Jan Sturgeon
Springfield
Summary
Dynamic Clinical Quality Program Manager with a proven track record at Elevance, excelling in strategic planning and project management. Adept at fostering stakeholder relationships and utilizing data-driven decision-making to enhance outcomes. Recognized for leadership in HEDIS initiatives and process improvement, demonstrating strong problem-solving and critical thinking skills.
Overview
34
34
years of professional experience
Work History
Clinical Quality Program Manager
Elevance
05.2023 - Current
- Established strong relationships with key stakeholders, ensuring support for program initiatives.
- Developed strategic plans, setting clear objectives and achievable milestones for the team.
- Utilized data-driven decision-making approaches to inform strategy development and optimize outcomes.
- Preparation and support of state reports as well as internal reports. requiring time management and prioritiziation skills, and strong coordination of information and support from others, to deliver reports on time and to specification without ever experiencing a CAP from the state on quarterly or annual quality reports.
- Work HEDIS season in collaboration with the national team with data abstraction, overreading and auditing member charts.
- 2 year long project in support of large provider groups and FQHC's data feeds through collaboration with the internal IT tteams, external customer IT teams as well as leadership at the group.
- Ability to change plans and schedules at the last minute to adapt to ever changing stakeholder dynamics, Elevance, NCQA and the state level.
- Develop and maintain relationships with Elevance teams for seamless creation of CAHPS survey project, as well as Healthy Rewards and VABs.
- Working with state level quality leadership to develop initiatives and working to implement corporate wide initiative while navigating the nuances of different state health plans needs.
- Provide education, evaluation and oversight of team members working with HEDIS initiatives.
Transition Care Coordinator
United Health Care
03.2021 - 05.2023
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions. Responsible for care management as well as utilization review of members in skilled nursing facilities and at home.
- Developed strong relationships with community partners, nursing home leadership and facilitating referrals and collaboration on behalf of patients.
- Conducted regular evaluations of care plan effectiveness, making necessary adjustments based a proprietary tool within UHC at Navihealth.
- Assessed patient needs and connected them with appropriate resources to ensure optimal health outcomes transitioning from facility to the home setting.
Case Manager Manager, Complex Care Management
Optum, UnitedHealth Group
09.2019 - 03.2021
- Case Managment Manger for DSNP members in plans with United Health Care. This was a telephonic role doing triage In Bound Calls for the On call NP team, answering and assessing in real time Nurses report of patients condition and producing SOAP note of information for transfers to the NP as needed. Monitoring and outreach on ongoing cases, adjusting case management strategies as needed based on evolving circumstances or new information.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Delegating to the facility nurses Orders and actions for care as per the Nursing Orders and delegate orders given by the NP for care.
- Oversee, manage and delegate to a team of nurses as well as acting as a liason between the nurses and NP's if issues arose.
- Collaborate with leadership for initiatives, changes and modifications to the contract between the health plan and Optum.
Senior Clinical Practice Consultant
UnitedHealth Group
08.2017 - 09.2019
- Managed multiple projects simultaneously, prioritizing tasks effectively to meet deadlines and exceed expectations.
- Delivered engaging presentations for Large Provider Groups, such as Ohio State University Physician group, detailing HEDIS findings and recommendations, promoting clear communication and understanding.
- Assisted in the development of initiatives highlighting the practice''s outcomes, opportunities for greater success and tools to bring the initiative to fruition.
- Collaborated with the national team for abstraction, overreading and auditing of member collected data for the HEDIS Hybrid project and NCQA compliance every year.
- Education to practice leadership, and quality leaders within the organization on guidelines and incentive payouts based on their contract with UHC.
- Managing, interpreting and educating Provider groups on data sources and work to drive change and progress within the health care groups.
Case Manager & Case Manager Manager
United Healthcare
08.2014 - 08.2017
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Responsible for working closely on a team in a pilot program for ISNP/DSNP CMS for an RN NP Model for delivery of patient care in the Long Term Skilled Facility as well as case management in the long term care MMP patients.
- Worked with internal and external providers’ case managing patients in the MMP program. Worked with the NP to give pre-authorization/pre-authorization for skilled stay in the nursing homes we serviced. Managed NOMNC and patient and family discussion when patient no longer qualified for skilled services.
- Responsible for a case load of patients and both their HEDIS & STAR measures for compliance of these programs. Responsible for assisting the NP & Providers with coding options, ensuring the providers were coding correctly to capture the HEDIS/STAR measures and with the NP to increase/stabilize members RAF scores for reimbursement.
- Manage a group of 12 case managements evaluating their progress, outcomes and metrics for patients being seen by them throughout the program.
Staff RN, Data Analyst, Transition of Care Manager
Mercy Health
01.1992 - 08.2014
- Worked as astaff RN, charge nurse and house supervision in ICU, CCU, ER, Interventional Radiology, and Cardiac Cath lab from January 1992 to January 2009
- in January 2009-October 2013 served as the Quality Data Manager and IT Liason for the Cardiology department, responsible for ACC outcomes, education and auditing.
- 2011 Managed the project for transition the cardiology departments in the hospital & hospital owned groups to bring on EPIC as well as GE Centricity into the cardiac cath lab with the opening of a t new hospital. Oversaw the starting of 13 other new data systems with monitoring of education, testing and compliance of the cardiology department staff.
- 2013, transitioned to a new role developing a transition of care manager team. Goals of outreach to discharged patients to decrease readmission and return to the hospital. Team was made up of a staff of 5.
Education
Health Care Administration
ITT
Dayton, Ohio06-1997
Associate of Science - Registered Nursing
Clark State Community College
Springfield, OH06-1993
Skills
- Problem-solving
- Project management
- Detail-oriented
- Strategic planning
- Process improvement
- Team leadership and direction
- Decision-making
- MS office applications
- Project coordination
- Critical thinking
- Interpersonal skills
- Work Planning and Prioritization
Timeline
Clinical Quality Program Manager
Elevance
05.2023 - Current
Transition Care Coordinator
United Health Care
03.2021 - 05.2023
Case Manager Manager, Complex Care Management
Optum, UnitedHealth Group
09.2019 - 03.2021
Senior Clinical Practice Consultant
UnitedHealth Group
08.2017 - 09.2019
Case Manager & Case Manager Manager
United Healthcare
08.2014 - 08.2017
Staff RN, Data Analyst, Transition of Care Manager
Mercy Health
01.1992 - 08.2014
Health Care Administration
ITT
Associate of Science - Registered Nursing
Clark State Community College
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