Dynamic Registered Nurse (RN) licensed in Pennsylvania with over 40 years of extensive experience in specialized nursing, patient care, and staff education. Expertise includes critical care, cardiac care, renal care, hem-oncology, and emergency medicine, with a proven track record in facilitating patient-centric services and driving clinical quality improvements. Demonstrated leadership in healthcare education and management of clinical quality metrics, including HCAHPS scores and NDNQI initiatives. Committed to enhancing patient satisfaction through effective monitoring and guidance of process improvements across all phases of healthcare advocacy programs.
Overview
45
45
years of professional experience
1
1
Certification
Work History
Clinical Quality Improvement Specialist
Pa Health and Wellness/Centene Corporation
Robinson Township, Pa
07.2019 - 12.2023
Work history as a Utilization Manager and Care Manager from 2005 through 2023: My work experience I have diligently focused independently to review medical records and apply all current clinical criteria to match the indicated services. This included length of stay, Interqual and medical policy guidelines.
I consistently maintained clear communications with dedicated health care providers, case management teams, and our immediate leadership to support congruent health care decisions and facilitate all treatment plans and all indicated delivery of care and those productive health improving outcomes.
Our department provided all medically appropriate services while advancing cases of which would not meet criteria to the Medical Director for further review and the appeal processes indicated.
In additional daily review of discharge planning needs and the reimbursement if indicated. Our teams discussed all federal, state, and accreditation standards and how we focus on implementing and adhering to all identified criteria.
Daily and often hourly documentation identified all patient care events and progress and or insufficiencies and to design a new and interdisciplinary teams review and enhanced plan of care. All interactions were focused on the advocation and representation of the patient and associated representative, such as Power of Attorney.
Led utilization review processes to ensure compliance with clinical guidelines and operational standards.
Led clinical quality initiatives to enhance patient outcomes and compliance standards.
Facilitated cross-functional teams to identify process inefficiencies and drive improvements.
Analyzed clinical data to monitor trends and inform strategic decision-making.
Developed and implemented quality improvement plans aligned with organizational goals.
Provided training and mentorship to staff on best practices in quality assurance.
Conducted regular audits to ensure adherence to regulatory requirements and policies.
Collaborated with stakeholders to establish benchmarks for performance evaluation.
Oversaw departmental operations, ensuring alignment with hospital policies and quality standards.
Implemented process improvements that enhanced operational efficiency and patient satisfaction.
Developed training programs for staff, promoting professional growth and compliance with regulations.
Collaborated with multidisciplinary teams to optimize resource allocation and service delivery.
Analyzed performance data to identify trends, driving strategic decision-making across departments.
Managed budgetary constraints while maintaining high-quality care through effective resource management.
Accomplished multiple tasks within established timeframes.
Managed and motivated employees to be productive and engaged in work.
Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
Led initiatives to enhance patient care protocols, resulting in improved health outcomes and safety measures.
Fostered a culture of teamwork and collaboration among staff, enhancing workplace morale and productivity.
Manager of Patient Experience and Clinical Care
Allegheny General Hospital
Pittsburgh, Pa
08.2018 - 02.2019
Oversaw departmental operations, ensuring alignment with hospital policies and quality standards.
Implemented process improvements that enhanced operational efficiency and patient satisfaction.
Developed training programs for staff, promoting professional growth and compliance with regulations.
Collaborated with multidisciplinary teams to optimize resource allocation and service delivery.
Analyzed performance data to identify trends, driving strategic decision-making across departments.
Managed budgetary constraints while maintaining high-quality care through effective resource management.
Led initiatives to enhance patient care protocols, resulting in improved health outcomes and safety measures.
RN Care Manager
Gateway Health Plan
Pittsburgh, Pa
08.2015 - 08.2018
Coordinated care plans with interdisciplinary teams to enhance patient outcomes.
Monitored patient health progress and adjusted care strategies as needed.
Developed educational materials for patients and families to promote self-management.
Conducted comprehensive assessments to identify patient needs and resources.
Facilitated communication between patients, families, and healthcare providers for streamlined care delivery.
Mentored junior nursing staff in best practices for patient management and documentation.
Implemented quality improvement initiatives to optimize clinical workflows and enhance service delivery.
Registered Nurse GI Nurse
Maxim Staffing
Pittsburgh, Pa
05.2015 - 08.2015
Delivered patient care through comprehensive assessments and tailored nursing interventions.
Collaborated with interdisciplinary teams to develop and implement individualized care plans.
Educated patients and families on health management and disease prevention strategies.
Administered medications and monitored patient responses, ensuring timely adjustments to treatment plans.
Streamlined workflow processes to enhance efficiency in patient documentation and reporting systems.
Led quality improvement initiatives that enhanced patient safety protocols within the department.
