Connie D. Cruz
Pasadena,CA
Summary
Healthcare professional with extensive experience in patient care and case management. Demonstrated success in program development and community engagement, leading to enhanced operational efficiency. Skilled in analyzing clinical data to implement improvements and advocate for patient needs effectively. Seeking to fill the demand for specialists in Addiction Nursing providing leadership, collaboration, education, support and promoting research and education for the prevention, compassionate intervention and treatment of addiction.
Overview
31
31
years of professional experience
4
4
Certification
Work History
Core Committee Member
Women's all 12-step Annual Retreat
05.2022 - Current
- Developed strategic initiatives to enhance community engagement through collaboration with diverse teams.
- Facilitated meetings to gather input and achieve consensus on key organizational decisions.
- Evaluated programs and policies for alignment with mission and community needs.
- Advocated for underrepresented voices within the committee, promoting inclusivity in decision-making.
- Coordinated outreach efforts to raise awareness of initiatives and available resources.
- Analyzed stakeholder feedback to inform future projects and refine processes.
- Mentored new committee members on procedures and best practices for effective participation.
- Conceptualized and managed activities and events to foster community involvement.
Senior Director Utilization/Enhanced CM
Calibrated healthcare
Ontario, California
06.2024 - 06.2025
- Responsible for UM teams offshore and ECM/Community support teams onshore.
- Stood up the company’s first Extended Care Management program meeting contractual milestones despite resource restraints
- Directed strategic initiatives to enhance operational efficiency within healthcare services.
- Developed comprehensive policies to ensure compliance with healthcare regulations and best practices.
- Developed and implemented strategic plans to maximize organizational efficiency, effectiveness, and profitability.
- Promoted a culture of collaboration among staff members through regular communication, feedback, and recognition.
Per Diem Infusion Nurse – Home health
Navenhealth
04.2024 - 06.2025
- Administered intravenous medications and therapies to patients in home settings.
- Monitored vital signs and communicated changes to healthcare team promptly.
- Educated patients and families on treatment plans and medication management.
- Maintained accurate records using electronic health record systems.
- Provided emotional support to patients throughout treatment processes.
Panel Representative-Elijah's House
Foothill Hospitals & Institutions
05.2022 - 07.2024
- Identified needs of customers promptly and efficiently.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Assisted with customer requests and answered questions to improve satisfaction.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
Clinical Program Manager
Cigna
Pasadena, California
07.2017 - 03.2024
- Reviewed and prioritized business strategies for implementation across Clinical Operations.
- Led clinical program development and implementation initiatives across diverse healthcare settings.
- Ensured synchronization of Hypertension and Pre-Diabetes Programs for seamless service delivery.
- Performed daily account reviews through cross-matrix analysis of information from multiple internal systems.
- Collaborated with external partners to transform health care delivery and ensure best-in-class services.
- Coordinated cross-functional teams to enhance patient care and service delivery strategies.
- Analyzed clinical data to identify trends and inform program improvements at Cigna.
- Managed stakeholder relationships to ensure alignment with organizational goals and objectives.
- Collaborated with external partners to expand service offerings and improve patient outcomes.
Clinical Operations Supervisor
Cigna
Pasadena, California
08.2010 - 07.2017
- Ensured customer satisfaction through top-tier case management service delivery.
- Managed national team of 24 Case Management staff, coaching performance to drive career advancement.
- Participated in accreditation audits with URAC and DMHC as part of leadership team.
- Coached staff to achieve successful outcomes during audit preparations.
- Supported strategic business growth through involvement in confidential projects.
- Collaborated with internal and external partners to enhance operational effectiveness.
- Designed and implemented process efficiencies, achieving ongoing annual savings of $60K.
- Onboarded 15 new case managers in 2015, facilitating smooth integration into roles.
Case manager - Specialty Oncology
Cigna
08.2009 - 09.2010
- Established collaborative relationships with clients, families, and healthcare providers to assess medical histories and determine care options.
- Set short-term and long-term goals, timelines for follow-up, and resources while involving all relevant parties.
- Implemented and monitored ongoing case management plans in coordination with clients and treating providers.
- Conducted comprehensive assessments to manage diverse client populations effectively.
- Developed tailored care plans based on individual client needs and treatment objectives.
- Collaborated with healthcare providers to ensure seamless continuity of care for clients.
- Monitored client progress through regular follow-ups and adjusted care plans for optimal outcomes.
- Advocated for clients' needs within healthcare systems while maintaining accurate electronic health records.
Medical Aesthetic Nurse & CEO
Immaculè Medical Aesthetics
09.2006 - 08.2009
- Responsible for client assessment and administration of injectable treatments for wrinkle reduction, volume enhancement, Mesotherapy, Sclerotherapy, Medical-grade Microdermabrasion with Ultrasound and electrical stimulation, Intense Pulse Light therapy for pigment, hair reduction and acne, Laser resurfacing for acne scars and advanced wrinkles, and Medical-grade skin care.
- Responsible for performing client consultation and full spectrum management of medical aesthetics facility, protocols and clientele.
