Ashley Burton
Jamestown,KY
Summary
- 4+ years management and leadership experience
- 11+ years of patient care management experience
- Highly competent in clinical and quality review
- 13+ years of nurse managment experience
- Knowledgeable with NCQA accreditation practices
- Strong leader who effectively inspires and motivates others, directs projects, and collaborates with business partners
- Effective interpersonal communication, data interpretation, educational training and presentation
- Personal management and development
Overview
12
12
years of professional experience
Work History
Population Health Manager, RN
Sanitas Medical Centers
Tennessee, TN
08.2022 - Current
- Management of population health care teams including community health workers, nurse care coordinators, nurse case managers, and care educators/coaches
- Work directly with the Sanitas Tennessee Chief Medical Director to provide timely reports for performance objectives and develop strategies for goals.
- Leadership team committee for operational and clinical quality compliance
- Contractual quality metrics interpretation, review, performance analysis, and auditing for required criteria and compliance and health data analysis
- Project management liaison, leadership, and strategy methodology
- Identify and assist with review of policies relative to population health outcomes and employee requirements
- Collaborator and strategist for implementation of population health platform projects and initiatives
- Business partner collaboration for quality metrics review, reporting, staff education including multiple lines of business including Medicaid, Medicare, Dual-Eligible, Commercial pediatric and adult populations.
- Executed additional pharmacy support program for patients with chronic health conditions, to address poly-pharmacy needs, and enabled pharmacist EMR accessibility
- Medicaid- Community Health Workers Infrastructure Grant in association with the a CHW healthcare model and platform to improve health inequities, enhanced population health platform for patient care review, care management, referrals, reporting and EMR integration
- TNCHW Accreditation Processes and Implementation
- NCQA Accreditation support panel for patient centered medical home
- Multidisciplinary team review for patient care coordination to include high complexity with multiple risk factors, chronic disease management, and social determinants of health inequities for improved health outcomes for patients
- Review and monitor key performance indicators for multiple teams and processes
- Management duties: Leadership, hiring and training staff, conduct meetings with care team, clinical and operational staff to provide education, supervision, feedback, coaching, set goals, conduct performance reviews to improve quality standards
- Develop, analyze and interpret reports related to team projects, goals, and metrics.
- Provided technical expertise when designing studies related to population health management initiatives.
Lead Care Coordinator, RN
Sanitas Medical Center
Murfreesboro, TN
09.2021 - 08.2022
- Duties: Leadership, assist with interviews for hiring staff, provide training, mentoring, conducted meetings with care team, clinical and operational staff to provide education, feedback, coaching, review goals, prepare care team reports, to maintain or improve quality standards
- Worked directly with the Sanitas Tennessee Chief Medical Director to provide timely reports for performance objectives and develop strategies for goals.
- Liaison of company and business care management partners for TN clinics
- Created and maintained staff work schedules
- Care Coordination program review and improvement, monitored for deficits, and strategized improvement methods
- Monitored and interpreted patient quality improvement initiatives for TN population
- Reviewed data sets and interpreted quality metrics for patient care and educational opportunities to staff for TN clinics
- Monitored patient complexities, chronicity, and prioritized population for care team management
- NCQA support panel for patient centered medical home accreditation.
Care Coordinator, RN
Sanitas Medical Center
11.2020 - 09.2021
- Opening and start-up of Sanitas Medical Centers in Tennessee
- Case management of diverse patient population
- Developed and coordinated health care programs
- Clinical support liaison with company, business partner, and patients
- Developed care plans for care management of designated patient population
- Supported clinical staff with quality metrics interpretation
- Participated in NCQA-PCMH daily huddles and clinical monthly meetings to support multidisciplinary approach for patient care
- Reviewed patient panel and determine priorities for engagement based on risk levels, chronicity, and health needs
- Patient engagement to set patient goals, determined barriers, nursing diagnosis, social inequities and monitor progress
- Transitions of care coordination for patients that are high utilization of hospital visits
- Referral coordination for DME, home health, or specialist needs
- Promoted clinical staff engagement and coordination of patient care needs.
