Lynette Cahill
Bradenton
Summary
Dynamic healthcare professional with experiences spanning case management, utilization review, Medicare and Medicaid operations, Healthcare Policy, regulatory compliance, quality improvement, accreditation consulting, and program management. Master of Science in Nursing with specialization in Healthcare Policy. Experienced in medical records review, clinical documentation analysis, audit support, provider education, process improvement and interdisciplinary collaboration.
Overview
37
37
years of professional experience
1
1
Certification
Work History
Home Health Registered Nurse Case Manager
BayCare
Bradenton
08.2025 - Current
- Conduct comprehensive in-home assessments, developing individualized care plans to meet reimbursement and compliance standards.
- Collaborate with physicians, families, and other healthcare professionals to provide patient education and ensure quality of care.
- Monitor patient progress and update care plans based on clinical assessments and physician collaboration.
- Educate patients and families on disease management and prevention techniques.
- Utilize computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
RN Case Manager
HCA Florida South Shore Hospital
Sun City Center
03.2025 - 08.2025
- Performed initial and concurrent reviews utilizing Interqual criteria to support appropriate utilization of healthcare resources.
- Facilitated discharge planning and collaborated with physicians, nursing staff, finance, and multidisciplinary teams to optimize patient outcomes.
- Participated in interdisciplinary rounds and coordinated transitions across the care continuum.
Account Manager
Acentra Health
McLean
05.2024 - 12.2024
- Acted as account manager and liaison for State of Indiana Medicaid contract, maintaining alignment with client expectations.
- Oversaw contract deliverables, reporting requirements, and compliance initiatives, contributing to successful contract adherence.
- Partnered with executive leadership to implement process improvements and corrective actions from audit findings, enhancing operational performance.
- Developed strategic account plans, monitored project milestones, and ensured timely completion of contractual obligations.
Vendor Program Manager
Elevance
Indianapolis
01.2009 - 05.2024
- Managed Medicare Advantage vendor relationships supporting chronic condition and risk adjustment initiatives.
- Oversight of reporting, project deliverables, documentation management, compliance monitoring, and operational performance for multiple healthcare vendors.
- Participated in Risk Adjustment Data Validation audits(RADV), internal audits, and compliance activities supporting program integrity and regulatory requirements.
- Collaborated with technology, clinical and operational teams to improve workflow and program effectiveness.(File automation)
- Facilitated communication among vendors and leadership to ensure achievement of organizational objectives.
Charge Nurse-Outpatient Treatment Area
Crestwood Hospital
Huntsville
01.2008 - 01.2009
- Directed clinical operations in outpatient treatment area, CHF clinic, and Coumadin clinic to ensure effective patient care delivery.
- Managed staffing, scheduling, and patient flow to enhance operational efficiency and support quality initiatives.
Accreditation Consultant
Society of Chest Pain Centers
Columbus
01.2007 - 01.2008
- Collaborated in development of national cardiac care guidelines and performance improvement initiatives.
- Reviewed policies, procedures, documentation, and operational workflows to identify opportunities for compliance and quality enhancement.
- Assisted organizations in meeting accreditation standards, regulatory requirements, and quality improvement objectives.
- Conducted organizational assessments, medical record reviews, and accreditation readiness evaluations for healthcare facilities nationwide.
Lung Transplant Coordinator
The Ohio State University Medical Center
Columbus
12.1989 - 01.2007
- Coordinated development and implementation of lung transplant program to enhance patient care and outcomes.
- Contributed to development of national lung transplant guidelines to standardize best practices across programs.
- Conducted utilization reviews, discharge planning, and care coordination activities utilizing Milliman and Interqual guidelines.
- Created patient and family education programs and support groups to improve understanding and support during the transplant process.
Education
Master of Science - Healthcare Policy
Chamberlain College of Nursing
Addison, IL08-2016
Bachelor of Science - Nursing
Franklin University
Columbus, OH01-2001
Associate of Science - Nursing
Columbus State Community College
Columbus, OH12-1988
Skills
- Clinical operations & care management
- Medicare Risk adjustment
- Medical record auditing
- Compliance monitoring
- Healthcare Vendor management
- Process Optimization
- Multidisciplinary collaboration
- Problem solving
- Effective communication
Certification
- Registered Nurse State of Florida
- BLS for Healthcare Provider
Timeline
Home Health Registered Nurse Case Manager
BayCare
08.2025 - Current
RN Case Manager
HCA Florida South Shore Hospital
03.2025 - 08.2025
Account Manager
Acentra Health
05.2024 - 12.2024
Vendor Program Manager
Elevance
01.2009 - 05.2024
Charge Nurse-Outpatient Treatment Area
Crestwood Hospital
01.2008 - 01.2009
Accreditation Consultant
Society of Chest Pain Centers
01.2007 - 01.2008
Lung Transplant Coordinator
The Ohio State University Medical Center
12.1989 - 01.2007
Master of Science - Healthcare Policy
Chamberlain College of Nursing
Bachelor of Science - Nursing
Franklin University
Associate of Science - Nursing
Columbus State Community College