Debra Gregory BSN, RN
Imperial,MO
Summary
Dedicated healthcare professional with over 10 years experience in Specialty Pharmacy Services. Proven to have effective time management, strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Clinical Nurse Coordinator
Payer Matrix
02.2023 - Current
- Developed strong working relationships with community resources to expand available support services for patients.
- Served as a liaison between patients, physicians, and insurance to determine treatment options and continuity of care.
- Interacted effectively with leadership and executives to promptly correct problems and improve services.
- Advanced internal communication channels by sharing best practices among colleagues, fostering an environment of continuous learning and improvement.
- Contributed to increased team productivity by consistently meeting or exceeding individual and team processing goals.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Delivered timely information to insurance plan and TPA to resolve common and complex issues.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Managed multiple priorities effectively under high-pressure deadlines without compromising accuracy or quality of work output.
- Assisted patients with understanding their benefits coverage, providing clear explanations regarding PA, appeal, alternate therapy, out-of-pocket expenses and reimbursements.
- Assisted patients in navigating the healthcare system by providing education on insurance coverage, financial resources, and available support services.
- Successfully resolved escalated issues, preventing potential loss of valuable clients while maintaining positive relationships with all parties involved.
- Collaborated with insurance providers to clarify requirements and ensure proper submission of claims for faster processing times.
- Developed strategies for optimizing cost containment measures without sacrificing quality or efficiency in management processes.
- Optimized resource utilization by identifying opportunities for cost containment while maintaining quality of care.
- Contributed to cost containment initiatives by identifying barriers and recommending alternative treatment options.
- Broad knowledge of specialty drugs use and management for rare and complex diseases.
- Experience working with Biosimilar drugs, 340B pharmacy program, and alternate funding resources.
- Experience and knowledge of insurance Medical and PBM process for specialty medication.
- Experience and knowledge of specialty drug procurement, distribution, and cost.
RN Support Specialist
Sonexus Cardinal Health Specialty Services
08.2017 - 01.2023
- Coordinated appropriate and efficient delivery of healthcare services to promote optimal outcomes by assessing and matching unmet needs with referrals and support services.
- Served as a liaison between patients, families, and healthcare providers to ensure seamless communication and continuity of care.
- Improved customer and patient satisfaction by implementing strategic account plans and tailored solutions.
- Provided expert guidance on drug programs and services, positioning clients for optimal results.
- Collaborated closely with senior leadership to establish account priorities aligning with overall business objectives.
- Ensured timely and effective communication with clients, collaborating on key initiatives to drive mutual success.
- Gained customer loyalty by providing exceptional follow-up support and addressing inquiries promptly.
- Educated patient, physicians and pharmacists on drug use, benefits, dosage and risks.
- Collaborated with Leadership and IT to customize EHR systems based on specific program needs, resulting in increased user satisfaction and improved patient outcomes.
- Supported quality improvement initiatives by analyzing data from various sources to identify trends, areas for improvement, and best practices.
- Facilitated seamless transitions during system upgrades or migrations, ensuring minimal disruption to patient care services.
- Applied medical subject matter knowledge to improve IT systems and functions.
- Managed the scheduling, coordination, and logistics of all virtual training on Orphan drug therapy across the country to healthcare providers, and client pharmaceutical sales teams.
- Optimized operational efficiency and client relationships for regulatory reporting requirements, auditing, and quality improvement programs for several drug programs.
- Assisted with insurance PA, appeal, copay, PAP, alternate funding programs, and buy & bill process.
- Managed PAP and 340B process for selected specialty drug programs.
Clinical Nurse Coordinator
Dohmen Life Science Services
01.2015 - 08.2017
- Coordinate and managed care for patients nationwide for multiple drug programs
- Launched Orphan drug programs from clinical trials
- Member of the Quality Assurance Review Committee
- Member of ACHC Accreditation Committee
- Multidisciplinary collaboration for Orphan drug program launch, transition, and maintenance.
- Managing antibody and biomarker lab program set up and monitoring for drug programs.
- Responsible for pharmaceutical company safety training to my fellow employees and contracted nurse consultants and agencies
- Provide in-services to nurse agencies, hospitals, pharmacies and infusion centers nationwide for infusion therapy as needed
- Monthly reporting for sales operation and marketing teams
- Weekly sales/marketing meeting with Clients
- Assist with writing and implementation of SOPs for client programs
- Responsible for all weekly, monthly, and annual reports to Corporate Compliance and Training
- Vendor Program Manager and trainer to training database system
- Coordinate and manage Annual Patient Satisfaction Survey
- Prompt reporting of Adverse Events and monthly reports to clients
- Applied nursing expertise to meet needs of Rare Disease patients in challenging home environment
- Participated in education activities, including evidence-based practice project implementation, nursing competency development and nursing simulation activities
- Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices
- Assisted with PA, appeal, copay, reimbursement, and PAP programs.
