HEATHER ROGERS, MSN RN
Corsicana,Texas
Summary
Patient-oriented nurse with 14 years of diverse experience in direct patient care, team leadership and health care quality. Extensive knowledge in patient assessments, process improvement workflows, patient safety, and partnering with interdisciplinary care teams to achieve best practices and the highest quality of care. Compassionate, goal-oriented, internally driven master prepared nurse seeking admission into the PMC-FNP program.
Overview
14
14
years of professional experience
Work History
National RN Quality Manager
Privia Health
10.2022 - Current
- Build strategy on key quality and clinical opportunity areas
- Assist AVP, Care Partners with Provider Engagement metrics/scorecard to promote buy-in and engagement across markets
- Internal subject matter expert on particular areas of clinical quality: MSSP, MA Stars, Commercial, CAHPS
- Implement of new Accountable Care Organizations (ACOs)
- Create and update quality program educational resources
- Execute quality initiatives to promote holistic safe patient care
- Perform onsite visits to assist in AWVs, medication reconciliation, chronic condition management and diabetic gap closure
- Support EHR Quality data conversions
- Manage and support relationships between internal partners and external payers
National RN Quality Training Consultant
Optum
01.2021 - 10.2022
- Development of quality education content for internal staff, providers and members while ensuring quality education materials are up-to-date, professionally created, and optimize learning for CDOs and the Clinical Performance Quality organization
- Research and development of best practice documents that support quality improvement strategies for provider and member initiatives to improve metrics
- Leading HEDIS and Stars training providing seminars
- Responsible for document repository management, intake of requests, and educational site
- Responsible for evaluating, development and updating SOPs, workflows, and job aids
- Responsible for management of NCQA PCS Q&A and ad-hoc trainings for annual and interim changes to
- Lead various committees to enhance and improve patient outcomes
- Interviewing and training of onboarding RNs
- Medical Record documentation review
Practice Performance Manager
Optum, Field Operations
03.2019 - 01.2021
- Collaborates with Senior leadership to drive performance for M&R contracts (80%+ of membership in 4 Star plans) including working with Group Retiree and C&S membership
- Lead PPM with responsibility of gathering necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation
- Responsible for increasing compliance with Part C non-structured and structured data submissions
- Collaborate with healthcare providers to discuss UHG and incentive programs focused on improving the quality of care for Medicare Advantage members
- Execute education & trainings for healthcare organizations
- Establish positive, long-term consultative relationships with physicians, medical groups, IPAs and ACOs
- Develop comprehensive, provider-specific plans to increase provider performance and improve patient outcomes
- Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
- Coordinate and perform onsite medical record reviews/audits
- Coordinate and lead Stars specific JOC meetings with provider groups to drive continual process improvement and achieve goals
Registered Nurse, ED (PRN)
Providence Health
02.2020 - 11.2021
- Assessed and prioritized patients based on severity of illness including pediatrics, adults, and geriatrics
- Provided direct patient care, stabilized patients and determined next course of action.
- Administered medications via oral, IV and intramuscular injections and monitored responses.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Monitored ongoing condition of patients
- Collected lab specimens per physician orders
Sr. Clinical Quality Practice Consultant
United Health Group, C&S
10.2015 - 03.2019
- Educate organizations on HEDIS, pay for performance, and medical record review criteria
- Lead Clinical Practice Consultant for Star Plus service delivery areas within our team
- Perform onsite medical record reviews/audits to determine compliance with quality metrics
- Referral for patients who need disease management or case management services
- Educates provider and office staff on updated coding that would result in administrative data retrieval
- Assist in identifying barriers and solutions that provider office faces in providing care to our members
- Participate heavily in the HEDIS medical record chase to support HEDIS data collection for reporting
- Provide follow-up education, practitioner intervention, and measurement as needed to drive quality improvement
- Managed a trusting professional relationship with providers in my assigned 31 counties
Clinical Care Manager
United Health Group, C&S
05.2014 - 10.2015
- RN Preceptor for Central Texas
- Perform holistic telephonic and face-to-face clinical assessments to aid in care coordination and management of member’s needs
- Responsible for performing MNLOC assessments and submitting via TMHP LTC online portal
- Manage members with chronic illness, co-morbidities, and disabilities to ensure effective utilization of health benefits
- Obtain accurate member health history to develop an accurate care plan with a focus on quality
- Assess members for potential upgrade to SPW within time limits set forth
