Work Preference
Summary
Overview
Work History
Education
Skills
Affiliations
Certification
Timeline
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Kimberley Willis
Open To Work

Kimberley Willis

Healthcare Leader - RN
Saint Augustine,FL

Work Preference

Job Search Status

Open to work
Desired start date: Open to discussion

Desired Job Title

Senior Director, Care ManagementDirector, Quality Improvement & Utilization Management

Work Type

Full Time

Location Preference

RemoteHybrid
Location: Saint Augustine, FL, USJacksonville, FL
Open to relocation: No

Salary Range

$150000/yr - $200000/yr

Important To Me

Work-life balanceCompany CultureHealthcare benefitsStock Options / Equity / Profit Sharing401k matchPaid sick leavePersonal development programsWork from home option

Summary

Dynamic healthcare leader with diverse clinical experience, known for integrity and authenticity. Skilled in leadership, business intelligence, operations management, value-based care management, population health, and utilization management. Strong strategic thinker with expertise in developing and executing solutions. Collaborative and forward-thinking, with excellent policy implementation and problem-solving abilities. Proficient in engaging stakeholders, building consensus, and promoting change management.

Overview

31
31
years of professional experience
2
2

Certifications

Work History

Senior Director, Care Management

United Health Care/OptumCare - WellMed
06.2015 - Current
  • Led initiatives resulting in consistent year-over-year decreases in utilization metrics for contracted and employed markets.
  • Evaluated regional care management programs, improving quality and performance outcomes.
  • Created and executed regional budgets and business plans aligned with strategic goals.
  • Monitored key metrics, implementing corrective measures to improve patient satisfaction and resource utilization.
  • Initiated system changes to enhance staffing efficiency for regional care management.
  • Established comprehensive policies ensuring adherence to compliance across the region.
  • Directed cross-functional teams to elevate patient engagement and satisfaction initiatives.
  • Orchestrated restructuring of care management services to enhance utilization metrics and cost efficiency.

Director, Quality Improvement & Utilization Management

Humana/MetCare
03.2014 - 06.2015
  • Directed strategy and operations for Quality Improvement and Utilization Management in North Central Florida employed clinics.
  • Created Patient Centered Medical Home model of care for MetCare employed clinic practices and served as SME for compliance NCQA accreditation standards.
  • Collaborated with senior leadership to align departmental goals and clinic operations with PCMH objectives.
  • Facilitated regular meetings with department heads to assess progress on strategic initiatives.
  • Identified performance improvement opportunities through operational metrics analysis.
  • Established quality improvement initiatives to enhance patient care and transition of care follow-up.
  • Served as care management SME; provided education and resources to providers and the clinic operations leadership team.
  • Facilitated interdisciplinary meetings between Utilization Management staff and other departments as needed.
  • Developed educational materials related to utilization management best practices for internal staff members as well as external partners.
  • Reported UM findings and cost savings achieved from implemented processes for high cost DME, ER diversions, and observation stays.

Corporate Manager, Transition Services

Orlando Health
01.2012 - 01.2014
  • Case management leader for Central Florida’s only Level One Trauma Center across 8 facilities.
  • Strategic development of Utilization Review - Case Management department with a corporate focus throughout care continuum.
  • Collaborated with executive leadership to cultivate and execute broad strategies with tangible financial improvement - decreased LOS and increased observation conversions.
  • InterQual Certified Instructor and educator for medical necessity guidelines, documentation improvement strategies, CMS guidelines, and denial/appeal management.
  • UM/CM operations including budgeting and management of all personnel functions: staffing, team development, coaching plans, and disciplinary actions.
  • Designed, implemented, and evaluated team education including development of practice standards, key performance indicators, and policies to facilitate best practice across Transition Services.
  • Collaborated with medical directors and key physician leaders regarding physician practice patterns.
  • Merged organizational objectives into department operations.
  • Aggregation, analysis, validation, and reporting of department Action OI data.
  • Coordinator and facilitator of Utilization Management Committee. Collection, analysis, and trending of utilization and quality data.
  • Transition Services Liaison for PRO/QIO – FMQAI, Managed Care Contracting, & Governmental Payer Affairs.
  • Second Curve - Value Creation Design Team – reorganization of the Population Health Management/Care Coordination department.

Manager, Corporate Quality Improvement

Physicians United Plan
04.2011 - 10.2011
  • Established Quality Improvement Department and executed comprehensive QI Work Plan.
  • Developed CMS-approved model of care for special needs plan within health plan.
  • Facilitated discussions with operations and health services leadership for URAC accreditation.
  • Conducted gap analysis and organizational readiness evaluation for special needs plan.
  • Reported CMS and NCQA audit findings to executive leadership; collaborated to create performance improvement plan submission to CMS.
  • Created educational resources for providers on HEDIS indicators and performance improvement.
  • Chaired Quality Management Steering Committee; coordinated analysis of performance metrics.
  • Contributed to strategic planning initiatives for achieving 5 Star Rating with health plan leadership.

