Gina Muller
Novato,CA
Summary
Healthcare leader with over 10 years of expertise in population health and utilization management. Proven success in developing and managing programs for over 80,000 members, enhancing clinical outcomes, and minimizing avoidable hospitalizations. Certified case manager skilled in Medicare Advantage and discharge planning, ensuring effective patient support and navigation through complex health systems. Committed to delivering compassionate, member-centered care.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Supervisor, Care Management and UM Concurrent Review
Meritage Medical Network
Petaluma, California
03.2023 - Current
- Supervise and support RNs, LVNs, care coordinators, SW, and CHWs across concurrent review, prior authorization, and discharge planning; complete authorizations for acute and post-acute services (SNF, home health, DME).
- Transitioned the program from standalone care management to a hybrid, concurrent review and care management model, improving the patient journey and hospital-to-home.
- Lead SNP care management delegation: audits, policy updates, CMS compliance, and nurse training.
- Implement post-discharge CTI, and monitor program metrics to reduce readmissions, improve quality outcomes, and enhance operational efficiency.
Supervisor of Care Management, DCE/ACO REACH
Meritage Medical Network
Petaluma, California
12.2021 - 03.2023
- Built and led a full-scope care management program serving 80K+ members under ACO REACH and Medicare Advantage.
- Hired, trained, and managed a new care management team, designing workflows to support high-risk populations.
- Integrated Remote Patient Monitoring (RPM) into care management workflows to improve outcomes and reduce avoidable hospitalizations.
- Created clinical workgroups with preferred post-acute providers (home health, SNF, hospitals, and medical networks) to engage high-value partners, improve LOS management, support quality programs, and strengthen collaboration between care managers and providers.
- Collaborated with providers to meet and exceed CMS quality benchmarks, strengthening performance in value-based care.
RN Care Manager
Meritage Medical Network
Marin County, CA
12.2019 - 12.2021
- Delivered post-discharge CTI interventions (telephonic and in-person) to reduce readmissions and ED utilization.
- Collaborated with interdisciplinary care teams (ICT) to develop member-centered care plans, balancing clinical needs with social and family goals.
- Guided patients and families through complex medical decisions, ensuring safe care transitions and connection to appropriate providers and resources.
Credentialed School Nurse
San Rafael City Schools
San Rafael, USA
08.2014 - 11.2019
- Coordinated care for students with chronic or complex conditions, developing Individualized Health Care Plans (IHCPs) and collaborating with schools, families, and providers to minimize absences.
- Supervised agency treatment nurses for students with Type 1 diabetes, providing education and oversight to ensure IHCPs and Diabetes Management Plans (DMMPs) were implemented safely and effectively.
- Trained school staff on medication management and implementation of care plans to ensure safe, compliant delivery of student care.
- Ensured compliance with state mandated screenings and immunizations, leading health promotion, disease prevention, and education initiatives in partnership with the county health department.
Education
Master of Science - Nursing
California State University, Sacramento
05-2018
Associate of Science - Nursing
Merritt College, Oakland
06-2012
BS - Business Administration: Marketing
California State University, Long Beach
05-2004
Skills
- Care transitions and readmission reduction
- Interdisciplinary team leadership
- Value-based care and Medicare Advantage
- Population health program design
- EMR and UM platforms
- Regulatory compliance in healthcare
- Clinical utilization management
- Patient advocacy and engagement
Certification
- Certified Case Manager (CCM) – Commission for Case Manager Certification | Jan 2025–Nov 2029 | Credential ID 4269060
- Credentialed School Nurse (CSN) – California Commission on Teacher Credentialing, 2017
- Registered Nurse (RN) – California Board of Registered Nursing | Current: ID 826199 | Expiration: April 30, 2026
Timeline
Supervisor, Care Management and UM Concurrent Review
Meritage Medical Network
03.2023 - Current
Supervisor of Care Management, DCE/ACO REACH
Meritage Medical Network
12.2021 - 03.2023
RN Care Manager
Meritage Medical Network
12.2019 - 12.2021
Credentialed School Nurse
San Rafael City Schools
08.2014 - 11.2019
Master of Science - Nursing
California State University, Sacramento
Associate of Science - Nursing
Merritt College, Oakland
BS - Business Administration: Marketing
California State University, Long Beach
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