Hi, I’m
Lori Prather
Deltona,FL
Summary
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Overview
33
years of professional experience
1
Certification
Work History
UnitedHealthcare
Senior Clinical Transformation Manager
02.2015 - 08.2023
Job overview
- Proven ability to cultivate and maintain collaborative clinical relationships for multiple groups participating in UHC Accountable Care Organization Value Based Programs. Conducted and arranged onsite and virtual monthly clinical and joint operational meetings
- Guided multi-disciplined practice transformation and practice performance population health improvement initiatives
- Led ACO in achieving targeted goals that included improved quality efficiency, utilization, and finance. ACO's located in Mississippi, Alabama, Louisiana, and Florida. Shared savings over 4 million dollars with assigned ACO groups
- Consulted ACO's with Commercial, Medicaid, and Medicare lines of business on best practices to achieve targeted goals
- Developed and managed tailored business growth strategies, supporting clients through design, construction and execution
Optum
RN Practice Performance Manager
06.2014 - 02.2015
Job overview
- Quality analyst relationship holder to assist providers with Medicare Quality Incentive program
- Identified performance improvement opportunities through analysis and discussion as HEDIS subject matter expert. Identified and assisted providers with increased Breast Cancer Screening compliance over 40%
- Utilized various software applications to support HEDIS operations and accurately enter results of chart audits
- Analyzed key cost, utilization, and quality data to assess performance and identify opportunities
WellCare
RN HEDIS Practice Educator
07.2013 - 06.2014
Job overview
- Educated provider and practice sites for HEDIS measures, appropriate medical record documentation and coding for Medicare and Medicaid lines of business
- Resolved deficiencies impacting plan compliance for meeting the state and federal standards for HEDIS guidelines
- Instructed diverse range of clinical and administrative professionals and provided data analytic and reporting information based on individual educational needs
Florida Hospital Fish Memorial
RN Cardiac Care Unit
02.2013 - 06.2013
Job overview
- Administered nursing care to cardiac patients undergoing diagnostic, therapeutic or emergency services
- Assisted in diagnosis and treatment of conditions such as unstable angina, cardiomyopathy, coronary artery disease and cardiac dysrhythmia
- Conducted initial assessments, documented findings in patient records and notified physicians of abnormal findings
- Administered medication, pain management and analysis of patient responses to interventions to improve individual performance
Daiichi Sankyo Pharmaceuticals
RN Pharmaceutical Diabetes Clinical Educator
09.2012 - 02.2013
Job overview
- Assessed client knowledge levels and abilities with detailed assessments
- Welchol Clinical Educator Support for Central pilot project
- Trained prescribers, office and patients to manage A1c in adults with Type 2 diabetes and primary hyperlipidemia
- Lead clinical educator for business reporting to entire central Florida Daiichi-Sankyo, Inc. pharmacy sales teams
Wellmed Medical Group
Visiting Complex Care Manager
08.2010 - 09.2012
Job overview
- Complex case management and Utilization. House call visits for high risk members post discharge. Performed physicals, fall/mental/depression/safety assessments, med reconciliation and reported to primary care physician
- Mediated between members, physicians and insurance companies (Wellcare, PUP, Citrus, UnitedHealth) to ensure patient comprehension of treatment plans for complex and disease management programs
- Decreased inpatient hospital readmissions by 28% by compiling and analyzing data to identify areas of improvement
- Educated clients and families on community resources, treatment options and health care services to better manage conditions
Florida Hospital DeLand
Director Diabetes Education Department
05.2005 - 11.2007
Job overview
- Directed and taught new hire nurse program and nurse continuing education programs
- Managed diabetes department, led all inpatient and outpatient teaching
- Initiated design and execution of process plan to submit claims for reimbursement of diabetes and
medical nutrition therapy outpatient education - Authored the insulin IV drip transition protocols for critical care
- Directed successful Cerner EMR implementation at diabetes clinic and hospital wide; provided on-going
support, including curriculum development and training sta development; development of standards for electronic documentation
Orlando Health South Seminole Hospital
RN Cardiac/Critical Care Unit
06.2004 - 05.2005
Job overview
- Administered nursing care to cardiac patients undergoing diagnostic, therapeutic or emergency services.
Fort Sanders Regional Medical Center
Fort Sanders Diabetes Center Education RN
05.2002 - 07.2004
Job overview
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options
- Updated patient charts with blood glucose results and medication doses to keep records current and support accurate treatments
- Specialized diabetes education with pregnant women with either pre-existing diabetes or gestational diabetes. Advised insulin titration doses onsite at Fort Sanders Perinatal Center
- Taught patients with Types 1 and 2 diabetes in individual and classroom settings
Magnolia Hospital
Float Pool Nurse
05.1990 - 05.2002
Job overview
- Full time bedside nurse cross trained to function in critical and non-critical units
- Home health and hospice
- Mentor to student and graduate nurses
Education
The University of Tennessee - MartinMartin, TN
Bachelor of Science from Nursing
05.2002
University Overview
- Honoree Sigma Theta Tau Honor Society of Nursing
- Graduated Magna Cum Laude
Northeast Mississippi Community CollegeBooneville, MS
Associate of Science from Nursing
05.1990
Skills
- Design Development
- Process Improvement Initiatives
- Database Management System Software
- Complex Care and Utilization Management
- Compliance/Waste/Fraud/Abuse Trained
- Auditing
- Patient/Provider Education
- Value Based Managed Care
- Staff Development
- Population Health
- Contract Management
- Patient Care
Certification
- American Heart Association Basic Life Support Training - August 2023
Languages
English
Native or Bilingual
French
Limited Working
Timeline
Senior Clinical Transformation Manager
UnitedHealthcare
02.2015 - 08.2023
RN Practice Performance Manager
Optum
06.2014 - 02.2015
RN HEDIS Practice Educator
WellCare
07.2013 - 06.2014
RN Cardiac Care Unit
Florida Hospital Fish Memorial
02.2013 - 06.2013
RN Pharmaceutical Diabetes Clinical Educator
Daiichi Sankyo Pharmaceuticals
09.2012 - 02.2013
Visiting Complex Care Manager
Wellmed Medical Group
08.2010 - 09.2012
Director Diabetes Education Department
Florida Hospital DeLand
05.2005 - 11.2007
RN Cardiac/Critical Care Unit
Orlando Health South Seminole Hospital
06.2004 - 05.2005
Fort Sanders Diabetes Center Education RN
Fort Sanders Regional Medical Center
05.2002 - 07.2004
Float Pool Nurse
Magnolia Hospital
05.1990 - 05.2002
The University of Tennessee - Martin
Bachelor of Science from Nursing
Northeast Mississippi Community College
Associate of Science from Nursing
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