Cynthia Alvey
Louisville,KY
Summary
Experienced Registered Nurse with a comprehensive background in quality improvement, patient safety initiatives, utilization management, quality auditing, home health coordination, HEDIS reviews, case management, women’s and mother-baby care, behavioral and geriatric health, sales, and public relations events. Demonstrates expertise in developing and implementing evidence-based interventions to elevate care standards, ensure regulatory compliance, and close clinical gaps for diverse patient populations. Recognized for fostering positive relationships with patients, families, physicians, and multidisciplinary teams; skilled in data analysis, provider and patient education, and process improvement. Adept at collaborating across departments, facilitating educational outreach, and supporting strategic member retention projects.
Overview
34
34
years of professional experience
Work History
Senior Stars Improvement Clinical Professional
Humana
07.2019 - Current
- Lead Medicare and Medicaid Stars/Quality Improvement initiatives, including complex data analysis and strategic development to close care gaps.
- Collaborate with provider groups to enhance HEDIS and Patient Safety compliance, facilitate data sharing, and manage provider engagement.
- Serve as subject matter expert for provider engagement teams; facilitate provider education and data sharing.
- Collect, research, report, and analyze HEDIS audit data for the market, ensuring supplemental gaps are closed to improve metrics.
- Participate in member retention and community outreach programs, encouraging preventive screenings and education at Humana Neighborhood Center.
Utilization Management, Home Health Nurse 2
Humana Senior Care Products East
06.2018 - 01.2019
- Provided prior authorizations for home health agencies, ensuring compliance with CMS and MCG guidelines.
- Assessed appropriate levels of care and referred members for case management or additional resources to address gaps.
- Trained new hires in utilization management protocols, supporting achievement of performance metrics.
Onsite Nurse, Skilled Nursing Facility
Humana Senior Care Products East
04.2016 - 07.2017
- Conducted detailed utilization management reviews and prior authorizations for skilled nursing facility (SNF) admissions, ensuring compliance with CMS and MCG guidelines and supporting optimal resource allocation.
- Assessed clinical documentation and coordinated with physicians, facility staff, and case managers to determine medical necessity and appropriate levels of care for incoming residents.
- Provided comprehensive case management throughout the patient stay, developing individualized care plans in collaboration with interdisciplinary teams.
- Facilitated safe and timely discharge planning by identifying patient needs, coordinating home health services, arranging follow-up appointments, and ensuring continuity of care post-discharge.
- Supported families and caregivers by providing education about discharge processes, available community resources, and post-acute care options.
- Monitored patient outcomes, tracked readmission rates, and participated in quality improvement initiatives to enhance patient safety and satisfaction within the SNF setting.
Auditor
Humana Senior Care Products East and Mid-Atlantic
03.2014 - 04.2016
- Conducted phone and chart reviews for the UM department in alignment with policy and procedures.
- Collaborated with UM leaders to support team metric goals and challenges.
- Developed and implemented QIO process flow sheets to train new staff in quality improvement procedures.
Senior Case Manager
Humana Senior Care Products East
02.2013 - 03.2014
- Educated members on preventative health strategies, medication adherence, and chronic disease management to proactively identify and close gaps in care.
- Provided individualized guidance on prescription regimens and self-care practices, enhancing members’ understanding of their conditions and promoting positive health outcomes.
- Referred members to appropriate Humana programs and coordinated with home health agencies and healthcare providers to ensure seamless transitions and continuity of care.
- Participated in innovative pilot programs addressing complex discharge scenarios, working collaboratively to facilitate safe returns to home settings.
- Served as a mentor and trainer to staff, supporting performance improvement, sharing best practices, and fostering the achievement of quality benchmarks across the care team.
Quality Improvement Nurse
Humana Senior Care Products East
07.2012 - 02.2013
- Led biweekly interdisciplinary team meetings to analyze provider performance data, identify opportunities for improvement, and develop targeted action plans to close HEDIS gaps and advance quality metrics.
- Delivered coaching and educational sessions to provider offices, addressing topics such as sensitivity to diversity, senior care needs, regulatory requirements, and evidence-based best practices.
- Assessed and supported unique practice needs by offering personalized coding assistance, facilitating proper documentation for quality programs, and enhancing provider understanding of relevant clinical care initiatives.
- Improved provider awareness and adoption of online tools and clinical programs by conducting demonstrations, troubleshooting issues, and promoting digital solutions to streamline workflow and reporting.
Utilization Management Nurse
Humana Senior Care Products East
08.2011 - 07.2012
- Accurately performed data entry and validation for hierarchical condition categories (HCCs) and Stars metrics, ensuring completeness and compliance for quality reporting and regulatory audits.
- Facilitated and tracked quality improvement initiatives, monitored progress, and communicated results with providers and leadership to sustain a culture of continuous improvement.
- Managed the end-to-end process of pre-authorizations for skilled nursing and hospital services, meticulously reviewing clinical documentation to ensure requests met established CMS, Milliman, and organizational guidelines.
