Heidee Love Sevilla
Springfield,OR
Summary
Talented Manager with expert team leadership, planning and organizational skills built during successful career. Smoothly equip employees to independently handle daily functions and meet customer needs. Diligent trainer and mentor with exceptional management abilities and results-driven approach. Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings. 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. Insightful Manager with experience directing and improving operations through effective employee motivational strategies and strong policy enforcement. Proficient in best practices, market trends and regulatory requirements of industry operations. Talented leader with analytical approach to business planning and day-to-day problem-solving. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
23
23
years of professional experience
Work History
Manager, Medical Management Auditing
Centene, Trillium Community Health Plan
04.2022 - Current
- Coordinated care/services and discharge planning for acute and chronically ill patients
- Accountable for cost-effective utilization and management of resources while maximizing quality care, provider/vendor negations
- Developed and maintained audit process and tools related to authorizations, appeals, quality events, and case management in CCMS; inter-rater reliability related to InterQual; and data entry into credentialing subsystem
- Created and maintained policies and procedures are well as workflows for Population Health and Clinical Operations Department as well as ensured national and state level compliance and other regulatory requirements
- Coordinated auditing outcomes with Directors to identify, develop and publish corrective actions/educational material related to audit errors
- Acted as point person for National Regulations and OARs as related policy and oversite processes for CCO as well as prepared reports and records on work function activities for management.
- Accomplished multiple tasks within established timeframes.
- Maximized performance by monitoring daily activities and mentoring team members.
- Cross-trained existing employees to maximize team agility and performance.
Supervisor, Utilization Management/Clinical Quality Improvement
Centene, Trillium Community Health Plan
03.2019 - 04.2022
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
- Monitored workflow to improve employee time management and increase productivity.
- Evaluated employee performance and coached and trained to improve weak areas.
- Maintained compliance with company policies, objectives, and communication goals.
- Mentored newly hired employees on operating equipment and safety and developed training manual to use for reference.
- Conducted routine inspections to check quality and compliance with established specifications.
- Solicited customer feedback to identify and improve on areas of weakness.
- Performed prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Self-motivated, with a strong sense of personal responsibility.
- Skilled at working independently and collaboratively in a team environment.
Lead Auditor/Quality Assurance
Centene, Trillium Community Health Plan
06.2017 - 03.2019
- Followed established auditing processes to meet internal and regulatory requirements.
- Communicated with auditee staff to obtain necessary information for audits.
- Performed observations and evaluated supporting documents to supplement audit findings.
- Analyzed data and findings to prepare reports detailing financial information.
- Planned audits and audit activities to allocate necessary resources and determine consistency of plans with audit objectives.
- Administered auditing program to address risks and evaluate compliance with regulatory requirements.
- Identified control gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
- Coordinated, managed and implemented auditing projects and prepared for evaluation.
- Interviewed auditees to gather data needed to conduct audits.
- Interpreted state and federal laws, accepted auditing principles and procedures and program standards to audited materials and data to detect non-compliance and facilitate recommendations.
- Obtained and interpreted relevant and authoritative criteria for program or issues under audit.
Director of Nursing
Hillside Heights Rehabilitation Suites
01.2015 - 03.2017
- Managed successful behavioral psych program in in-patient setting
- Coordinated mental health services for 50+ patients with both practitioners within facility and community services
- Completed utilization reviews and quality assurance audits, including analysis for data, facility action plans and integrations of best practices
- Maintained open line of communication with Union bargaining team and successfully negotiated contracts for 2 consecutive years
- Acted as key Quality Assurance person and reported monthly/quarterly/yearly to federal and state reporting agencies.
- Monitored and evaluated nursing staff performance, providing feedback and guidance to support standards of care.
- Built and maintained positive working relationships with physicians and staff to support seamless healthcare operations.
- Established new policies and updated existing policies to improve standard of care for patients.
Director of Nursing Services
Avamere Eugene Rehabilitation Center
07.2013 - 12.2014
- Monitored and evaluated nursing staff performance, providing feedback and guidance to support standards of care.
- Participated in management team meetings to discuss resident status, census changes, and resident complaints or concerns.
- Performed rounds to observe care and interview staff, residents, and families.
- Established new policies and updated existing policies to improve standard of care for patients.
- Developed positive employee relations, incentives, and recognition programs to promote teamwork and mutual respect.
- Collaborated with staff, management, and external groups to coordinate patient care.
- Worked closely administration to develop and implement best practices to improve patient outcomes.
