Kristy Ritch Email & Phone Number

Serve as single point of contact, managing an assigned book of business, covering multiple industries and client locationsDevelop client trust and confidence to nurture the partnershipsPartner with Sales Team and actively participate in sales presentations to bring in new businessOnboard new clients and guide them through the TPA/Client partnership process by identifying their needs, creating service instructions specific to their stipulation, creating meaningful Xcel reports to track and trend results, providing training on products, cross-selling products that would enhance their program, reviewing and identifying gaps in service via Key Performance Indicators and collaborating across department lines to initiate corrective action plansTeam up with the financial analyst to review market trends, draft Cost & Terms within Sales Force to reflect percentage increases, and negotiate contract renewals with clients by balancing company financial needs with competitor ratesDemonstrate effective project management skills by managing and conveying deliverables to others as neededObtain data through internal tools and manipulate to identify trends and meaningful information for clients Execute and presents analysis results proficiently to clients, carriers, brokers, and executivesOrganize and lead effective group meetings, including: Claims reviews, Stewardships, and Partnerships Proficient in Excel, PowerPoint, and Sales Force Deliver all messages (written or verbally) in a concise, logical manner with focus on insights and decisions/action Prioritize work effectively within fast moving, challenging role

Orlando, Florida, United States

Serve as single point of contact, managing an assigned book of business, covering multiple industries and client locationsDevelop client trust and confidence to nurture the partnershipsPartner with Sales Team and actively participate in sales presentations to bring in new businessOnboard new clients and guide them through the TPA/Client partnership process by identifying their needs, creating service instructions specific to their stipulation, creating meaningful Xcel reports to track and trend results, providing training on products, cross-selling products that would enhance their program, reviewing and identifying gaps in service via Key Performance Indicators and collaborating across department lines to initiate corrective action plansTeam up with the financial analyst to review market trends, draft Cost & Terms within Sales Force to reflect percentage increases, and negotiate contract renewals with clients by balancing company financial needs with competitor ratesDemonstrate effective project management skills by managing and conveying deliverables to others as neededObtain data through internal tools and manipulate to identify trends and meaningful information for clients Execute and presents analysis results proficiently to clients, carriers, brokers, and executivesOrganize and lead effective group meetings, including: Claims reviews, Stewardships, and Partnerships Proficient in Excel, PowerPoint, and Sales Force Deliver all messages (written or verbally) in a concise, logical manner with focus on insights and decisions/action Prioritize work effectively within fast moving, challenging role

Jupiter, Florida, United States

Oversee the medical management of G4S Workers Compensation claims on a National level, identifying financial and safety risksDeveloped and streamlined a cost saving program involving third party provider case management services to manage financial risk through planning and problem solving; Tracked and trended data to support the initiative, created goals, and monitored progress; Created Xcel spreadsheets and continually monitored and reported the 1.5-2.5M annual cost savings associated with the endeavorUtilize extensive cross collaboration between claimants, employers, field offices, third party administrators, medical providers, attorneys and assigned telephonic/field case managers to drive appropriateness of medical care, mitigate claim expense and push claim to closureCoordinate and communicate with adjusters, legal counsel, risk & claims analysts, providers, and claimants to facilitate optimal care and treatment and help posture claims for settlementEvaluate internal and external processes, compare to relevant standards and identify gaps in compliance and performanceConduct Third Party Administrator (TPA) claim audits based on client service instructions (SI) Help TPA adjusters determine the appropriateness of ordered medical interventions based on current medical based evidence and standards of care Triage new claims for medical and third-party needsAuthorize and monitor the TPA’s appropriate use of nurse case managersWork closely with Risk Management and Safety VPs to help identify injury trends and safety risks of the organization Partnered with claim analysts and TPA resolution managers to increase indemnity and medical claim savings by 67% from 2019 to 2020 with aggressive utilization of ReEmployability’s Return to Work Program. Estimated year over year savings of $159,606.Decreased overall claim expenditures by decreasing claimant attorney representation by 57% within first six months of service

Tampa/St. Petersburg, Florida Area

Manage, direct and guide a team of practice performance consultants on clinical qualityimprovements and management programsSet team direction related to provider compliance in assigned marketsConduct clinical quality audits on contracted/PAR providers Responsible for the reporting and analysis of member care quality and the development of plans and programs to support continuous quality improvements using NCQA/HEDIS/CAHPS/Member satisfaction specificationsAdapt departmental plans and priorities to address business and operational challengesInfluence and provide input to forecasting and planning activitiesReview processes and performance against customer expectations to provide needed informationor serviceEvaluate current processes, compare to relevant standards and identify gaps in compliance or performanceManage meetings (e.g. schedule, present, facilitate)Track timeframes/deadlines and collect data within required timeframesIdentify, prioritize, and proactively communicate potential barrier or risks to key stakeholdersEducate, motivate and influence others (e.g. leadership and other stakeholders) to overcomebarriers and maintain line of sight to achievement of objectivesInterview, hire and onboard new professional staffDevelop educational materialsTrain others on relevant policies, rules and regulations (e.g. appropriate release of data, handlingprotected health information)Serve as a Subject Matter Expert for HEDIS related activities

