Maura Cappiello Email & Phone Number

United States

Operations leader for program with revenue of over $34 million annually and over 150 domestic and global clinical FTEs supporting utilization management and case management activities for maternity and NICU members to achieve operational and quality excellence for multiple lines of business including Medicaid, commercial, and external payer.Collaborative end to end work with cross functional teams and matrix partners including product, business analytics, client management, quality, legal and finance to develop and execute operational quality and excellence while balancing patient and client satisfaction, operational efficiencies, and medical cost savings.Responsible for ongoing operational and quality metrics, KPIs, execution of objectives including targeted affordability savings, NPS for patient and client satisfaction, and all regulatory, licensing, compliance and audit standards

Responsible for delivery of utilization management and case management services to ensure that critical quality metrics and customer expectations were achieved for high-risk maternity and NICU case management programs.Ensured appropriate staffing plan, supported recruitment and hiring of staff, direct reporting responsibility for 5 ClinicalTeam Managers and 80 field based Nurse Case Managers.Managed and mentored clinical teams to meet quality and operational standards, critical metrics and best practices.Participated in client audits and accreditation surveys including URAC and NCQA; supported customer satisfaction and fostered client relationships.

Served as clinical liaison to IT/ Development team for NICU computer system; functioned as system super-userAchieved ANCC Accreditation as a provider of continuing nursing education for the organization.Developed and provided orientation training, executed quality initiatives to support URAC and NCQA requirements, and provided continuing education to ensure enhancement of skills for clinical staff.Identified quality issues, developed training programs and corrective strategies to address real and potential defects.

Provided onsite and telephonic Utilization Management and Case Management reviews for neonatal patients to contracted clients.

New Brusnwick, Nj

Provided family-centered care for neonates in a Level III NICU.

East Brunswick, Nj

Supervised staff nurses in the home environment to ensure quality and appropriateness of services to pediatric patients inthe home setting.Interviewed hired, and evaluated staff nurses; served as clinical resource for staff.

Houston, Texas Area

Provided family centered clinical care for neonates in Level III NICU.

Bachelor Of Science In Nursing, Registered Nursing/Registered Nurse

Master Of Science In Nursing, Healthcare Administration