RN/Waiver Coordinator
Lake Cumberland Area Development District
Russell Springs, KY, KY
07.2018 - 10.2020
- RN/Medicaid Waiver & Eligibility Coordinator/Veteran-Directed Services
- Immediate Supervisor for Case Managers/Service Advisors that provide case management to individuals receiving waiver services through LCAAAIL
- Medical Advisory/Committee and Board member of the Lake Area Foundation where resources and funding are established to help the Lake Cumberland communities, covering a ten-county area
- Project planning for funds and grants to positively impact communities by the Lake Area Foundation, including educational grants, community memorials, women’s health, and safety services
- Screened applicants from Medicaid waiver intake to determine the best possible direction for in home services to prevent individuals' from entering a skilled nursing facility
- Educated the participant, family members, or caregivers to understand permissible services within their home and communities, as well as their individual rights, responsibilities, and expectations of the Medicaid Waiver program, along with potential patient liabilities and estate recovery requirements
- Ensured program integrity by assisting the Case Managers
- Evaluated eligibility, liability, and appropriate billing of each participant through Kentucky Medicaid Management Information System (KYMMIS)
- Utilized Medicaid Waiver Management Applications (MWMA) system to coordinate care with Medicaid and the Department of Community Based Services, other service providers, then review and approve plans of care for the participants' who receive waiver services
- Created and maintained accurate records of departmental activities, including budgets, personnel documents and project timelines for compliance
RN/Veteran Directed Care Coordinator
Lake Cumberland Area Development District
Russell Springs, KY, KY
07.2018 - 10.2020
- As the Veteran-Directed Home and Community Based Service (VD-HCBS) Coordinator, I provided monthly coordinated care and case management services to veterans' who reside in the Upper Cumberland area of Tennessee and Kentucky through the Nashville Veteran Administration
- Completed annual and six month Mental/Emotional/Behavioral Health Assessment (MEBH) of the veterans, annual Veteran Satisfaction Surveys
- Assist with the completion of employee training, resource management, and criminal record checks for all employees
- Developed care plans for services to be provided by the employee in the veteran's home
- Conducted annual and pro-rated budget spending plans for each veteran to submit to Nashville VA for final approval
- Submitted quarterly reports to Nashville VA regarding hospitalizations, care needs, and the health, safety, and welfare of each veteran
- Conducted quarterly in-home visits, more frequently if required, to ensure that the VD- HCBS services were being provided adequately and to the satisfaction of the veteran and family members
- Collaborated with the VD-HCBS Coordinator of the Nashville VA to direct in-home care services to veterans, who might otherwise be admitted in a skilled nursing facility
- Reviewed and submitted bi- weekly timesheets of the veteran's employee(s) to the finance department
- Developed and maintained quality care systems and standards, including creating and improving protocols and guidelines
- Worked with management to identify and implement initiatives to increase staff retention, morale, and satisfaction
- Monitored participant admission and discharge processes
- Communicated with primary care physicians or providers to relay participant needs.
RN/Participant Directed Service Advisor
PDS
Russell Springs, KY
01.2012 - 07.2018
- As a case manager, I provided assistance to individuals who qualify for Medicaid waiver programs
- RN review and approval of MAP 351 Waiver Assessments for accuracy and completion, prior to submitting to a Division of Medicaid, for final approval, and prior authorization for waiver services for the case management team.
- Evaluated each client's individual needs, writing a personalized care with Medicaid approval, educated the client or caregiver of eligible services, and directed services to meet each individual's needs to offset long-term care placement
- Medicaid Waivers experience include Home and Community Based, Michelle P, and Acquired Brain Injury-LTC waivers of all age groups
- Worked closely with Medicaid and evaluated waiver assessments to ensure that they met criteria by providing approval for Medicaid to issue prior authorizations for services
- Consulted with client's and their families monthly to determine that approved services are being rendered as outlined on the client's plan of care, and assist clients with obtaining DME and medical supplies
- Maintained each client's records and closely monitored the PDS employees that render services to each client
- Kept records and approved the client’s employee services through timesheets and service documentation
- Coordinated a range of care and services which required teamwork, client education and training, good written and verbal communication skills, critical thinking skills, and the ability to relate to individuals of diverse circumstances and culture.
Education
Associates in Applied Science-Nursing -
Somerset Community College
05.2011
Associate of Applied Arts: Education -
Somerset Community College
05.2009
Skills
- Population Health Management
- Product, Strategy and Project Planning
- Program and Performance Management
- Multidisciplinary team management
- HEDIS/Star Ratings in accordance with CMS
- Mentoring, coaching and leadership
- Conflict resolution
- Data analysis and reporting
- Policy, Planning and Development
- Workflow Development
- Community and business partnerships
- Health Equity
- Proficient in Microsoft Office and Google Software
- Care Management for patients with multiple complexities
Accomplishments
- Development and implementation of Community Health Worker Medicaid grant funding and platform to meet population needs related to social determinants of health
- Integrated and employed pharmacy home delivery services for patient population and direct pharmacy relationships with clinical staff
- Incorporated, strategized and assisted to improve processes for newly designed population health platform
References
Chara Hoover
Risk and Compliance Manager
Sanitas Medical Centers of Tennessee
209-585-8914
choover@mysanitas.com
_____________________________
Kristi Holloway
Lead Clinical Nurse
Sanitas Medical Centers of Tennessee
606-273-4321
kholloway@mysanitas.com
______________________________
Latisha Cucic
PDS Coordinator
Lake Cumberland Area Development District
270-585-7538
tisha@lcadd.org
Timeline
Population Health Manager, RN
Sanitas Medical Centers
08.2022 - Current
Lead Care Coordinator, RN
Sanitas Medical Center
09.2021 - 08.2022
Care Coordinator, RN
Sanitas Medical Center
11.2020 - 09.2021
RN/Waiver Coordinator
Lake Cumberland Area Development District
07.2018 - 10.2020
RN/Veteran Directed Care Coordinator
Lake Cumberland Area Development District
07.2018 - 10.2020
RN/Participant Directed Service Advisor
PDS
01.2012 - 07.2018
Associates in Applied Science-Nursing -
Somerset Community College
Associate of Applied Arts: Education -
Somerset Community College
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