Tampa/St. Petersburg, Florida Area

Manage Commercial and Medicare HEDIS projects based on rating forecasts and NCQA guidelinesRun multiple queries and management reports for excel export and managementPerform HEDIS measure abstraction/Over-reads Create collaborative provider/client relationships via outreach and relationship building techniques to support the “Provider Escalation” processOversee Vendor responsibilities at the project/market levelIdentify opportunities for Rate Maximization to achieve optimal Hybrid rates via data analysis and interpretation pulled from multiple applicationsScreen resume’s and conduct interviews for seasonal temporary staff hiringAct as a clinical consultant and manage temporary administrative/clinical staff hired to support productionPerform Beta testing on upgraded systems

United Healthcare

Act as a preceptor for Expansion Team new hires which consists of auditing, tracking and trending quality issues, providing constructive feedback, and educatingSelected and actively participating in the United Health Group mentoring iNspire programCreate educational tutorials and matrix’s for the Orlando Market Team to reinforce Standard Operational ProceduresDeveloped “Inpatient Case Manager Best Practices” utilized by the Orlando Market ManagerTeam captain for the American Heart Association 2012 heart walkVolunteered as project manager of the “Platform Modification Team” 2013Manage an assigned patient case load as a telephonic Utilization Review Nurse for Medicare, Medicaid, and Commercial members while maintaining compliance with contract and regulatory requirementsConduct telephonic and electronic medical record (EMR) utilization reviews for acute care settings including complex cases, such as: trauma, surgical, organ transplants, oncology, complex wounds, and high risk cases with multiple comorbiditiesUtilize MCG to monitor clinical progress established by evidence based medicine of members’ hospitalization to align with market and management goals Ensure accurate billing codes (ICD9/CPT) for claim processing accuracyProactively determine discharge needs and coordinate resources/referralsAct as a liaison between members, family, physicians, and hospital care coordinatorsInterface with Medical Directors, management, nurses, and contacts within other operational areas to address quality improvement needs, process improvement needs, and contribute to improvement projects

Tampa/St. Petersburg, Florida Area

Oversee an assigned patient case load as a telephonic Utilization Review Nurse for Medicare and Medicaid members while maintaining compliance with contract and regulatory requirementsConduct onsite and telephonic utilization reviews for hospital, long term acute care hospital, acute inpatient rehabilitation, and skilled nursing facility settingsUtilize Interqual to guide appropriateness of members hospitalization to align with market and management goals Ensure accurate billing codes (ICD9/CPT) for claim processing accuracyCoordinate members discharge planNegotiate rates as needed for non-par skilled nursing facilities and home health care needsActs as a liaison between members, family, physicians, hospital care coordinators, and insurance providerProvide disease management to members with complex disease processes, including: heart failure, COPD, ESRD, and HIV/AIDS

Polk & Hillsborough Counties, Florida

Manage the quality of care provided by staff within four self-standing assisted living facilities in the Polk and Hillsborough County areasSupervise 25+ nursing staff, including LPN’s and CNA’sAssist the Executive Director of each building with interviews and hiring of new staffSupervise ALF extended licenses and ensured compliance with state guidelinesDevelop and maintain monthly statistical reports on quality of care issuesAnalyze quality of care reports for tracking and trending purposesUtilize the data extracted from statistical reports to formulate educational needs of the staffCreate educational presentations for staff based on the needs of each individual facilityLead education and training for newly hired employees and management Attained deficiency-free bi-annual AHCA surveyAchieved reaccredidation of Extended Congregate Care (ECC) and Limited Nursing Services (LNS) licensure with the American Health Care Association (AHCA)

Winter Haven, Florida

Partnered with Risk Management Department to decrease the number of occupational injuries in the State of FloridaProvide employee first aid, Company physical exams, and medical referralsProcess Florida Medical Leave Act (FMLA) and Workers Compensation claimsAdminister first aid and case management to injured employeesInitiate First Report of Injury documentation and refer injured employees to preferred occupational health injury clinics for medical managementMaintain OSHA injury logs for regulatory compliancePresent health education to employeesDeveloped and led wellness health fairs Perform ergonomic assessments on Florida Zoned employeesConduct Department of Transportation/Commercial Driver License physicals Served as a United Way RepresentativeMember of the National Occupational Health Nurse Association where I attended annual State and National Conferences

Winter Haven, Florida

Pre-op, PACU, Post-op and Admissions with Orthopedic, Obstetric/Gynecology, Podiatry, Ophthalmic, Cosmetics, and Pain Management patients; Labor and DeliveryAssisted with the development of women’s wellness health fairs and participated by teaching self-breast exams, providing eye exams, and blood pressure monitoringTest and maintained medical equipment: Code cart, AEDACLS Certified

Bsn, Nursing, 3.5

Graduated Cum Laude

Associate Of Science (A.S.), Registered Nursing/Registered Nurse

Activities and Societies: Phi Theta Kappa