Mamie W
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Population Health Specialist- Case Manager
Spring, Texas, United States
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Résumé
Jobs
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Manager, Utilization ReviewCentene CorporationMar 2022 - Jul 2023 (1 year 5 months)• Managed a team of 48 clinical staff to ensure adherence to regulations and the achievement of goals. • Improved staffing productivity through one-on-one coaching, monthly auditing of clinical records, & standardization of job aides and workflows. • Worked cross functional to stand up North Carolina Medicaid program and team.- Sr. Manager, Case ManagementCommunity Health ChoiceDec 2014 - Aug 2021 (6 years 9 months)Direct a team of 17+ case managers in ensuring alignment with overarching strategies, programs, policies, and procedures. Provide expertise in Complex Case management for cross-functional teams and physician advisors. Oversee team development, hiring, training, coaching, and performance management for direct reports. Coordinate monthly process improvement, quality assurance, and compliance meetings. Support case managers effectively managing caseloads, interpreting regulations, operational procedures, objectives, and policies to maintain compliance with organizational standards. Key Accomplishments: • Established a Complex Case management Program, achieving departmental goals of decreasing ED visits and reduction of 30-day hospitalization,
- UClinical Documentation SpecialistUniversity Health SystemsFeb 2014 - Dec 2014 (11 months)Provided clinical documentation for review of cases, including medical records, assigning appropriate ICD-9 diagnosis and procedure codes, as well as ensuring effective coding and billing procedures. Key Accomplishment: • Performed medical record review using EPIC during inpatient stay, capturing risk-based diagnoses, submitting to code to submit billing and prevent delay in filing claims.
- Utilization Review SupervisorUnitedHealth GroupJul 2013 - Jan 2014 (7 months)Developed remote and in-office and remote teams to ensure achievement of production and quality standards. Leveraged Microsoft Office Suite, WebEx conferences, and Care One, among others in documentation, analysis, and review. Key Accomplishment: • Managed a team of 22 clinical staff to ensure adherence to regulations and achievement of goals. • Performed one-on-one coaching and annual performance evaluations.
- Nurse AuditorPerformant Financial CorporationMay 2012 - Jul 2013 (1 year 3 months)Conducted audits of medical records for inpatient medical records to identify incorrect payments made by Medicare to acute care facilities. Summarized findings in EMR and submit notifications to providers; utilized InterQual, True Code, and Microsoft Office.
- GAdministrator/ Director of Clinical OperationsGrace Independent Home Care, Inc.Jan 2002 - Dec 2011 (10 years)Owned and operated a Medicare/Medicaid Certified Home health agency, providing skilled and non-skilled nursing care in a home setting. Led operations in Medicare/Medicaid, and LTS certified home care agency with up to 300 patients. Managed cases and utilization review of services provided. Conducted billing for primary home care, family care, and community based alternative care. Key Accomplishment: • Established an agency with $20K and achieved gross sales of $1.5M in three years; operational for 10 years. • Established training programs for Oasis-C, Coding, disease management, and motivational interviewing. Show less
Education
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- AAmerican Board of Managed Care Nursing — Certification, Managed Care NursingAmerican Board of Managed Care NursingJan 2019 - Dec 2022 (4 years)
- Chamberlain University — Masters of Science, NursingChamberlain UniversityJan 2019 - Dec 2021 (3 years)
- CCase Management Society of America — Case Management Certification, Certfied Case ManagerCase Management Society of AmericaJan 2017 - Dec 2021 (5 years)
- Chamberlain University — Bachelor of Science - BS, Registered Nursing/Registered Nurse, 3.8Chamberlain UniversityJan 2015 - Dec 2017 (3 years)
- Northwestern State University — Associate Degree, Registered Nursing/Registered NurseNorthwestern State UniversityJan 1992 - Dec 1994 (3 years)