Judy Fears
Ravenswood
Summary
Dynamic and results-driven Registered Nurse with over 20 years of expertise in case management, managed care disease management, and utilization review, complemented by advanced proficiency in healthcare IT systems, including Health Informatics and Epic implementations. As an Oncology Nurse Navigator, excelled in bridging over 250 patients annually to essential providers, diagnostics, and resources, reducing treatment delays by 30% and improving patient satisfaction scores to 95%. Served as Clinical Systems Manager for a Fortune 50 organization, spearheading Epic command center launches, upgrades, and go-lives for 5,000+ clinicians, optimizing workflows and cutting system downtime by 40%. Proven clinical leader adept at fostering interdisciplinary collaboration across teams of 20+, delivering coordinated care and excels in multitasking a caseload of 50 high-risk patients, conflict resolution, and cultivating positive team environments through exemplary guidance.
Overview
19
19
years of professional experience
1
1
Certification
Work History
RN Case Manager, ER Census Program
Wellpoint
02.2024 - Current
- One of two RN Case Managers to work the ER Census Program managing members who have had greater than 6 ER visits in the previous six months w/inpatient review, Point Click Care, Gainwell and Member 360 as well as others.
- Received three Impact Award Bonuses for diligent and concise documentation and presentation work in 2004.
- Utilizes the nursing process to meet an individual’s health needs, utilizing plan benefits and community resources.
- Educates members about contracted physicians, facilities and healthcare providers.
- Developed favorable working partnerships and collaborative relationships with members, physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members.
- Works in collaboration with medical management and care management associates to identify issues, problems, and resource needs and refer to appropriate care management program.
- Partners with social work as appropriate.
- Identifies and refers cases or issues to QI, SIU, Subrogation, Underwriting, or other departments as appropriate.
- Develops a working knowledge of member benefits, contracts, medical policy, professional standards of practice, and current healthcare practices.
Oncology Nurse Navigator, Case Manager RN Oncology
WVU Medicine Camden Clark Medical Center
09.2023 - 12.2024
- RN Nurse Navigator for 2 departments in busy Oncology clinic consisting of patient population of 1800 cancer patients and 500 active treatment patients.
- Provide support and resources to oncology patients throughout the healthcare process, from cancer detection to chemotherapy/radiation therapy and beyond.
- Active in process improvement projects including improvements to patient materials and Epic EMR improvements for orders and documentation.
- Public speaking for Breast Cancer Awareness Month at local events.
- Genetics testing coordinator for ordering and sending off Oncotype DX and germline genetics testing. Companies consulted with include Natera, Invitae and Myriad.
Product Manager, Digital Solutions & Product
Centene Corporation
11.2022 - 08.2023
- Managed cross product work and initiatives for team of 12 Product Owners for managed care clinical and business documentation system, NexGen TruCare Cloud with focus on clinical appeals, reviews, denials and authorizations.
- Worked key business areas to maximize value and gains for IT investment. Attended SCRUM as needed.
- Identified feature enhancements, managed backlog and roadmap leading to the delivery of cross-department customer success.
- Supported innovation by leading collaboration among Cloud design architects, UX designers, key stakeholders, and IT leadership.
Grant Project Manager
Illinois Prescription Monitoring Program
05.2021 - 11.2022
- Implemented new project management processes including team training, budgetary design, process improvement and procurement for new project management software.
- Audit duties including running meetings with government leaders and organizing a new SharePoint.
- Oversight of contracts and project concerns involving multiple government entities.
Manager, Clinical Systems Medical Management
Centene Corporation
04.2016 - 07.2017
- Oversaw team of Clinical Systems Analysts creating a more robust TruCare clinical documentation application supporting 20+ million Medicaid/Medicare members and $40+B in sales. Developed and chartered TruCare Council.
- Managed system support and participated in SCRUM with change management, testing, and successfully implementing multiple upgrades and system changes.
- Executed multiple high-profile projects within clinical systems, aligning business with customer’s needs. Areas include claims, authorizations, quality, and payment. Launched pilot of highly valuable offline application for remote workers.
- Chartered and served as project owner and leader for TruCare Council, ensuring information, tools, and structure of the TruCare application were appropriate, effective, and user-friendly.
Senior Clinical Systems Business Analyst
Mercy Healthcare Technology Services, Epic Division
08.2012 - 04.2016
- Led Epic EMR Systems Builds and Deployments: Delivered business, operational, and project leadership for Epic electronic medical record systems across multiple implementations, ensuring seamless integration and operational efficiency.
- Applied Advanced Project Management Expertise: Utilized Daptiv application, SDLC methodologies, change management processes, and Ernst & Young requirements to drive structured project execution and compliance.
- Supported Epic Implementations and Go-Lives: Contributed to Epic go-live command center operations, issue resolution, and post-implementation support to minimize disruptions and optimize system performance.
- Enhanced Security and Quality Initiatives: Collaborated on security builds, Meaningful Use compliance, and quality improvement projects, including chart audits and clinical documentation enhancement efforts.