- Liaised with hospitals and nursing homes to clarify clinical criteria, facilitate timely authorizations, and support optimal patient placement and care transitions.
- Developed comprehensive job aids and training materials to onboard new hires and support ongoing education for nursing staff, resulting in improved workflow efficiency and regulatory compliance; recognized with the Star Award for these contributions.
- Actively participated in the preceptor program, providing mentorship, orientation, and performance evaluations for newly hired nurses, ensuring their competency and successful integration into the team.
- Utilized electronic medical records (EMR) and clinical decision support tools to maintain accurate records and uphold quality standards.
DME Sales Representative
SCM Life Care Oxygen & Home Medical
01.2010 - 08.2011
- Built referral relationships for durable medical equipment and oxygen services across Louisville and surrounding areas.
- Supported safe discharges by collaborating with social workers, discharge planners, and healthcare teams.
Home Health Coordinator
Visiting Nurse Association of Nazareth
01.2002 - 01.2010
- Coordinated and managed all referrals for home health services across 12 long-term care facilities, serving as a central liaison between facility staff, physicians, patients, and home health agencies to ensure timely and appropriate care transitions.
- Reviewed patient records and collaborated with multidisciplinary teams to assess eligibility, develop individualized care plans, and facilitate the initiation of home health services tailored to each patient’s needs.
- Maintained ongoing communication with facility case managers and external providers, tracking patient progress and resolving barriers to care for optimal outcomes.
- Organized and led community flu clinics, overseeing scheduling, vaccine administration, and post-injection monitoring, while providing education on influenza prevention to patients, families, and facility staff.
- Developed and distributed educational materials and presentations to support health promotion, disease prevention, and awareness of available home health services within the community.
- Tracked referral trends and clinic participation data to inform process improvement and outreach strategies.
Home Health Nurse
Amedisys Home Health
- Served as a certified Medicare psychiatric registered nurse, collaborating closely with interdisciplinary teams including physicians, social workers, therapists, and psychiatrists to provide coordinated care for patients with complex mental health needs.
- Conducted comprehensive psychiatric assessments in the home setting, evaluating patient status, medication compliance, and psychosocial factors affecting health and safety.
- Developed and implemented individualized treatment plans, incorporating evidence-based interventions for conditions such as depression, anxiety, dementia, and other behavioral health diagnoses.
- Provided ongoing education and support to patients and family members regarding mental health management, medication administration, crisis prevention, and community resources.
- Monitored patient progress and responded to changes in condition, adjusting care plans as needed to ensure safety, stability, and optimal outcomes.
- Maintained detailed clinical documentation in compliance with Medicare guidelines, facilitating communication among care team members and supporting regulatory requirements.
Registered Nurse
Baptist Hospital East
01.1992 - 01.2010
- Provided comprehensive bedside care, clinical treatment, and documentation for patients in women’s health, medical-surgical, antepartum, mother-baby, and geriatric psychiatry units.
- Managed medication administration, IV therapy, wound care, post-operative recovery, lactation consulting, and all aspects of direct nursing care.
- Facilitated patient admissions and discharges, maintained detailed chart notes, and communicated effectively with interdisciplinary teams to ensure continuity of care.
- Delivered preventative health screenings and education in the community; promoted hospital services to patients and families.
- Conducted TB screenings, administered vaccines (Hepatitis B & MMR), performed TB mask fittings, and assisted in new hire orientation.
Education
Associate of Science - Nursing
Jefferson Community College
Louisville12-1997
Skills
- Care coordination
- Clinical documentation
- Mental health care
- Home health care
- Maternal-newborn care
- Medication reconciliation
- Discharge planning
- Patient care and education
- RN case management
- Electronic health records management
- Discharge coordination
- Medical record review
- HEDIS compliance
- Data collection techniques
Timeline
Senior Stars Improvement Clinical Professional
Humana
07.2019 - Current
Utilization Management, Home Health Nurse 2
Humana Senior Care Products East
06.2018 - 01.2019
Onsite Nurse, Skilled Nursing Facility
Humana Senior Care Products East
04.2016 - 07.2017
Auditor
Humana Senior Care Products East and Mid-Atlantic
03.2014 - 04.2016
Senior Case Manager
Humana Senior Care Products East
02.2013 - 03.2014
Quality Improvement Nurse
Humana Senior Care Products East
07.2012 - 02.2013
Utilization Management Nurse
Humana Senior Care Products East
08.2011 - 07.2012
DME Sales Representative
SCM Life Care Oxygen & Home Medical
01.2010 - 08.2011
Home Health Coordinator
Visiting Nurse Association of Nazareth
01.2002 - 01.2010
Registered Nurse
Baptist Hospital East
01.1992 - 01.2010
Home Health Nurse
Amedisys Home Health
Associate of Science - Nursing
Jefferson Community College