Holly Palivoda
Registered Nurse, BSN
Canonsburg,Pa
Summary
Offers demonstrated strengths in clinical acumen and leadership honed over extensive healthcare career. Confident in approach and analytical in dealing with common problems. Handles emergencies with calm, level-headed mindset.
Overview
20
20
years of professional experience
4
4
years of post-secondary education
2
2
Certificates
Work History
Quality Clinical Management Advisor
Cigna Healthcare
05.2020 - Current
- NCQA and URAC – File review, policy review, presentation to accrediting body.
- Reporting for Customer Satisfaction, Case Management department quality and Individual Quality.
- Quality Improvement Projects and Corrective Action Plan: Initiation, monitoring, oversight, interventions and completion.
- Digital Case Management Project Quality SME.
- Maintenance and creation of Case Management Policies and Procedures.
- Various other ad hoc quality and case management projects and process improvements.
Transplant Nurse Case Management Manager
Cigna Healthcare
09.2015 - 05.2020
- Direct oversight of team of 16-18 transplant case managers who perform all Case Management and Utilization Management activities across lifespan for Solid Organ, Stem Cell Transplant, CAR-T cell therapy and related clinical trials.
- Dedicated to mentoring and supporting professional development of staff across department as well as individual members of personal team.
- Work escalated cases in conjunction with Leadership regarding customers or providers that expressed discontent with product delivery or benefit limitations.
- Responsible for ensuring that program guarantees are met with dedicated client accounts.
- Support external client audits in case preparation, support of presentation and representation of leadership in audit room.
- Transplant Supervisory Lead for:
- Arizona Medicare Remediation and Medicare Sustainment – Developed Utilization Management program within CMS guidelines alongside development of case management program to meet population needs
- CAR-T Cell and Other Cellular Therapies – Worked closely with Cigna Stem Cell Transplant Medical Director and Cigna Lifesource Transplant Network Financial team to develop a Utilization Review process and provider network in conjunction with a case management program specifically designed for the CAR-T cell recipient
- Capacity and Finance – FTE management for department with capacity and finance team; worked with HR services for job postings and interview scheduling; performed onsite and virtual interviews
- Multiple Lines of Business Lead
- Lifesource Contracting Supervisory Lead – worked closely with Cigna Lifesource Transplant Network Leadership team in areas of claims, appeals and contract review.
- MOS Redesign and Continued Sustainment – Management Operating System (MOS) - detailed a case manager's work day activities which allowed for coaching, development of performance improvement plans and metric achievement for the nurse case manager
Transplant Case Manager Team Lead
Cigna Healthcare
12.2013 - 09.2015
- Responsible for assisting supervisor with team and project work
Transplant Case Manager
Cigna Healthcare
06.2009 - 12.2013
- Responsible for managing a Transplant CM caseload.
- Managed multiple dedicated accounts - high touch clients and customers.
PRN Float Nurse
Children’s Hospital of Pittsburgh
03.2005 - 05.2009
- Acute Care Float: Med/Surg, Neurosurg, ortho,oncology, & transplant to support staffing needs.
- Conducted rounds with medical staff to promote improved understanding between patients, nursing staff and medical staff to support continued quality of communication and care.
- Promoted patient and family teaching to enhance patient understanding of needs and potentially accelerate recovery.
NICU Registered Nurse
Children's Hospital Of Pittsburgh
10.2001 - 06.2002
- Assessed, evaluated and cared for neonate and pediatric infants.
- Communicated with family members and loved ones to provide information about patient care, treatments and medical options.
Pediatric Surgery Charge RN
Children's Hospital Of Pittsburgh
05.1998 - 11.2000
- Provided patient post-surgical care for pediatric patients infant-20 & addressed concerns, supported staff & collaborated with surgical team for positive outcomes.
Education
Bachelor of Science - Nursing
Duquesne University
01.1994 - 01.1998
Skills
Leadership
undefinedCertification
Registered Nurse RN522502-L
Timeline
Quality Clinical Management Advisor
Cigna Healthcare
05.2020 - Current
ANCC Board Certification in Case Management Certification # 2018075561
09-2018
Transplant Nurse Case Management Manager
Cigna Healthcare
09.2015 - 05.2020
Transplant Case Manager Team Lead
Cigna Healthcare
12.2013 - 09.2015
Transplant Case Manager
Cigna Healthcare
06.2009 - 12.2013
PRN Float Nurse
Children’s Hospital of Pittsburgh
03.2005 - 05.2009
NICU Registered Nurse
Children's Hospital Of Pittsburgh
10.2001 - 06.2002
Registered Nurse RN522502-L
07-1998
Pediatric Surgery Charge RN
Children's Hospital Of Pittsburgh
05.1998 - 11.2000
Bachelor of Science - Nursing
Duquesne University
01.1994 - 01.1998
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