medical, clinical, coverage, and utilization review• Adhered to all relevant compliance regulations (HIPAA, FISMA, URAC, CMS)• Member of Diversity, Equity, and Inclusion Committee

• Remote retrieval, review and abstraction of medical record data required for HEDIS quality measures• Athena/Cerner/NextGen/Epic/Practice Velocity/Practice Fusion/AllScripts/eClinicalWorks

• Interacted telephonically and face-to-face with patients, families and healthcare providers to achieve optimum health outcomes and disease management for patients with complex, comorbid conditions utilizing evidence based practice and motivational interviewing• Provided disease, medication, and utilization management education to foster maximum health efficacy• Navigated social determinants of health to overcome barriers for patients’ long term psychosocial benefit• Interfaced with Congestive Heart Failure patients, families and their healthcare providers to ensure appropriate level of discharge status, conducted post discharge follow up phone calls to deliver patient education to minimize further exacerbations and readmissions• COVID-19 Hotline nurse response team• Co-chaired Evidence Based Nursing Research Practice Council

• Launched new quality improvement program for HEDIS, STARS, NCQA accreditation and quality improvement initiatives for Arkansas, Mississippi, and Tennessee Medicare Advantage product• Achieved 100% accuracy of NCQA medical record review audit• Managed project activities from original concept through implementation, completion and ongoing project maintenance• Wrote Corrective Action and Performance Improvement Plans for CMS for case and utilization management

• Ground up project management build of new product line for rural interventional pain management• Interfaced with Electronic Medical Record (EMR) vendor to ensure accurate clinical application and support• Trained medical, clinical and financial teams on pain management program, EMR and billing practices• Regional Vice President for two multispecialty Ambulatory Surgical Centers, led to AAAHC certification

• Directed >250 national/international clinical utilization review staff in call center/telework environment• Maintained strong relationships and communication with sales team and client key stakeholders• Increased clinical accuracy from 31% to 90%, decreased voluntary attrition by 12%• Managed $3M budget

• Implemented project plan and cross project dependencies throughout the project life cycle for new Tennessee Medicaid CHOICES Long Term Care Home and Community Based Services product line• Weekly interactions with TennCare leadership to ensure product design met contract specifications• Created and deployed staffing plan for >200 multidisciplinary care management and call center staff • Directed $1.6M budget

• HEDIS medical record review abstractor, retriever and overreader• Clinical research coordinator for three major hospitals in Centers for Disease Control and Prevention (CDC) influenza epidemic and Intensive Care Unit (ICU) delirium studies

• Designed, implemented, and maintained cardiac, diabetes, back pain, and Medicare Advantage suite of disease management software products, in Agile environment, delivered to >2M national participants• Consulted with internal developers and external health plan customers to ensure sound clinical, financial, and client outcomes

• Established start-up and implementation of new telemedicine home health business line at multiple sites, ensured highest levels of clinical compliance and financial success• Developed and facilitated multidisciplinary staff development, training, and core competencies

CLINICAL QUALITY AND RESEARCH COORDINATOR (2002 - 2005)• Established clinical research program assuring compliance with regulatory processes and good clinical practices, opened three major studies in 18 months-to include IRB submissions• Developed, delivered, and maintained medical and clinical staff training curricula• Attained Society of Clinical Research Associates (SoCRA) international credentials as Certified Clinical Research Associate (CCRP)• Created disease management programs for heart failure and stroke to realize positive patient and financial outcomes, decreasing heart failure 30-day readmission rate by 33%• Led teams to achieve The Joint Commission (TJC) disease specific certifications for Diabetes and Heart Failure, active member of team responsible for TJC Primary Stroke Center designation• Initiated and managed CRUSADE National Quality Improvement program• Served on organization’s Cancer Committee and Tumor BoardsCARDIAC AND PULMONARY REHAB RN (2000 - 2002)• Assessed and monitored cardiac, pulmonary, and diabetes patients in out patient rehabilitative exercise programs• Achieved board certification as Cardiovascular Registered Nurse by American Nurses Credentialing Center