Diane Butler
Knightstown,IN
Summary
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Overview
14
14
years of professional experience
Work History
Medical Management Supervisor
MDwise
01.2021 - Current
- Managed a team of nurses for Utilization Management, Appeals, and Medically Frail.
- Provided oversight for adjudicating Prior Authorizations and performing Medical Management Appeals, IRO, and State Fair Hearings.
- Streamlined UM processes and provided efficient and concise policy and procedures.
- Hired, trained, audited, and evaluated staff
- Bid writing and win for HIP and HHW Medicaid
- NCQA preparation, presentation, and staff education while applying project management skills.
- State reporting, data analysis, along with presentations.
- Increased prior authorization turnaround times to 98.2%
FEP CASE MANAGER II
ANTHEM FEDERAL
03.2019 - 01.2021
- Provided Complex Case Management for high-risk members by using Motivational Interviewing Skills while completing assessments, developing care plans with member, providing condition education, and coordinating care with providers/ members for promoting a positive health outcome
- Worked within FHPS contracted benefits, and when appropriate, negotiated out of network services and fees while providing community resources and Anthem programs to promote the best possible health outcome for the member while containing costs
- Obtained CCM certification 9/1/2020.
Manager of Case Management, II
ANTHEM MEDICAID
03.2015 - 03.2019
- Managed team of 25 nurses, social workers, and non-clinical associates that provide Care Management for Indiana Medicaid population
- Collaborated and developed new programs for discharge planning with facilities, vendors, utilization management, case management, and community resources to effectively decrease readmission rates
- Interviewed and hired staff, provided training, and evaluated/counseled staff performance while assisting associates to advance in their careers
- Provided efficient and concise policy and procedure writing, ensured compliance with government and contractual guidelines, collaborative building of reports from reporting manual specs, and reviewing and submitting State reports
- Assisted with NCQA preparation, presentation, and staff education while applying project management skills
- Increased member CCM engagement rates to 51%.
- Decreased physical health readmission rates by 20%.
CCM MANAGER, QI Manager, TBI Out of State Manager
ADVANTAGE HEALTH SOLUTIONS
12.2009 - 02.2015
- Worked with following areas of business: Dual Aid Eligible, Medicare and Medicaid.
- Managed department of 43 clinical and non-clinical staff for Care Management of high risk members.
- Developed care plan library, as well as, member educational material library.
- Interviewed , hired, trained, counseled, and evaluated staff. Created policy and procedures.
- Drastically improved and decreased behavioral health readmission rate from 18.3% to 5.4%.
- Impacted and decreased physical health readmission rate from 21.3% to 6.2%.
Education
Bachelor of Science - Nursing
Ball State University, RN
Muncie05.1990
RN Compact License
10.2020
CCM Certification -
CCMC
09.2020
Indiana RN License
07.1990
Skills
- Population Management
- Project Management
- Data Analysis
- Government and Executive Leadership Presentations
- Increase HEDIS, CAHPS scores
- Proficient use of Microsoft Word, Excel, and Power Point
- Develop strategy to increase improvement
- Strong relationship building
- Care Coordination, Quality Improvement (QI), and Complex Case Management
- Contract Procurement
Timeline
Medical Management Supervisor
MDwise
01.2021 - Current
FEP CASE MANAGER II
ANTHEM FEDERAL
03.2019 - 01.2021
Manager of Case Management, II
ANTHEM MEDICAID
03.2015 - 03.2019
CCM MANAGER, QI Manager, TBI Out of State Manager
ADVANTAGE HEALTH SOLUTIONS
12.2009 - 02.2015
Bachelor of Science - Nursing
Ball State University, RN
RN Compact License
CCM Certification -
CCMC
Indiana RN License
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