Denise Shoaff
Clinical Nurse Manager, RN
Stow,OH
Summary
Registered Nurse with 20+ years of experience in direct patient care, case management and nursing management positions in managed care/insurance. My management experience spans Case Management, Utilization Review, Pre-authorization. and Medication Therapy Management. Passionate about providing an atmosphere of teamwork, productivity and caring.
Overview
28
28
years of professional experience
Work History
Clinical Nurse Manager
Health Dialog/Rite Aid
01.2019 - Current
- Manage a team of nurse who outreach to Medicare and Medicaid members to complete comprehensive medication reviews, provides counseling for chronic conditions and encourage adherence per CMS guidelines for the Medication Therapy Management program.
- Streamlined workflow for increased efficiency by optimizing scheduling and delegating tasks to the appropriate staff members.
- Mentored new nursing staff, fostering professional growth and development through comprehensive training programs.
- Increased employee retention rates by creating a supportive work environment that valued teamwork and open communication.
- Managed budgets and resources, consistently meeting financial and plan sponsor goals while maintaining high-quality patient outreach standards.
- Conducted routine performance evaluations, providing constructive feedback to drive continuous improvement among nursing staff members.
- Ensured compliance with regulatory requirements by maintaining accurate documentation and adhering to established policies and procedures.
- Implemented quality improvement initiatives to identify areas for potential enhancements in patient care delivery methods.
- Facilitated team-building activities to promote collaboration among nursing staff, resulting in improved morale and job satisfaction levels.
- Maximized nursing staff potential by providing ongoing coaching and support, leading to higher levels of competence and confidence in delivering quality care.
- Interacted effectively with department managers to promptly correct problems and improve services.
- Administered performance evaluations and probationary reviews to assess nursing personnel.
- Coordinated departmental operations according to administrative, legal and medical guidelines.
- Managed team of 18 nurses and one clinical nursing assistants.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Clinical Health Services Nurse Supervisor
Aetna, A CVS Health
01.2015 - 06.2017
- Managed staff performance and compensation budgets over $1,000,000.00
- Supervised, directed, and motivated high-quality performance from RN Case Managers and Utilization Review RNs.
- Collaborated with interdisciplinary teams through Grand Rounds to assess progression for complex patients, determining alternate treatment options resulting in better health outcomes.
- Conducted regular performance evaluations of nursing staff, identifying strengths and areas needing improvement while providing guidance on career advancement strategies.
- Increased staff retention rates by fostering a supportive work environment and providing opportunities for professional growth.
- Championed the integration of new technology into daily workflows by leading demonstrations, troubleshooting issues as needed, and offering support during the transition phase. Served as subject matter expert for Aetna Total View (ATV) when introduced to staff.
- Led staff meetings to keep team informed of departmental changes and provide opportunities for nurses to share ideas and concerns.
- Reviewed department performance and adjusted coverage to compensate for changing conditions.
Clinical Health Services Team Lead
Aetna, A CVS Health
04.2014 - 01.2015
- Assigned daily caseload for utilization review and case management nurses
- Trained new team members by relaying information on company procedures and safety requirements.
- Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
- Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
Quality Nurse Management Consultant
Aetna, A CVS Health
07.2012 - 04.2014
- Performed quantitative and qualitative data analysis and created comprehensive reports to align with reporting metrics
- Documented quality management activities to demonstrate business compliance, regulatory and accreditation requirements.
• Assisted in development and implementation of QM projects and activities
• Evaluated and made recommendations for corrective actions i.e., credentialing events and quality concerns. - Performed Inter-rater reliability evaluations.
Nurse Case Manager
Aetna, A CVS Health
07.2010 - 07.2012
- Assess insured members health status and care coordination needs in a managed care environment.
- Collaborated with member, various support services and multiple disciplines determining optimal care plan and cost-effective resources.
- Offered member-patient advocacy while performing utilization review for inpatient stay, collaborated with facilities for discharge planning. Pre-authorization for DME.
- Served as a liaison between patients and various support services such as financial assistance programs, community resources, and mental health counseling to ensure holistic care was provided.
Clinical Instructional Design and Development
Aetna, A CVS Health
06.2007 - 07.2010
- Design, develop and distribute clinical training content for new and existing medical management staff.
- Optimized design processes by implementing innovative software tools and techniques.
- Utilize desktop technology, self-paced video, and audio simulation
- Collaborate with teams and all levels of leadership to align project planning outcomes.
- Conduct program rollouts and evaluations to measure results.
- Manage project plans through Quickbase project management.
