Georgina Cyrillien MHL, BSN, RN CCM
Bronx,NY
Summary
Driven and dynamic healthcare professional with a track record for quality clinical care, process improvement, policy development, and health plan (Medicare, Medicaid, and Commercial) medical management operations within an integrated health system. Extensive experience in developing and managing clinical and non-clinical staff to support organizational goals while collaborating with health plan client, promoting a mutual partnership to deliver quality health care services. Adept in case / management and clinical oversight. Proficient in conducting data analysis to close gaps and improve outcomes.
Overview
23
23
years of professional experience
Work History
Clinical Director
Montefiore Medical Center - CMO
06.2019 - Current
- Provides supervision and oversite of daily operations of the utilization management and review team, including development, implementation, and ongoing monitoring of policies, procedures, and operational workflows
- Monitors and refines staffing models, operating budgets, and performance metrics
- Monitors and assesses the effectiveness of departmental programs/activities/processes continuously
- Prioritizes required changes/performance improvement initiatives; Allocates resources and implements changes as needed to achieve desired outcomes
- Collaborates with the VP, AVP, Directors, and Chief Medical Officer and leads the development and implementation of utilization management and review programs, optimizing healthcare quality, brand recognition, and performance under risk contracts
- Apprises the VP, Chief Medical Officer, and other senior leadership team members of developing and ongoing issues affecting optimal performance within areas of responsibility
- Provides oversight of all health plan audits and NCQA accreditation activities.
- Enhanced patient care by implementing evidence-based clinical practices and protocols.
Assistant Clinical Director
Montefiore Medical Center - CMO
09.2018 - 05.2019
- Provided direct oversight for Utilization and Care Management teams responsible for Inpatient Skilled Nursing Facilities, Home Care and Hospice Utilization Management and Review
- Developed and monitored departmental operational performance metrics, including LOS and readmission rates; Developed and implemented department policies, procedures, and workflows
- Worked in collaboration with AVP regarding budget review, personnel management, staff development, and productivity monitoring
- Assisted in all phases of Montefiore CMO's accreditation process for NCQA accreditation.
Medical Management Clinical Coordinator
Montefiore Medical Center - CMO
02.2016 - 09.2017
- Managed delegated health plan members' skilled nursing facility (SNF) benefits per their health plan’s (Oxford/UHC Medicare and Emblem/HIP Medicare, Medicaid, and Commercial plans) guidelines and state and federal regulations; Performed utilization management/ concurrent reviews to ensure medical necessity and appropriateness of continued stays per health guidelines while maintaining compliance with state and federal regulations
- Collaborated with interdisciplinary team members at the SNFs and the medical directors at Montefiore CMO in accordance with regulatory and benefit coverage parameters to coordinate comprehensive care plans appropriate to the members' health care needs, including outpatient services, home care services, and DMEs; Identified and managed members at high risk for readmissions due to complex medical and psycho-social needs and collaborated with IDT members to coordinate post-discharge care and services.
Clinical Care Manager
09.2014 - 02.2016
- Managed a multidisciplinary team responsible for implementing the Intensive Case Management (ICM) program
- Ensured appropriate workflows and processes were implemented and adhered to; Developed policies, procedures, and workflows while monitoring effectiveness and staff productivity
- Monitored program effectiveness and identified and resolved barriers
- Collaborated with the Medical Director and other members of the interdisciplinary team to promote appropriate resource utilization
- Performed all other general managerial duties.
Team Manager
VNSNY Choice Community Care
02.2013 - 07.2014
- Managed the interdisciplinary healthcare weekend team by providing administrative and staff support for regional operations; Completed weekend staffing assignments; Reviewed specific care management issues with the weekend team, and responded to quality issues/complaints and approvals requiring next-level authorization
- Served as a liaison between weekday and weekend staff and performed all other managerial duties.
Nurse Consultant
VNSNY Choice Community Care
03.2005 - 02.2013
- Provided care management and advocacy for options and services to meet members' health needs
- Maintained members in the most independent living situation possible and ensured consistent care along the entire health care continuum by assessing and closely monitoring the member's needs and status, providing nursing services, and authorizing/coordinating services within a capitated managed care system
- Closely communicated and collaborated with primary care practitioners, interdisciplinary teams, and family members.
Community Health Nurse
Beth Abraham Certified Home Health Agency
03.2004 - 03.2005
- Coordinated and provided multidisciplinary health services for patients, including administering medications and treatments, performing wound care and wound assessments, changing foley/suprapubic catheters, providing patient and family teaching, completing OASIS forms, and supervising paraprofessionals.
Staff Nurse
St. Barnabas Hospital
07.2001 - 02.2004
- Provided direct patient care, administered medications and treatments, supervised ancillary staff, and performed all other general nursing duties.
Education
Master of Health Leadership -
Western Governors University
09.2022
Population Care Coordinator Certificate -
Duke University
04.2014
Bachelor of Science in Nursing -
College of New Rochelle
01.2011
Associate Degree in Nursing -
Hostos Community College
05.1999
Skills
- Clinical Quality Improvement
- Patient and Population Care Coordination
- Interdisciplinary Collaboration
- Clinical Supervision
- Utilization Management
- Case Management
- Critical thinking and Decision-making
- Effective Communication
- Staff Development
- Process Implemenataion
Licensure and Certifications
- NY State Registered Professional Nurse, 07/1999, Present
- Certified Case Manager (CCM), 10/2011, Present
- NYS H/C PRI Assessor, 02/2017, Present
Special Projects
Participated in NYSDOH Beta testing for UAS-NY (2012)
Led the Montefiore CMO Utilization Management team through a successful initial NCQA accreditation process (2017-2019)
References
Supplied upon request.
Timeline
Clinical Director
Montefiore Medical Center - CMO
06.2019 - Current
Assistant Clinical Director
Montefiore Medical Center - CMO
09.2018 - 05.2019
Medical Management Clinical Coordinator
Montefiore Medical Center - CMO
02.2016 - 09.2017
Clinical Care Manager
09.2014 - 02.2016
Team Manager
VNSNY Choice Community Care
02.2013 - 07.2014
Nurse Consultant
VNSNY Choice Community Care
03.2005 - 02.2013
Community Health Nurse
Beth Abraham Certified Home Health Agency
03.2004 - 03.2005
Staff Nurse
St. Barnabas Hospital
07.2001 - 02.2004
Master of Health Leadership -
Western Governors University
Population Care Coordinator Certificate -
Duke University
Bachelor of Science in Nursing -
College of New Rochelle
Associate Degree in Nursing -
Hostos Community College
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