Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Cindy Gardner

Zuni,VA

Summary

Personable and knowledgeable BSN/RN/CCM Leader in Hospital and Managed Care Organization focusing on LTSS population. Interested in roles that offer opportunities to continue to grow as an effective leader in the managed care industry. Excellent critical thinking and decision-making skills in health care systems. Experienced social and clinical work with a variety of Waivered/Non-waivered members including children, elderly, and disabled individuals.

Overview

23
23
years of professional experience
1
1
Certification

Work History

LTSS Manager, Clinical Services

Molina Healthcare
01.2021 - 07.2025
  • Supervise day-to-day activities of the LTSS Care Management team. Supervise 15+ direct reports which includes time card management, performance reviews, monthly 1:1 coaching and advisement, etc.
  • Lead High Risk CM’s with PDN/Tech members.
  • Responsible for hiring new staff and ensuring proper orientation/onboarding.
  • Ensure quality outcomes ie: LTSS SAI savings, reduction in ED/inpatient admissions, and other cost effectiveness. Utilize data to track, trend, and report productivity and timely completion of contractual requirements. Collaboration with UM Department to manage appropriate member utilization.
  • Perform ongoing quality reviews to ensure accuracy and compliance.
  • Responsible for monitoring waiver eligibility, portal updates for level of care, training waiver specialists, monthly reporting and auditing.
  • Participate in resolutions of DMAS escalations and prepare responses for state regulator. Escalate issues to leadership proactively.
  • Participate in State Fair Hearings and LOCERI Appeals.
  • Review, develop, modify P&Ps/SOPs/Workflows.
  • Participated in a system/company migration and RFP procurement.
  • Knowledgeable in various platforms: Kronos, PEGA, Clinical Care Advance, Care Advance, mCare, Optum iPro, Evolve, Salesforce 360, QNXT, Docusign, TCare, Healthwise, Agent Workspace, ZOOM, Microsoft Teams/Excel/Word/Outlook, WebEx, Concur, PointClickCare, DMAS MES Portal

LTSS Lead Care Coordinator

Molina Healthcare
01.2019 - 01.2021
  • Participate in preparing NCQA audit and DMAS table audit.
  • Assisting manager in leading team of care coordinators, conducting interviews, monthly 1:1’s, education, mentoring.
  • Act as a resource for CC’s, assist with issues related to assessments, members, authorizations, complaints and any other situation they may have question or needs for daily.
  • Conflict resolution
  • Implementation and monitoring of multiple grids to measure accountability and ensure contractual guidelines are met and following up with staff daily
  • Maintaining caseload(s) in addition to lead role due to staffing shortages.
  • Management of Medicaid enrollees care to include assessments and developing plan of care to those in the community, nursing facilities, ALF, and telephonic members.
  • Mentor/Preceptor to new Care Coordinators.
  • Acts as point of contact between members Interdisciplinary Care Team to ensure member is getting quality care to assist individual needs.
  • Identifies gaps in care and/or barriers and assist as needed.
  • Collaborates with community service boards, home health agencies, service facilitators, DME companies to ensure member’s needs are met.
  • Works closely with Transition Coordinator for member’s with hospitalizations, change in eligibility, location to prevent gaps in care and provide education to improve outcomes.

Senior Care Coordinator

Magellan Health
01.2017 - 01.2019

Registered Nurse Clin II/Stepdown/Telemetry

Sentara Obici Hospital
01.2008 - 01.2017
  • Highly skilled career professional with 10 years of direct bedside patient care experience.
  • Over ten years of multifaceted practical hospital experience.
  • Established in Stepdown/Telemetry patient support including assessment, counseling, education regarding medications and treatment, lab work, documentation with care plan for diagnosis, and administration of treatment procedures.
  • Act as charge nurse of maintaining a 24 bed unit while directing patient care and delegation to RN’s, LPN’s, PCA’s.
  • Preceptor to new nurses/students to unit.
  • Computer skills, managing heavy daily patient volume including EMAR, Hyperspace, OmniCell programs. Proficient in all documentation/record maintenance/paperwork to ensure accuracy and patient confidentiality.
  • Act as change agent for implementation of new computer system in 2009 and continuous corresponding upgrades.
  • Complete post-procedural surgical care in hospital environment.
  • Communicating with other health care professionals including but not limited to physicians, therapy departments, radiological staff, and laboratory services.

Nurse Tech/Telemetry

Sentara Obici Hospital
01.2007 - 01.2008

Administrative Assistant

Sentara Obici Hospital
01.2003 - 01.2006

Education

Bachelors - Nursing

Chamberlain University

Associate - Nursing

Paul D Camp Community College
Franklin, Virginia

Skills

  • Customer service
  • Team leadership
  • Time management
  • Decision-making
  • Staff training and development
  • Task delegation
  • Documentation and reporting
  • Conflict resolution
  • Clear communication
  • Change management
  • Regulatory compliance

Certification

  • Board Examination 2008
  • Current RN License, State of Virginia 2008
  • CCM, Certified Case Management 2020

Timeline

LTSS Manager, Clinical Services

Molina Healthcare
01.2021 - 07.2025

LTSS Lead Care Coordinator

Molina Healthcare
01.2019 - 01.2021

Senior Care Coordinator

Magellan Health
01.2017 - 01.2019

Registered Nurse Clin II/Stepdown/Telemetry

Sentara Obici Hospital
01.2008 - 01.2017

Nurse Tech/Telemetry

Sentara Obici Hospital
01.2007 - 01.2008

Administrative Assistant

Sentara Obici Hospital
01.2003 - 01.2006

Bachelors - Nursing

Chamberlain University

Associate - Nursing

Paul D Camp Community College

Similar Profiles

CREATE PROFILE
Cindy Gardner