- Administered aesthetic treatments including injectables and skin rejuvenation procedures.
- Assessed patient needs and developed personalized treatment plans.
- Educated clients on post-treatment care and aesthetics best practices.
- Maintained inventory of medical supplies and ensured compliance with safety standards.
- Monitored patient progress and adjusted treatments as necessary for optimal results.
- Trained new staff on protocols, treatment techniques, and client communication strategies.
- Performed laser vein therapy and laser hair removal procedures.
- Maintained a clean work environment while adhering to safety protocols and OSHA regulations.
- Assessed patient medical history, skin type and aesthetic goals to determine appropriate treatment plans.
- Responded promptly to inquiries from patients via phone calls or emails.
- Educated patients on proper skincare techniques that will enhance their overall appearance.
Quality Assurance Nurse
Great-West Healthcare
08.2006 - 09.2006
- Reviewed patient records for accuracy and completeness in documentation processes.
- Provided training and mentorship to junior nursing staff on quality assurance practices.
- Monitored nursing practices for adherence to established safety procedures and policies.
- Provided guidance, education, and training sessions for nursing staff on quality assurance topics such as infection control, medication management, documentation accuracy.
- Performed regular audits of medical records to ensure accuracy and completeness of documentation.
- Performed periodic audits of patient charts to ensure compliance with relevant laws and regulations.
- Participated in interdisciplinary meetings focused on developing strategies for improving the delivery of safe, high-quality care.
- Performs Case Management staff quality case evaluations and telephone evaluations.
- Track and trend staff performance to ensure regional success and compliance with corporate initiatives.
Director, Knowledge Management
Great-West Healthcare
05.2003 - 08.2006
- Co-manage the Medical Outreach Department, which consists of 19 clinical and 8 non-clinical personnel, as part of the regional leadership team.
- Responsible for the full spectrum of day-to-day management of medical outreach programs.
- Develop regional strategies to meet corporate goals.
- Responsible for training and staff development, including quality evaluations.
- Work in partnership with the Director of Care Management, and co-develop workflows to assure regional compliance with regulatory standards such as URAC, DMHC, and other state and federal mandates.
- Participate in the peer review, quality management, and national committees.
- Participate in hiring, supervising, and counseling staff as needed.
- Work in collaboration with matrix partners to ensure service delivery is consistent with company initiatives and partnerships.
- Directed company-wide strategic initiatives to enhance operational efficiency.
- Managed cross-functional teams to align goals and drive project success.
- Led performance reviews and provided constructive feedback to team members.
- Implemented training programs to develop leadership skills within the organization.
- Recruited, trained, supervised, evaluated and mentored staff members.
- Conducted regular meetings with department heads to review progress on strategic initiatives.
- Developed policies and procedures to ensure compliance with corporate standards.
- Collaborated with senior leadership to set long-term objectives for the company.
Manager, Utilization Management
Great-West Healthcare
07.2002 - 05.2003
- Supervised staff of 8 clinical and 2 non-clinical personnel for Director of Episodic Care Management.
- Conducted audits and managed Joint Operation Meetings for delegated Utilization Management groups in California.
- Revamped audit tool to comply with 2003 NCQA standards and URAC 4.2 standards.
- Developed DOFR Matrix to enhance management of company resources and finances.
- Facilitated utilization of DOFR availability across departments including Provider Relations, Customer Service, and Claims.
- Developed training programs to enhance team skills and performance.
- Implemented process improvements to increase efficiency and reduce costs.
Case Manager
Great-West Healthcare
09.2001 - 07.2002
- Coordinated initial CCMS training with Director of Episodic Case Management.
- Led implementation and integration of CCMS workflows between Service Operations and Medical Management.
- Served as national representative for Clinical Case Management System production support.
- Contributed to Great Beginnings, Hi-Risk Maternity, and Breast Care Programs.
- Nominated for Fanatic Award and President's Award for outstanding contributions.
- Coordinated patient care plans with healthcare providers and community resources.
- Conducted comprehensive assessments to identify client needs and service eligibility.
- Managed case files using electronic health record systems and documentation protocols.
- Advocated for clients' rights and navigated complex healthcare systems effectively.
Case Manager
Network Medical Management - Allied Physicians
06.2000 - 09.2001
- Case Manager for several IPAs averaging 50,000 lives.
- Worked closely with our Medical Director, functioned as the Lead case manager, assisted in selecting oncoming RNs and facilitated new employee training.
- Streamlined systems and documentation tools for the case management department with supporting Policy and Procedures.
- Created a departmental orientation syllabus, as well as a departmental case management reference distributed to all case managers.
Case Manager
Glendale Memorial Hospital and Health Center
09.1997 - 06.2000
- Case Manager for Women’s Health and Neonatal Intensive Care areas.
- Functions as a float, covering Critical Care, Medical-Surgical, telemetry, oncology and pre-admitting areas.
- Program Manager for DRG assurance program (1998).
- Successfully structured the program to fit organizational needs.