- Assists with the implementation of member care plans by initiating authorizations Identifies high risk members and facilitates referrals that aid in the enhancement of member’s health
- Collaborate with interdisciplinary teams on the development of care treatment plans
- Documentation within an electronic computer program within a specified timeframe
- Obtain medical equipment, adaptive aids, and minor home mods utilizing Medicare and Medicaid guidelines
- Identify delays or barriers that may hinder the member’s ability to live within the home
- Act as a liaison and member advocate between member/family, physician, and agencies
- Assume a leadership role within the Interdisciplinary Team to achieve optimal clinical and resource outcomes for the member
RN Case Manager
Baylor Scott & White Hillcrest
05.2011 - 05.2014
- Daily assignments, Meeting agendas, point of contact for members of the team if barriers occur, monitoring and supervising the daily work activities and progress
- Actively participated in the interviewing and hiring process for new hires
- Provide mentorship to new Case Managers and students
- Responsible for helping develop and train employees on new computer system for health care organization
- Developed process improvement plan that aims to increase patient and family engagement in CHF patients with a goal to reduce admissions and improve patient satisfaction scores
- Apply clinical criteria for severity of illness and intensity of service
- Perform Utilization reviews for admissions and concurrent reviews for continued stay using McKesson
- InterQual
- Communicate coverage, financial and clinical information to appropriate staff
- Identify patients for whom resource consumption poses an actual or potential risk to the hospital
- Ensure appropriate utilization of resources in accordance with Medicare/Medicaid guidelines and reimbursements
- Plan for nursing home placement, home health services, home equipment and supplies, and transportation for safe discharge planning
- Assure appropriate referrals are made to community support agencies to ensure safe transitions
- Assign working DRG’s for all inpatient admissions based upon clinical information
- Work with physicians to perform chart reviews and justify diagnoses in accordance with guidelines
- Identification and documentation of delays or barriers that hinder appropriate inpatient hospital utilization
- Identify opportunities for improvement of quality care
- Prepare appropriate documentation for discharge such as patient and family teaching
Emergency Room Registered Nurse
Baylor Scott & White Hillcrest
05.2009 - 11.2014
- Provide emergency medical care for a 42 bed Level II Trauma Center with 4 Critical Care/Trauma Rooms
- Acting as a leader by orientating new hires and providing mentorship to nursing students
- Charge Nurse
- Quality emergency medical care to patients requiring emergency treatment in accordance with physician orders, hospital policy, and standard nursing practice
- Perform patient assessment and nursing diagnosis while managing the planning and implementation of interventions
- Coordinate patient referrals and discharge planning activities
- Experience in all fields of emergency nursing: minor, intermediate, major care, and triage
- Responsible for assessing and prioritizing a wide variety of patients including pediatrics, adults, and geriatrics
- Responsible for admission, assessment, intervention care and evaluation of patients and undertaking any orders prescribed by doctors
- Responsible for teaching Trauma Certification course for both adult and pediatrics
- Workedwithmanagementtodevelophuddlesatthebeginningoftheshifttofocusonprocessimprovements, daily goals, and staffing needs
Education
Master Science Nursing Administration -
Texas Tech University Health Sciences Center
Lubbock, TX12.2013
Bachelor Science Nursing -
Texas Tech University Health Sciences Center
Lubbock, TX05.2011
Associate Degree Nursing -
McLennan Community College
Waco, TX05.2009
Skills
- Evidence Based Practice
- Chronic Disease Management
- Conflict Resolution
- Quality Improvement Activities
- Emergency Situations
- Utilization Review
- Disease Management
- Individualized Care Plans
- Preventive Care
- Patient Education
- Health Promotion
- Patient Safety
Professional Memberships
- American Nurse Association (ANA)
- Texas Nurse Association (TNA)
- National Association for Healthcare Quality (NAHQ)
References
Sherrie Hogg, MSN, RN
Ph: (404) 578-8978
Email: hosher76@gmail.com
Abbey Fynewever, MBA
Ph: (616) 745-4476
Email: abbey.fynewever@northisde.com
Amy Rusterholtz, RN
Ph: (254) 723-5315
Email: amyrusterholtz@uhc.com
Lisa Spencer, RN
Ph: (860) 402-0081
Email: lspencer@optum.com
Cheryl Wadley Russell, MSN, RN
Ph: (708) 769-6379
Timeline
National RN Quality Manager
Privia Health
10.2022 - Current
National RN Quality Training Consultant
Optum
01.2021 - 10.2022
Registered Nurse, ED (PRN)
Providence Health
02.2020 - 11.2021
Practice Performance Manager
Optum, Field Operations
03.2019 - 01.2021
Sr. Clinical Quality Practice Consultant
United Health Group, C&S
10.2015 - 03.2019
Clinical Care Manager
United Health Group, C&S
05.2014 - 10.2015
RN Case Manager
Baylor Scott & White Hillcrest
05.2011 - 05.2014
Emergency Room Registered Nurse
Baylor Scott & White Hillcrest
05.2009 - 11.2014
Master Science Nursing Administration -
Texas Tech University Health Sciences Center
Bachelor Science Nursing -
Texas Tech University Health Sciences Center
Associate Degree Nursing -
McLennan Community College
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