Felicia Session
Richmond
Summary
Dynamic healthcare leader with over 25 years of experience in quality improvement, auditing, and case management. Proven success in enhancing operational efficiency through effective team mentorship and data-driven decision-making, aiming to drive continuous improvement in patient care within a forward-thinking organization.
Overview
25
25
years of professional experience
Work History
Quality of Care Unit Nurse -Team Lead
Healthspring
Richmond
01.2014 - Current
- Reporting to the Senior Quality of Care Manager. Triages and collectively oversees the day-to-day operations of the quality department.
- The nurse also performs management responsibilities, including selecting, scheduling, supervising, retaining, and evaluating employees in the Quality department.
- Developed and mentored staff to meet or exceed department turnover goals.
- Additionally, the nurse developed direct reports to perform these same functions.
- Reviewed quality complaints and grievances submitted by members, applying continuous quality improvement and performance improvement processes.
- Led process improvement teams, coordinating agendas and discussions for quality-related committees.
- Analyzed and prioritized quality data to inform planning and evaluation of improvement activities.
- Assisted with clinical and quality service initiatives and quality reporting.
Audit Nurse (Team Lead)
Cigna Medicare Advantage
07.2002 - 01.2014
- The Nurse will assist in identifying high-volume, high-risk coding, reimbursement, and data quality problems, aggregate data, and report any trends.
- The Nurse develops action plans in the event of compliance issues found.
- Compiled recommendations for Medical Director review, ensuring adherence to compliance standards.
- Developed findings statements and assisted in formulating corrective action plans.
- Communicated with providers, departments, and staff to enhance clarity and coordination.
Case Manager Level 2
Cyberonics, Inc.
03.2002 - 04.2007
- Facilitated full utilization of patient relationship marketing (PRM) system while addressing educational needs and implant logistics for patients and families.
- Collaborated with field sales personnel to achieve territory quotas and revenue objectives by providing comprehensive patient education.
- This position is significant in assisting patients to make well-informed decisions regarding VNS Therapy.
- Participated in regional and national meetings to enhance professional knowledge.
- Researched, monitored, and identified VNS payer policies within assigned areas, communicating relevant information to internal stakeholders.
Preauthorization Nurse
Macgregor Medical
07.2001 - 02.2002
- Executed precertification and authorization of inpatient and outpatient medical procedures using InterQual and Milliman and Robertson criteria, ensuring compliance with established guidelines.
- Wrote endorsement or denial letters for pre-authorizations, detailing case-specific information and rationale.
- Deferred non-compliant cases to Medical Director for approval or denial, facilitating timely decision-making.
Education
Master of Science - Nursing Administration
The University of Texas At Arlington
Arlington, TX07-2024
Bachelor of Science -
The University of Texas At Arlington
Arlington, TX05-2022
Associates Applied Science Degree -
Lone Star College School of Nursing
Houston, TX05-2017
LVN - Licensed Vocational Nurse
Houston Community College
Houston, TX08-1988
Skills
- Quality improvement
- Case management
- Clinical judgment
- Clinical auditing
- Data analysis
- Healthcare administration
- Team leadership
- Team training and development
- Staff mentorship
- Attention to detail
- Problem solving
- Critical thinking
- Effective communication
- Conflict resolution
- Compassion and empathy
References
Available upon request.
Timeline
Quality of Care Unit Nurse -Team Lead
Healthspring
01.2014 - Current
Audit Nurse (Team Lead)
Cigna Medicare Advantage
07.2002 - 01.2014
Case Manager Level 2
Cyberonics, Inc.
03.2002 - 04.2007
Preauthorization Nurse
Macgregor Medical
07.2001 - 02.2002
Master of Science - Nursing Administration
The University of Texas At Arlington
Bachelor of Science -
The University of Texas At Arlington
Associates Applied Science Degree -
Lone Star College School of Nursing
LVN - Licensed Vocational Nurse
Houston Community College