- Provided interdepartmental outcomes reports and updates.
- Supervised a case management staff of 13 during implementation and created departmental competency.
- Streamlined documentation through developing an improved Discharge Assessment and Planning tool consistent with JCAHO requirements.
- Developed Policy and Procedure with guidelines for the above.
Case Manager
Sisters of Providence, Holy Cross Medical Center
02.1997 - 02.1998
- Headed weekly interdisciplinary case conferences.
- Systemized process for clinical case conference, developed documentation tool and implemented the documentation process consistent with JCAHO requirements.
- Influenced other units to utilize the same process.
- Result: Increased time efficiency for the interdisciplinary team members.
Clinical Nurse
Sisters of Providence - St. Joseph Medical Center
03.1995 - 02.1997
- Clinical Nurse. Medical-Surgical/Vascular unit.
- Functioned as a relief charge nurse.
- Supported departmental goals by functioning as a communication team leader.
Clinical Nurse
Queen of Angels-Hollywood Presbyterian
12.1994 - 03.1995
- Clinical Nurse. Medical-Surgical/Oncology unit.
- Highly motivated in a demanding floor with high acuity patients.
Clinical Nurse
Huntington Memorial Hospital
11.1994 - 03.1995
- Clinical Nurse. Progressive experience as a new graduate in a renal-diabetic ward.
- Supported organizational requirements assisting in staffing needs by alternating work schedule of day and night shifts.
Education
Diploma - Addictions, Substance Abuse And Mental Health
Alison
Online 08.2025 - Current
Nursing Practice - Addiction
Continuing Education
American Society Of Addiction Nursing 08.2025 - Current
Continuing Education - Clinical Skills For Healthcare Practitioners
Coursera
08.2025 - Current
Master of Business Administration (M.B.A.) - Health/Health Care Administration/Management
University of Phoenix
01.2018
Bachelor of Science (BS) - Registered Nursing/Registered Nurse
University of Phoenix
01.1997
Associate of Arts (AA) - Nursing Science
Pasadena City College
01.1994
Associate of Science (AS) - Registered Nursing/Registered Nurse
Pasadena City College
01.1994
Skills
- Patient care and case management
- Healthcare administration
- Community engagement and strategic planning
- Team collaboration
- Professionalism and courtesy
- Computer proficiency
- Program development
Certification
Six Sigma Yellow-Belt Certified, 01/01/12
CCM Certified Case Manager through CCMC, 05/01/05 - 0008457
CMCN Certification in Managed Care Nursing through American Board of Managed Care Nursing, 11/1/2016 - 12-0947
MEP-C Medical Esthetic Practitioner through Association of Medical Esthetic Nurses, 08/01/2008
CARN Certified Addiction Registered Nurse through Addictions Nursing Certification Board, in progress
References
References available upon request.
Timeline
Diploma - Addictions, Substance Abuse And Mental Health
Alison
08.2025 - Current
Nursing Practice - Addiction
Continuing Education
08.2025 - Current
Continuing Education - Clinical Skills For Healthcare Practitioners
Coursera
08.2025 - Current
Senior Director Utilization/Enhanced CM
Calibrated healthcare
06.2024 - 06.2025
Per Diem Infusion Nurse – Home health
Navenhealth
04.2024 - 06.2025
Core Committee Member
Women's all 12-step Annual Retreat
05.2022 - Current
Panel Representative-Elijah's House
Foothill Hospitals & Institutions
05.2022 - 07.2024
Clinical Program Manager
Cigna
07.2017 - 03.2024
Clinical Operations Supervisor
Cigna
08.2010 - 07.2017
Case manager - Specialty Oncology
Cigna
08.2009 - 09.2010
Medical Aesthetic Nurse & CEO
Immaculè Medical Aesthetics
09.2006 - 08.2009
Quality Assurance Nurse
Great-West Healthcare
08.2006 - 09.2006
Director, Knowledge Management
Great-West Healthcare
05.2003 - 08.2006
Manager, Utilization Management
Great-West Healthcare
07.2002 - 05.2003
Case Manager
Great-West Healthcare
09.2001 - 07.2002
Case Manager
Network Medical Management - Allied Physicians
06.2000 - 09.2001
Case Manager
Glendale Memorial Hospital and Health Center
09.1997 - 06.2000
Case Manager
Sisters of Providence, Holy Cross Medical Center
02.1997 - 02.1998
Clinical Nurse
Sisters of Providence - St. Joseph Medical Center
03.1995 - 02.1997
Clinical Nurse
Queen of Angels-Hollywood Presbyterian
12.1994 - 03.1995
Clinical Nurse
Huntington Memorial Hospital
11.1994 - 03.1995
Master of Business Administration (M.B.A.) - Health/Health Care Administration/Management
University of Phoenix
Bachelor of Science (BS) - Registered Nursing/Registered Nurse
University of Phoenix
Associate of Arts (AA) - Nursing Science
Pasadena City College
Associate of Science (AS) - Registered Nursing/Registered Nurse
Pasadena City College
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