Mentored junior nurses in clinical best practices and effective patient communication techniques.
Fostered a culture of teamwork and collaboration among staff, enhancing workplace morale and productivity.
Managed and motivated employees to be productive and engaged in work.
Accomplished multiple tasks within established timeframes.
Maintained professional, organized, and safe environment for employees and patrons.
Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
Maximized performance by monitoring daily activities and mentoring team members.
Cross-trained existing employees to maximize team agility and performance.
Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
Improved safety procedures to create safe working conditions for workers.
Executive Director of Resident Care Services Operations and Staff Development
Integra Care Assisted Living
Wexford, Pa
04.2014 - 06.2014
Directed operational strategies to enhance resident care and satisfaction across multiple facilities.
Implemented best practices for staff training and development to improve service delivery standards.
Established partnerships with healthcare providers to ensure comprehensive support for residents' health needs.
Oversaw budget management and resource allocation to optimize operational efficiency and cost-effectiveness.
Led initiatives to improve regulatory compliance, resulting in successful audits and inspections.
Developed strategic plans that aligned organizational goals with community needs, enhancing service offerings.
Fostered a culture of continuous improvement through regular performance evaluations and feedback mechanisms.
Advocated for resident rights and quality of life improvements through community engagement and outreach programs.
Worked closely with organizational leadership and board of directors to guide operational strategy.
Guided staff through periods of organizational change, maintaining morale and engagement during transitions.
Forge strong relationships with board members, providing regular updates on organizational progress and soliciting their expertise when needed.
Senior Clinical Care Coordinator
UPMC St. Margaret Hospital
Pittsburgh, Pa
10.1980 - 11.2013
Registered Nurse Specialities: Critical Cardiac Care Medicine, Assistant Unit Director of ICU, IV Team, Emergency Medicine, Inpatient Pre and Post Operative care, Intervention Radiology RN, Senior Clinical Care Coordinator.
Coordinated patient care plans to enhance treatment outcomes and streamline communication among healthcare providers.
Developed and implemented initiatives to improve patient education and engagement in managing their health.
Collaborated with interdisciplinary teams to optimize resource allocation for comprehensive patient support.
Led training sessions for staff on best practices in care coordination and patient advocacy strategies.
Monitored compliance with regulatory standards, ensuring adherence to quality assurance protocols within the department.
Improved efficiency in case management tasks through the implementation of evidence-based best practices and standardized procedures.
Collaborated with interdisciplinary teams to optimize resource utilization, reducing costs while maintaining high-quality care standards.
Assisted in the development of protocols for complex case management, leading to improved outcomes for high-risk patient populations.
Educated patients on disease management strategies, enabling them to make informed choices about their health and wellbeing.
Supported organizational performance improvement initiatives by participating in data analysis, root cause identification, and action plan development efforts.
Built strong relationships with patients and families for optimized care satisfaction.
Implemented new policies and educated staff on changes.
Devised and implemented clinical protocols to ensure high-quality patient care.
Upheld quality assurance procedures to maintain patient safety and satisfaction.
Mentored new clinical staff members for proper onboarding and orientation processes.
Supervised and managed daily activities of clinical team consisting of [Number] physicians, nurses, and support staff.
Created weekly schedules for nurses, taking into account sick days and vacation time.
Coordinated, monitored, assigned, and documented patient and clinical care activities.
Assessed clinical policies and procedures for compliance with changing regulations.
Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
Registered Nurse
West Penn Hospital
Pittsburgh, Pa
06.1979 - 10.1980
Registered Nurse on 48 bed Unit Medical Surgical Unit.
Education
Bachelor Degree Program - Nursing
Duquesne University
06.1979
Masters - Organizational Leadership
Robert Morris University
06.2015
Skills
Nursing Leadership
Healthcare Administration
Staff Development
Member Relations
Quality Assurance
Compliance Measures and Audit
Team Membership
PC Proficiency/Microsoft Office
Clinical Operations
Program Management
Verbal and Written Communication Skills
Patient safety
Healthcare regulations
Interdisciplinary collaboration
Lean six sigma
Teamwork
Customer service
Team leadership
Time management
Decision-making
Verbal and written communication
Complex Problem-solving
Staff training and development
Staff management
Certification
I carry an Active Registered Nurse (RN) license in Pennsylvania.
Timeline
Clinical Quality Improvement Specialist
Pa Health and Wellness/Centene Corporation
07.2019 - 12.2023
Manager of Patient Experience and Clinical Care
Allegheny General Hospital
08.2018 - 02.2019
RN Care Manager
Gateway Health Plan
08.2015 - 08.2018
Registered Nurse GI Nurse
Maxim Staffing
05.2015 - 08.2015
Executive Director of Resident Care Services Operations and Staff Development