Jessica Herrera
Miramar,FL
Summary
Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Star Program Manager
Clear Spring Health
03.2024 - Current
- Lead the strategic planning, development, and execution of the company’s Medicare Advantage Stars initiatives to improve CMS Star Ratings and overall plan performance.
- Analyze performance data, including HEDIS, CAHPS, and HOS measures to identify trends, gaps, and opportunities for quality improvement across multiple domains.
- Collaborate cross-functionally with Quality, Care Management, Member Services, Pharmacy, Provider Relations, Compliance, IT, and external vendors to design and implement interventions that drive measurable results.
- Develop and present executive-level reports and dashboards to communicate Stars performance, risks, and mitigation strategies.
- Take part in and lead all Star committee and sub-committee groups for strategic oversight.
- Manage Stars project plans, timelines, and reporting, ensuring timely completion of deliverables and compliance with CMS requirements.
- Monitor regulatory updates and translate CMS technical specifications into actionable operational plans.
- Work toward achieving company goal of 4+ Star Rating across all Medicare Advantage markets for Clear Spring Health.
Clinical Guide: Case Manager
Devoted Health
04.2023 - 03.2024
- Assessing member’s health status throughout enrollment
- Engaging with high-risk members to understand their needs
- Conducting SDOH evaluation and connecting members to Community Social Workers as needed for resources at the community level
- Conducting holistic assessments to identify comorbid conditions, ER/hospitalization history, medications, psychosocial factors, and member values and preferences
- Applying CMS’s Health Equity Index framework to optimize member care outcomes
- Creating member Care Plans tailored to the individual member’s needs
- Working closely with Devoted Community Guides (locally based social workers) to identify community-based organizations to support Devoted members in meeting their goals
- Coordinating care between the member, member’s provider, and the health plan
- Facilitating a seamless transition of care from acute care settings to lower levels of care
- Collaborating closely with our PCP partners, as well as Devoted Medical Group, to coordinate care and deliver evidence based, effective, and accessible health care
- Closing STARS gaps for members through collaborative approach
- Adhering to the Model of Care for SNP members
Case Manager & Quality Improvement Specialist
Clear Spring Health
03.2019 - 04.2023
- Assessed member’s health status throughout enrollment
- Provided up-to-date health education to members
- Coordinated comprehensive care plans tailored to individual client needs.
- Worked with area-specific Agencies on Aging for additional member resources
- Coordinated care between the member, member’s provider, and the health plan
- Facilitated a seamless transition of care from acute care settings to lower levels of care
- Adhered to the Model of Care for SNP members
- Followed state and federal laws and regulations as required for member population
- Reviewed medical records and documents to abstract clinical data for HEDIS reporting
- Documented findings in MedHOK
- Met daily abstraction goals and maintained a high abstraction accuracy percentage
- Preparing and presenting HEDIS compliance reports to health facility managers.
- Helped trained appropriate staff on HEDIS compliance
- Kept up-to-date knowledge HEDIS measures.
- Brainstormed ideas to help close STARS gaps in member population
- Participated in STARS conventions for up-do-date information
RN Health Center Operator
TeleMedCare America
07.2018 - 02.2019
- Provided patient telemonitoring services: assessing and supporting patient's physical and emotional status; communicating altered patient statuses to relevant care providers
- Provided patient teachings regarding healthy habits and medication regimen compliance
- Helped develop and implement a new EMR program
- Created and implemented policies and procedures for Health Control Center
- Created bilingual Patient Manuals and RN Equipment Installation Manuals
School Nurse
Integrity Health Services
08.2017 - 07.2018
- Administered first aid and medication to students, ensuring compliance with health regulations.
- Conducted health assessments and screenings, identifying potential health issues among students.
- Served as a liaison between school personnel, family, and healthcare providers
- Developed individual and emergency care plans for students at-risk of experiencing a health emergency
Medical-Surgical Registered Nurse
Palmetto General Hospital
11.2017 - 04.2018
- Performed evidence-based practices to provide nursing care
- Monitored, documented, and communicated patient’s condition
- Administered medications and monitored patient responses to ensure optimal therapeutic outcomes.
- Collaborated with interdisciplinary teams to develop and implement individualized care plans.
Education
Master of Science - Nursing, Family Nurse Practitioner
Ana G. Mendez University
05.2025
Bachelor of Science - Nursing
Florida International University
Miami, FL04.2017
Skills
- Clinical assessment
- Preventive care
- Patient education
- Health promotion
- Interprofessional collaboration
- Chronic disease management
- Remote patient monitoring
- Healthcare software proficiency
- Nursing informatics
- Detail-oriented
- Strategic planning
- Problem-solving
Certification
- Florida Registered Nurse Multistate Registered Nurse License # 9462855 Expires April 30, 2027
- Illinois Registered Nurse License # 041520538 Expires May 31, 2026
- BLS Certified American Heart Association Expires August 2026
LANGUAGES
Fluent in English and Spanish
Timeline
Star Program Manager
Clear Spring Health
03.2024 - Current
Clinical Guide: Case Manager
Devoted Health
04.2023 - 03.2024
Case Manager & Quality Improvement Specialist
Clear Spring Health
03.2019 - 04.2023
RN Health Center Operator
TeleMedCare America
07.2018 - 02.2019
Medical-Surgical Registered Nurse
Palmetto General Hospital
11.2017 - 04.2018
School Nurse
Integrity Health Services
08.2017 - 07.2018
Bachelor of Science - Nursing
Florida International University
Master of Science - Nursing, Family Nurse Practitioner
Ana G. Mendez University
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