- Achieved Epic Certifications: Earned certifications in Inpatient Orders and Beacon Oncology modules, enabling specialized configuration and optimization of oncology workflows.
- Fostered Cross-Functional Collaboration: Partnered with physicians, coordinators, clinical informatics professional, and Epic training specialists to validate strategies, promote project alignment, and deliver successful outcomes.
RN Consultant / RN Senior Case Manager/Utilization Review
WellPoint
03.2007 - 04.2011
- Worked closely with IT to implement3 clinical applications within a 3-year timeframe including a large-scale phone system, Avaya. Created materials for Learning and Development and utilized ImpactPro predictive modeling as well as Verint phone system data reporting.
- Received promotion to Senior RN as part of a pilot program, resulting in the successful launch of a product saving $16M for WellPoint care management clients in 2-years.
- Worked Medicare/Medicaid disease management programs caring for the top 5 core diseases: COPD, Asthma, Heart Failure, Diabetes and Kidney Failure supporting an unprecedented 1,300 healthcare professionals in a virtual work environment.
- As consultant worked utilization management initiatives monitoring and reducing hospital readmissions.
- Performed level 1 utilization review including precertification according to guidelines.
- Performed chart audits and worked utilization management pool performing intake and authorization submissions.
- Workflows familiar in Medcompass/AssureCare, Milliman Care Guidelines (MCG) and Ingenix ImpactPro.
Education
Master of Science (MS) - Health Informatics and Bioinformatics
University of Missouri School of Medicine
Columbia, MOBachelor of Science (BS) - Nursing
Chamberlain College of Nursing
St. Louis, MOAssociate in applied science (AAS) - Nursing
West Virginia University
Parkersburg, WVSkills
Microsoft Word programs (Teams, Outlook, Office, Excel, Visio, One-Note)
Certification
- Current Registered Nurse (RN) in West Virginia and Licensure Compact states
- Certified Case Manager (CCM)
- Epic Certification, Orders
- Epic Certification, Beacon Oncology
AWARDS & PROFESSIONAL AFFILIATIONS
Applied Health Informatics Group Project Concept, Recipient for AVMA PLIT Architecture Planning, Presidential Honors Recipient BSN, Sigma Theta Tau International Nursing Honor Society, St. Louis Chapter, Phi Pi, St. Joseph’s Hospital Documentation of the Year Award, Heart of Phoenix Equine Rescue Volunteer, Old Salt Fishing Foundation, Good Works, Tampa, All-American Academic Achievement Academy Inductee, Who’s Who among America’s Universities
CORE COMPETENCIES
Healthcare Administration | Medicaid/Medicare | Clinical Services/Critical Care/Oncology | Case Management | Inpatient Review | Strategic Care Planning | Managed Care Operations | Clinical Systems Analysis | Clinical Documentation System Management | Project Coordination
PAST CERTIFICATIONS AND COURSES
- TNCC, TNCC instructor course | BLS/ACLS/ACLS-EP | CAT-N, CAT-N II | ENPC/PALS
- Specialty training courses completed include:Senn-Delaney Leadership, Culture Shaping and Behavioral Change Management.
- Master courses rigorously studied include Enterprise Architecture Planning, Decision Support Systems, IT Architecture, Data Mining/Data Mapping, Knowledge Management and Health Information Management.
ADDITIONAL RELEVANT EXPERIENCE
- WellPoint | St. Louis, MO(Continued) Nurse Care Manager, Disease Management
- HCA Largo Medical Center |Largo, FL Registered Nurse/FLEX Nurse
- St. Joseph’s Hospital | Parkersburg, WV Interim Manager, Charge Nurse, RN Critical Care
- Mease Dunedin Hospital, Nurses RX | Dunedin, FL RN, Travel Nurse Contract
Accomplishments
Earned 3 Impact Awards at Elevance Health for productivity and speed project.
Promoted to Senior RN Case Manager at WellPoint Health Management Corporation
Certified Case Manager
Affiliations
Operation Fancy Free Cat Rescue, Ravenswood, WV
Heart of Phoenix Horse Rescue, LeSage, WV
Timeline
RN Case Manager, ER Census Program
Wellpoint
02.2024 - Current
Oncology Nurse Navigator, Case Manager RN Oncology
WVU Medicine Camden Clark Medical Center
09.2023 - 12.2024
Product Manager, Digital Solutions & Product
Centene Corporation
11.2022 - 08.2023
Grant Project Manager
Illinois Prescription Monitoring Program
05.2021 - 11.2022
Manager, Clinical Systems Medical Management
Centene Corporation
04.2016 - 07.2017
Senior Clinical Systems Business Analyst
Mercy Healthcare Technology Services, Epic Division
08.2012 - 04.2016
RN Consultant / RN Senior Case Manager/Utilization Review
WellPoint
03.2007 - 04.2011
Master of Science (MS) - Health Informatics and Bioinformatics
University of Missouri School of Medicine
Bachelor of Science (BS) - Nursing
Chamberlain College of Nursing
Associate in applied science (AAS) - Nursing
West Virginia University