- Built and maintained positive working relationships with physicians and staff to support seamless healthcare operations.
- Identified department issues to recommend corrective actions.
- Oversaw and approved recruitment, hiring and orientation of new nursing staff.
- Prepared and reviewed infection control surveillance reports to identify trends and develop effective actions to control and prevent infections.
- Facilitated continuing education and training programs to drive staff competency and professional development.
Director of Nursing
Laurel's Rehabilitation Center (Contract)
07.2012 - 06.2013
- Monitored and evaluated nursing staff performance, providing feedback and guidance to support standards of care.
- Built and maintained positive working relationships with physicians and staff to support seamless healthcare operations.
- Oversaw and approved recruitment, hiring and orientation of new nursing staff.
- Participated in management team meetings to discuss resident status, census changes, and resident complaints or concerns.
- Worked closely administration to develop and implement best practices to improve patient outcomes.
- Performed rounds to observe care and interview staff, residents, and families.
- Facilitated continuing education and training programs to drive staff competency and professional development.
- Established new policies and updated existing policies to improve standard of care for patients.
Director of Nursing Services
Riverside Health System (Contract)
01.2012 - 06.2012
- Monitored and evaluated nursing staff performance, providing feedback and guidance to support standards of care.
- Participated in management team meetings to discuss resident status, census changes, and resident complaints or concerns.
- Performed rounds to observe care and interview staff, residents, and families.
- Established new policies and updated existing policies to improve standard of care for patients.
- Worked closely administration to develop and implement best practices to improve patient outcomes.
- Built and maintained positive working relationships with physicians and staff to support seamless healthcare operations.
- Collaborated with staff, management, and external groups to coordinate patient care.
- Oversaw and approved recruitment, hiring and orientation of new nursing staff.
- Facilitated continuing education and training programs to drive staff competency and professional development.
Director of Clinical Operations
Maxim Health Services
01.2011 - 01.2012
- Developed systems and procedures for effective project management and clinical operations.
- Planned and managed adherence to project budget and contracts and assisted in identification and development of scope change documents.
- Oversaw clinical studies focused on quality assessment, financial health and customer relations.
- Coached nursing employees and supported positive behavior and interactions with patients and colleagues.
- Established and maintained contacts at various management levels regarding clinical operations department and specific projects.
- Represented organization at all community events, answering questions, providing details and giving informative presentations.
- Developed, implemented, revised, and evaluated policies and procedures.
- Developed and implemented strategic plans enabling facility to meet budgetary and quality assurance goals.
- Monitored, analyzed, and corrected staff performance and worked with nurse manager to raise standards of practice.
- Provide ongoing case management to patients to implement appropriate treatment plan, adhere to quality models and maximize utilization of services needed to achieve optimal outcomes.
Director of Nursing
Brookdale Senior Living Facility
01.2010 - 01.2011
- Monitored and evaluated nursing staff performance, providing feedback and guidance to support standards of care.
- Built and maintained positive working relationships with physicians and staff to support seamless healthcare operations.
- Oversaw and approved recruitment, hiring and orientation of new nursing staff.
- Participated in management team meetings to discuss resident status, census changes, and resident complaints or concerns.
- Worked closely administration to develop and implement best practices to improve patient outcomes.
- Performed rounds to observe care and interview staff, residents, and families.
- Collaborated with staff, management, and external groups to coordinate patient care.
- Established new policies and updated existing policies to improve standard of care for patients.
- Established and monitored infection control programs to provide safe, sanitary environment to prevent transmission of disease and infection.
- Prepared and reviewed infection control surveillance reports to identify trends and develop effective actions to control and prevent infections.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
- Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
Assistant Director of Nursing
Kindred Healthcare Inc.
01.2009 - 01.2010
- Participated in management team meetings to discuss resident status, census changes, and resident complaints or concerns.
- Established and monitored infection control programs to provide safe, sanitary environment to prevent transmission of disease and infection.
- Performed rounds to observe care and interview staff, residents, and families.
- Prepared and reviewed infection control surveillance reports to identify trends and develop effective actions to control and prevent infections.
- Collaborated with staff, management, and external groups to coordinate patient care.
- Established new policies and updated existing policies to improve standard of care for patients.
- Developed positive employee relations, incentives, and recognition programs to promote teamwork and mutual respect.
- Built and maintained positive working relationships with physicians and staff to support seamless healthcare operations.
- Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
Nursing Informatics Specialist
Cleveland Clinic
01.2008 - 01.2009
- Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows.
