Cheryl Thompson
Gardena,CA
Summary
Dynamic Clinical Claim Review Manager with over 13 years at Optum Health, excelling in team leadership and operations management. Enhanced claim department satisfaction through effective conflict resolution and process improvements, achieving timely regulatory compliance. Proven track record in staff training and development, driving high-quality service delivery and cost savings.
Knowledgeable Case Management leader with solid history of managing teams with financial insight and driving operational success. Skilled in implementing strategic initiatives that enhance productivity and efficiency. Demonstrated ability in problem-solving and decision-making.
Overview
25
25
years of professional experience
Work History
Clinical Claim Review Manager
Optum Health
04.2012 - Current
- Managed and motivated employees to be productive and engaged in work by implementing process improvement work flows.
- Accomplished multiple tasks within established timeframes meeting regulatory requirements for the team.
- Created standardized end to end process flows for improving routine audit outcomes.
- Created and drafted various policy and procedure and standard operating procedure documents
- Collaborated and maintained productive relationships with Utilization Management and Financial departments
- Enhanced claim department satisfaction by resolving health plan disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery and cost savings.
- Lead a team of 20+ employees for the past 13years.
Clinical Case Manager
Health Care Partners
04.2007 - 01.2012
- Enhanced care coordination for patients with complex medical needs through effective communication and collaboration with multidisciplinary teams.
- Reduced hospital readmission rates by conducting thorough patient assessments ensuring each level of care was appropriate for the patients condition and care required,
- Providing patient education on available resources,and patient rights, within the healthcare system.
- Improved patient outcomes by developing and implementing comprehensive case management plans in post hospital stay.
- Initiated patient transfers to higher level of care when appropriate for various patient requirements/health condition needs.
- Conducted patient and family meetings to assist with multi-specialist discussions and care planning discussion.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
Telephonic Nurse Case Manager
Lavida Medical Group
02.2006 - 04.2007
- Collected and inputted case data in managed care system and timely and accurately generated required correspondence and review notification for management.
- Provided resources and referrals for patients seeking additional support services, such as mental health counseling or nutrition counseling.
- Presented case management findings at interdisciplinary team meetings, contributing valuable insights for improved patient care strategies.
VA Primary Care Office Nurse Supervisor
Spectrum Health Care
08.2003 - 02.2006
- Assessed health status of patients by eliciting health histories, conducting physical assessments, and analyzing data to formulate plans of care.
- Resupplied offices and examination rooms, labeled drawers and ordered new stock.
- Called patients to share lab results and discuss physician orders.
- Managed the back office area, performing EKG's, patient injections, and phlebotomy services
- Worked closely with lead Physician
LVN Charge Nurse
Providence Little Company of Mary Hospital
01.2000 - 09.2003
- Documented patient vitals, behaviors, and conditions to communicate concerns to supervising nurse.
- Oversaw patient conditions, administered medicine, performed interventions and took detailed records.
- Promoted continuity of care by maintaining comprehensive medical records and updating physicians on significant changes in patients'' conditions.
- Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
Education
High School Diploma -
Palisades High
Pacific Palisades, CAVN Nursing - Vocational Nursing
American Career College
CA01-1999
Skills
- Customer service
- Team leadership
- Time management
- Decision-making
- Verbal and written communication
- Staff management
- Staff training and development
- Complex Problem-solving
Timeline
Clinical Claim Review Manager
Optum Health
04.2012 - Current
Clinical Case Manager
Health Care Partners
04.2007 - 01.2012
Telephonic Nurse Case Manager
Lavida Medical Group
02.2006 - 04.2007
VA Primary Care Office Nurse Supervisor
Spectrum Health Care
08.2003 - 02.2006
LVN Charge Nurse
Providence Little Company of Mary Hospital
01.2000 - 09.2003
High School Diploma -
Palisades High
VN Nursing - Vocational Nursing
American Career College