Revenue Integrity Clinical Liaison

Orlando Health
06.2008 - 04.2011
  • Managed oncology/radiation medical necessity audit process for MD Anderson Cancer Center /Orlando Health, ensuring compliance with CMS coverage and billing guidelines.
  • Expert consultant regarding coverage criteria and regulatory compliance.
  • Coordination of timely responses to CERT, RAC, & MAC audits as well as Medicare appeals.
  • Delivered revenue enhancement opportunities to Executive Leadership → National Publication, Designed concepts and facilitated Erythropoietin Stimulating Agent Management Program resulting in $600K net revenue improvement for oncology/ambulatory service lines.
  • Devised strategic plans and implemented processes to ensure compliance and enhance revenue → IVIG Protocol implemented across organization resulting in $300K annual increase in net reimbursement.
  • Managed audit process for RAC and CERT; developed action plans and directed account representatives.
  • Developed and instituted workflow process between financial services, audit team, and coding with reduction in A/R days.
  • Case Management department development; education regarding CM/UM/UR best practices.
  • Designed and implemented audit process to improve charge capture and coding accuracy resulting in $70K net revenue recognition and reduced claim rejections/claims holding.
  • Project management for documentation improvement and revenue enhancement projects; developed practice improvement initiatives throughout the ambulatory service line.
  • Delivered educational presentations to medical staff, senior leadership, and administration.
  • Member of Adult Hospital Group Revenue Enhancement Committee, Benchmarking & Metric Development Committee, ICD-10 Transition Committee, MD Anderson Cancer Center Outpatient Performance Improvement Committee.

Clinical Documentation Improvement Specialist

Mayo Clinic/St. Luke’s Hospital
Jacksonville
07.2005 - 09.2006

Case Manager

Mayo Clinic Foundation
Jacksonville
06.1997 - 09.2006

Urology Staff Nurse, Outpatient

Mayo Clinic
Jacksonville
06.2002 - 08.2003

Home Health Case Manager/Supervisor

Mayo Clinic/St. Luke’s Hospital
Jacksonville
06.1997 - 06.2002

Staff RN - Clinical Care

Maxim Healthcare
01.1995 - 01.1998

Mental Health Care Manager

Choice Behavioral Health Partnership
01.1996 - 01.1997

Charge Nurse

Cathedral Gerontology Center
01.1995 - 01.1996

Education

MHA – Master of Health Administration -

Capella University
Minneapolis, MN
01.2022

BSN – Bachelor of Science - Nursing

University of Central Florida
Orlando, FL
01.2010

AA – Associate in Arts -

Florida Community College
Jacksonville, FL
01.2002

ASN – Associate in Science - Nursing

Florida Community College
Jacksonville, FL
01.1994

Skills

  • Data analysis/trend identification
  • Leadership and collaboration
  • Change management
  • Patient care coordination
  • Performance tracking
  • Utilization management
  • Policy development
  • Care management
  • Value-based care
  • Cross-functional teamwork

Affiliations

  • Case Management Society of America
  • American Academy of Professional Coders

Certification

  • CCM, Certified Case Manager, Commission for Case Management Certification
  • COC, Certified Outpatient Coder, American Academy of Professional Coders
  • IQCI, InterQual Certified Instructor, McKesson

Timeline

Senior Director, Care Management

United Health Care/OptumCare - WellMed
06.2015 - Current

Director, Quality Improvement & Utilization Management

Humana/MetCare
03.2014 - 06.2015

Corporate Manager, Transition Services

Orlando Health
01.2012 - 01.2014

Manager, Corporate Quality Improvement

Physicians United Plan
04.2011 - 10.2011

Revenue Integrity Clinical Liaison

Orlando Health
06.2008 - 04.2011

Clinical Documentation Improvement Specialist

Mayo Clinic/St. Luke’s Hospital
07.2005 - 09.2006

Urology Staff Nurse, Outpatient

Mayo Clinic
06.2002 - 08.2003

Case Manager

Mayo Clinic Foundation
06.1997 - 09.2006

Home Health Case Manager/Supervisor

Mayo Clinic/St. Luke’s Hospital
06.1997 - 06.2002

Mental Health Care Manager

Choice Behavioral Health Partnership
01.1996 - 01.1997

Staff RN - Clinical Care

Maxim Healthcare
01.1995 - 01.1998

Charge Nurse

Cathedral Gerontology Center
01.1995 - 01.1996

MHA – Master of Health Administration -

Capella University

BSN – Bachelor of Science - Nursing

University of Central Florida

AA – Associate in Arts -

Florida Community College

ASN – Associate in Science - Nursing

Florida Community College

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Kimberley WillisHealthcare Leader - RN