- Adhered to strict safety measures by carefully determining proper dosages before administering medications
RN Case Manager
Crossroads Hospice
04.2013 - 01.2015
- Serve on Safety, Ethics and Quality Improvement Committees
- Preceptor
- Direct patient care
- Assisted PR with Marketing & Presentations to Healthcare Providers
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols to optimize performance and safety
- Provided home healthcare providers with training, guidance, support and supervision to achieve objectives
- Provided ongoing counseling to help patients deal with conditions and processes
- Worked with medical teams, patients and families to implement effective treatment plans
- Used Microsoft Word and other software tools to create documents and other communications
- Resolved problems, improved operations and provided exceptional service
- Managed quality assurance program, including on-site evaluations, internal audits and customer surveys
- Used critical thinking to break down problems, evaluate solutions and make decisions.
RN Case Manager
Apollo Home Care
01.2012 - 04.2013
- Specialty medication infusion therapy for rare and complex diseases.
- Collaborated with healthcare providers to ensure optimal medication therapy outcomes for patients.
- Coordinated with insurance companies to resolve billing discrepancies or obtain prior authorizations for specialty medications promptly.
- Assisted in managing specialty medications by tracking and monitoring patient progress throughout treatment courses.
- Participated in continuing education opportunities focused on current developments in home infusion therapy, maintaining up-to-date knowledge base for optimal patient care provision.
- Ensured timely delivery of home infusion medications and supplies through close coordination with specialty pharmacies.
RN Charge Nurse
St. Anthony's Medical Center
03.2008 - 03.2012
- Co-chair Shared-Governance Committee
- Charge Nurse role
- Preceptor
- Epic Super User/ Trainer
- Observed and reported patient condition, progress and medication side effects to accurately document updates
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions
- Supervised patient admissions and discharges from hospital to various settings, including home care, rehabilitative facility or self-care
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders and communicating with ancillary departments and assisting staff
- Educated patients and answered questions about health condition, prognosis and treatment
- Vaccinated patients to protect individuals from measles, pneumonia, influenza and other illnesses of concern
- Educated family members and caregivers on patient care instructions
- Strengthened unit care standards and policies with focus on patient safety and dignity
- Maximized team performance by monitoring nursing care, including patient assessment processes and treatment implementations
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols to optimize performance and safety.
Registered Nurse
St. Louis University Hospital
02.1997 - 03.2008
- JACHO & State Review Committee
- Instructor to Annual Nurse Competency Skills Training
- Charge Nurse role
- RN Preceptor
- Float RN
- Clinical Nurse Facilitator
- Observed and reported patient condition, progress and medication side effects to accurately document updates
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols to optimize performance and safety
- Implemented quality patient care techniques to align with safety, health and organizational regulations
- Strengthened unit care standards and policies with focus on patient safety and dignity
- Identified unit areas of inadequacy and adjusted procedures to close gaps and improve policies
- Maximized team performance by monitoring nursing care, including patient assessment processes and treatment implementations
- Directed patient care activities and provided guidance and training to RNs, LPNs and residential advisors during shift while delegating assignments and providing treatment
- Worked with patients diagnosed with chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), cerebrovascular accidents (CVA), diabetes or sepsis to assess needs and determine best options for care
- Supervised patient admissions and discharges from hospital to various settings, including home care, rehabilitative facility or self-care
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders and communicating with ancillary departments and assisting staff.
Education
Bachelor of Science: Nursing -
Aspen University
Denver, CO04.2021
Diploma Graduate: Nursing -
Lutheran School of Nursing
St Louis, MO12.1996
Skills
- Clinical Leadership
- Patient Advocacy
- Interdisciplinary Collaboration
- Attention to Detail
- Problem-solving abilities
- Multitasking
- Reliability
- Effective Communication
- Decision-Making
- Proficient computer skills
- Cost Containment Strategies
- HIPAA Compliance
- Professionalism
- Time management abilities
Certification
- RN License, #145169, Missouri, 1997
- Member of Delta Epsilon Honor Society, 2021
Affiliations
State of Missouri, #RN-145169, active, compact licensure
Timeline
Clinical Nurse Coordinator
Payer Matrix
02.2023 - Current
RN Support Specialist
Sonexus Cardinal Health Specialty Services
08.2017 - 01.2023
Clinical Nurse Coordinator
Dohmen Life Science Services
01.2015 - 08.2017
RN Case Manager
Crossroads Hospice
04.2013 - 01.2015
RN Case Manager
Apollo Home Care
01.2012 - 04.2013
RN Charge Nurse
St. Anthony's Medical Center
03.2008 - 03.2012
Registered Nurse
St. Louis University Hospital
02.1997 - 03.2008
Bachelor of Science: Nursing -
Aspen University
Diploma Graduate: Nursing -
Lutheran School of Nursing
Similar Profiles
Gary BerenholtzGary Berenholtz
Care Coordinator at Payer MatrixCare Coordinator at Payer Matrix
Rebecca GrisaffiRebecca Grisaffi
Patient Care Coordinator at Payer MatrixPatient Care Coordinator at Payer Matrix
Rebecca GrisaffiRebecca Grisaffi
Patient Care Specialist/Reimbursement Specialist at Payer MatrixPatient Care Specialist/Reimbursement Specialist at Payer Matrix
Brianna BrownBrianna Brown
Data Entry Clerk at Metropolitan Title DataData Entry Clerk at Metropolitan Title Data
Sherrie BaykowskiSherrie Baykowski
Customer Service Representative at Pyramid ConsultingCustomer Service Representative at Pyramid Consulting