- Influenced care outcomes by implementing improvements and optimizing health information technology.
- Served as liaison between end-users and health IT team.
- Applied medical subject matter knowledge to improve IT systems and functions.
- Worked closely with subject matter experts to develop solutions and improvements for clinical systems.
- Researched and validated clinical data.
- Analyzed electronic health records to identify areas for care improvement and cost reduction.
- Applied knowledge, data, information and workflow to develop evidence-based models for health information technology solutions.
- Incorporated quality improvement and safety-enhancing methodologies and tools to improve workflow processes,
- Operated computer-based systems to retrieve and store information and records.
- Worked with product engineering team to define clinical requirements and assist with testing.
- Used advanced health informatics knowledge and judgment to promote colleague involvement in planning, decision-making and evaluating outcomes.
- Developed and updated health information systems and interfaces.
- Led, facilitated and attended focus groups and meetings to strategize workflow issues.
Licensed Practical Nurse
US Army
01.2001 - 01.2008
- Cared for wounds, provided treatments, and assisted with procedures.
- Assisted with admissions, appointments, transfers, and discharges.
- Documented accurate and complete patient information to address patient problems and expected outcomes.
- Obtained patient vital signs and input/output measurements from inpatients.
- Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
- Administered controlled narcotics, inserted IVs, and performed catheterizations.
- Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Used aseptic techniques to provide sterilized wound care and dressing applications.
- Performed routine evaluations of each patient's status, needs, and preferences.
- Delivered updates in patient status to charge nurse, recording changes in medical records.
- Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning.
- Gathered lab specimens, ordered testing, and interpreted results to diagnose patients.
- Answered incoming phone calls from patients to provide basic assistance and triage medical concerns.
- Comforted and counseled patients and families throughout care process.
Education
Master of Science - Family Practice Nurse Practitioner
Chamberlain College of Nursing
St Louis, MO2025
Bachelor of Science - Registered Nursing
Chamberlain College of Nursing
St Louis, MO2012
Associate of Science - Registered Nursing
Rets School of Nursing
Cuyahoga Falls, OH2009
Licensure - Practical Nursing
US Army School of Practical Nursing
Ft Sam Houston, TX2003
Skills
- CASE MANAGEMENT/UTLIZATION MANAGEMENT
- MICROSOFT OFFICE/SHAREPOINT
- QUALITY ASSURANCE/ANALYTICS
- EMR SYSTEMS/HEALTH INFORMATTION MANAGEMENT
- POLICY DEVELOPMENT
- MEDICARE AND MEDICAID
- NQCA/HEDIS
- PROGRAM DEVELOPMENT/PROCESS IMPROVEMENT
- COMMUNICATION/PRESENTATION SKILLS
- TRAINING AND DEVELOPMENT
- LEADERSHIP
- SOCIAL LISTENING/PUBLIC SPEAKING
- COMPLIANCE AND REGULATORY REPORTING,
- CLINICAL DEVELOPMENT/CHANGE MANAGEMENT
- BUSINESS DEVELOPMENT AND OPERATIONS
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Manager, Medical Management Auditing
Centene, Trillium Community Health Plan
04.2022 - Current
Supervisor, Utilization Management/Clinical Quality Improvement
Centene, Trillium Community Health Plan
03.2019 - 04.2022
Lead Auditor/Quality Assurance
Centene, Trillium Community Health Plan
06.2017 - 03.2019
Director of Nursing
Hillside Heights Rehabilitation Suites
01.2015 - 03.2017
Director of Nursing Services
Avamere Eugene Rehabilitation Center
07.2013 - 12.2014
Director of Nursing
Laurel's Rehabilitation Center (Contract)
07.2012 - 06.2013
Director of Nursing Services
Riverside Health System (Contract)
01.2012 - 06.2012
Director of Clinical Operations
Maxim Health Services
01.2011 - 01.2012
Director of Nursing
Brookdale Senior Living Facility
01.2010 - 01.2011
Assistant Director of Nursing
Kindred Healthcare Inc.
01.2009 - 01.2010
Nursing Informatics Specialist
Cleveland Clinic
01.2008 - 01.2009
Licensed Practical Nurse
US Army
01.2001 - 01.2008
Master of Science - Family Practice Nurse Practitioner
Chamberlain College of Nursing
Bachelor of Science - Registered Nursing
Chamberlain College of Nursing
Associate of Science - Registered Nursing
Rets School of Nursing
Licensure - Practical Nursing
US Army School of Practical Nursing
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