Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

LAURA MESMER

Midlothian,IL

Summary

  • Experienced registered nurse working in a broad variety of healthcare organizations, specializing in managed care, case management, disease management, quality management, process improvement, and professional/talent development. Demonstrated expertise in the following areas:
  • Proficiency in report analysis and data specifications
  • Mentoring and coaching of junior staff and peers
  • Supervision of clinical and non-clinical staff productivity and performance development
  • Program implementation and strategic direction for outcome improvements, cost-saving initiatives, and process changes

Overview

36
years of professional experience

Work History

PURPLE LAB, Inc

SR. MANAGER CLINICAL ANALYTICS
05.2024 - 06.2025

Job overview

  • Develop and modify clinical code value sets and methodology for treatments and episodes of care that won a $1.2mil contract for the Top Hospitals report
  • SME for clinical concepts to validate health research and outcomes studies

BLUE HEALTH INTELLIGENCE

CLINICAL ANALYST
02.2021 - 01.2024

Job overview

  • Developed clinical code sets for diagnoses (condition episodes) and services (treatment episodes) for internal classification grouper logic
  • Provided subject matter expertise for clinical coding for multiple teams and provided documentation of clinical ontology for episodes of care

INNOVISTA HEALTH SOLUTIONS

UTILIZATION MANAGEMENT LEAD
03.2019 - 12.2020

Job overview

  • Conducted data analysis of utilization management metrics and kpi’s; medical record/chart reviews to summarize episodes of care for complex cases
  • Implemented cost-savings initiatives relating to newborn claims (identified cases totaling over $75K incorrectly paid) and self-injectable drugs (identified errors of over $100K) and worked closely with CMO on a project identifying a $350K spend on specialty drugs administered in the incorrect setting
  • Conducted monthly UM meetings to NCQA specifications with 95% audit scores
  • Educated teammates on proper documentation to decrease errors on automated reports as well as worked with Analytics to correct report requirements to improve accuracy

BLUE HEALTH INTELLIGENCE

CLINICAL PRODUCT CONSULTANT
09.2017 - 02.2019

Job overview

  • Demonstration of product features and functionality to internal and external clients to support sales
  • Responsible for business requirements for the care management risk identification and stratification application
  • Developed subject matter expertise in risk stratification methodology from the end-user perspective, validating case scenarios, providing feedback for sales positioning concepts

AETNA BETTER HEALTH OF ILLINOIS

MANAGER CLINICAL HEALTH SERVICES
06.2014 - 09.2017

Job overview

  • Oversaw the Care Management department (FHP) with 5 direct reports (leadership) and up to 110 indirect reports (line staff); responsible for administering services through Aetna Better Health’s Illinois Medicaid Plan for FHP from program start-up through first 2.5yr of program implementation
  • Developed, implemented, supported and provided consultation on corporate/enterprise Clinical Health Services strategies, policies, processes, and programs to drive clinical quality improving outcomes for members and meeting contractual obligations to the State and CMS
  • Managed teams focused on improving key metrics: Telemonitoring team showed significant decrease in ER (12-15% reduction in cost) and IP admissions (40-60% decrease in cost) for enrolled members, Discharge Planning team also recorded reduction of readmissions (greater than 25%) and length of stay (by 1.1 days) through facilitation of timely and appropriate discharge planning

HEALTH CARE SERVICE CORPORATION (BCBSIL)

VARIOUS ROLES
04.2007 - 04.2013

Job overview

  • MANAGER HEALTH SERVICES PROGRAM (NETWORK HMO MARKET) Managed a team of clinical staff responsible for delegated HMO and Medicare Advantage UM & CM Oversight; Developed case management program requirements to enhance the HMO CM program and ensure NCQA compliance; Facilitated the HMO UM Workgroup and Policy & Procedure Approval Committee
  • CLINICAL ACCOUNT CONSULTANT (2010-2012) Served as liaison between Marketing/Sales of Major/National and Mid-Market Accounts and BCBS PPO medical management; Presented marketing materials to employer groups and prospective customers (involved in preparation of rfp’s). Analyzed data and interpreted information to develop recommendations for program enhancements through cost and utilization analysis and/or client feedback
  • QUALITY MANAGEMENT SPECIALIST (2007-2010) Responsible for managing quality improvement projects for BCBS HMO line of business; Facilitated workgroups for assigned projects and HEDIS data submissions. Involved in preparation for NCQA audits

MACNEAL HOSPITAL SYSTEM

VARIOUS ROLES
01.1989 - 01.2007

Job overview

  • Quality Management Specialist (5 yrs)
  • Utilization Management Nurse (3.5 yrs)
  • Family Practice Staff Nurse (4.5 yrs)
  • Medical/Surgical Floor Nurse (4.5 yrs)

Education

College of DuPage

Associate's Degree from Applied Sciences - Nursing

University Overview

RN License, unrestricted and current through 2026 in Illinois

Spertus Institute

Master of Science from Non-Profit Management
01.2011

University Overview

  • Completed the MS program with gpa of 4.2 (on 4pt scale)
  • GPA: 4.2 (on 4pt scale)

Governors State University

BA
01.2007

University Overview

Completed coursework for BA in one year with focus on healthcare administration

Skills

  • Systems: Cerner, EPIC, Aerial, Jira, QNext, CSIS, Availity, EzCap/EzNet, CareView, CareWeb QI, MS Project
  • Other: Team Building, Utilization Management, Quality Metrics, Milliman, NCQA Standards, HEDIS, claim review, Medicare and Medicaid Standards, expert knowledge in MS-DRG, ICD and HCPCS coding

Timeline

SR. MANAGER CLINICAL ANALYTICS
PURPLE LAB, Inc
05.2024 - 06.2025
CLINICAL ANALYST
BLUE HEALTH INTELLIGENCE
02.2021 - 01.2024
UTILIZATION MANAGEMENT LEAD
INNOVISTA HEALTH SOLUTIONS
03.2019 - 12.2020
CLINICAL PRODUCT CONSULTANT
BLUE HEALTH INTELLIGENCE
09.2017 - 02.2019
MANAGER CLINICAL HEALTH SERVICES
AETNA BETTER HEALTH OF ILLINOIS
06.2014 - 09.2017
VARIOUS ROLES
HEALTH CARE SERVICE CORPORATION (BCBSIL)
04.2007 - 04.2013
VARIOUS ROLES
MACNEAL HOSPITAL SYSTEM
01.1989 - 01.2007
College of DuPage
Associate's Degree from Applied Sciences - Nursing
Spertus Institute
Master of Science from Non-Profit Management
Governors State University
BA
LAURA MESMER