Clinical Team Lead
Aetna, A CVS Health
08.2006 - 07.2007
- Leader and resource for team of precertification as well as Training, Reporting, Auditing and Quality (TRAQ team) nurses and non clinical staff.
- Perform audits for patient management staff including case manager RNs, utilization review RNs, pre-authorization LPNs and non clinical support staff.
- Support supervisor as liaison in case management and quality workgroups.
Quality Management Consultant
Aetna, A CVS Health
06.2005 - 08.2006
- Collect and analyze data for reporting and quality purposes
- Restructured and facilitated case management orientation for new hires.
- Developed training materials and process change communication for clinical dept
Nurse Case Manager
09.2003 - 06.2005
- See responsibilities as listed for 2010 position with Aetna above.
Qualified Health Plan Coordinator
Bunch & Associates
08.2002 - 09.2003
- Supervised team of worker's compensation nurse case managers
- Reviewed files for data integrity and progression to closure
- Facilitated communication between case managers, employers, and insurance adjusters
- Coordinated grievance and dispute resolution for Qualified Health Plan, OH
Team Lead/Qualified Health Plan Coordinator
Bunch & Associates
05.2001 - 09.2003
- Supervised team of worker's compensation nurse case managers
- Reviewed case manager's files for data integrity and progression to closure
- Facilitated communication between case managers, employers, and insurance adjusters
- Coordinated grievance and dispute resolution for Qualified Health Plan, OH
Nurse Case Manager for Worker's Compensation
Bunch & Associates
04.2000 - 08.2002
- Provided case management services for worker's compensation claims
- Authorized medical care as appropriate
- Negotiated fees for clinical services while achieving record savings for insurance company
- Progressed claims to full duty and maximum medical improvement through physician advice and independent medical exams.
Health Promotions Coordinator
Outlook Pointe at Sagamore Hills
11.1999 - 04.2001
- Director of Nursing for a new assisted living facility.
- Coordinated system implementation, policy and procedure formation and prospective resident assessments.
- Created system for monitoring and tracking healthcare related services.
- Reviewed and conducted clinical care to meet and exceed state regulations.
- Facility deemed deficiency – free in first year of operation
Clinical Nurse
Edwin Shaw Rehabilitation Hospital
07.1997 - 12.1998
- Administered medication and performed medical treatments such as IV initiation, maintenance blood draws, wound care and assessments
Charge Nurse
Kent Quality Care
09.1996 - 07.1997
- Patient assessment, medication administration, wound care, treatments, order transcription, charting, supervision of support staff, collaboration with various disciplines on staff.
Education
Registered Nurse - Diploma - Nursing
Summa St. Thomas School of Nursing
Akron, OH06.1996
Skills
- Clinical Leadership
- Nurse Leadership
- Staff Education
- Case Management
- Clinical Quality Improvement
- Staff Development
Education Certifications Awards
- Summa St. Thomas School of Nursing, Graduated, 06/01/96, 1077 Gorge Blvd., Akron, OH, 44310
- Certified Case Manager (CCM), 04/01/03 - 5/1/2023
- Recipient of the Annual Bunch & Associates Case Manager of the year 2002
Personal Information
Title: Registered Nurse, CCM
Timeline
Clinical Nurse Manager
Health Dialog/Rite Aid
01.2019 - Current
Clinical Health Services Nurse Supervisor
Aetna, A CVS Health
01.2015 - 06.2017
Clinical Health Services Team Lead
Aetna, A CVS Health
04.2014 - 01.2015
Quality Nurse Management Consultant
Aetna, A CVS Health
07.2012 - 04.2014
Nurse Case Manager
Aetna, A CVS Health
07.2010 - 07.2012
Clinical Instructional Design and Development
Aetna, A CVS Health
06.2007 - 07.2010
Clinical Team Lead
Aetna, A CVS Health
08.2006 - 07.2007
Quality Management Consultant
Aetna, A CVS Health
06.2005 - 08.2006
Nurse Case Manager
09.2003 - 06.2005
Qualified Health Plan Coordinator
Bunch & Associates
08.2002 - 09.2003
Team Lead/Qualified Health Plan Coordinator
Bunch & Associates
05.2001 - 09.2003
Nurse Case Manager for Worker's Compensation
Bunch & Associates
04.2000 - 08.2002
Health Promotions Coordinator
Outlook Pointe at Sagamore Hills
11.1999 - 04.2001
Clinical Nurse
Edwin Shaw Rehabilitation Hospital
07.1997 - 12.1998
Charge Nurse
Kent Quality Care
09.1996 - 07.1997
Registered Nurse - Diploma - Nursing
Summa St. Thomas School of Nursing
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