Martha Moses
Marietta,GA
Summary
Registered Nurse experienced in health care management, quality assurance, legal consulting, and risk management. Proven track record in overseeing credentialing, utilization review, and managed care processes across diverse service lines. Demonstrates strong analytical skills and commitment to delivering high-quality patient care. Recognized for adaptability, strong work ethic, and ability to excel in independent roles.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Clinical & Operational Risk Manager/Legal Nurse
WELLSTAR HEALTH SYSTEM
Marietta, GA
01.2011 - 05.2023
- Responsible for all aspects of risk management programs for three Wellstar hospitals, nursing home, urgent care center, outpatient laboratories and imaging, outpatient and inpatient hospice facilities, multiple infusion centers, inpatient Behavioral Health facility, and Home Health. Produced and maintained loss run reports. Developed strategies to prevent patient injuries, reduce losses and costs associated with medical malpractice claims.
- Conducted claim investigations and settled non-suit claims directly.
- Served as liaison with outside defense attorneys. Prepared discovery and timelines. Assisted at depositions and trials.
- Partnered with hospital administrators, physicians, medical directors, and defense attorneys for risk education and special investigations. Served on hospital quality and safety committees, sentinel event teams, and System Claims Committee.
- Supported staff in depositions and trial preparedness.
- CS Stars/RL6 education/incident reporting.
- Retired from Wellstar Health System 5/1/2023.
Quality Improvement Manager
WELLSTAR HEALTH SYSTEM
Marietta, GA
03.2010 - 01.2011
- Oversaw physician peer review and Performance Improvement activities for Cardiovascular, Surgery, and Musculoskeletal Service Lines.
- Ensured regulatory compliance while supervising four RNs and collaborating with quality committees.
- Managed distribution and analysis of quality report card data, coordinating multiple data sources.
- Utilized various data collection methodologies and metrics to enhance reporting accuracy.
Clinical Project Manager
WELLSTAR HEALTH SYSTEM
Marietta, GA
06.2009 - 03.2010
- Oversaw system-wide stroke programs, providing in-service training on stroke education and conducting chart abstraction for Get with the Guidelines.
- Trained new Stroke Abstractor to ensure compliance with American Stroke Association standards.
- Participated in hospital stroke committees to enhance program effectiveness.
Quality Improvement Coordinator, Cobb Hospital
WELLSTAR HEALTH SYSTEM
Marietta, GA
06.2007 - 06.2009
- Coordinated hospital-wide practitioner performance improvement activities per WellStar Medical Staff Peer Review Policy.
- Collaborated with physician department heads on peer review and quality issues for Surgery, Anesthesia, and Vascular Institute.
- Conducted comprehensive data collection, analysis, and reporting of comparative performance metrics.
- Facilitated quality improvement recommendations and comparative profiling for physician credentialing and reappointment.
- Reviewed and summarized sentinel event processes while creating actionable timelines for QI initiatives.
- Presented quality chart review data at MCE meetings and prepared QI reports for relevant committees.
- Served as data liaison across Quality & Patient Safety, Medical Executive, and other key committees.
- Achieved promotion to Project Manager due to exemplary performance in quality improvement efforts.
Nurse Case Manager/Senior Nurse Case Manager
Anthem Blue Cross & Blue Shield/Blue Cross & Blue Shield of Georgia
Roanoke, VA
07.1999 - 05.2007
- Promoted to senior role, delivering clinical and administrative expertise in HMO/PPO managed care products for nine hospitals in Central-SW Virginia.
- Specialized in managing potentially high-cost and high-utilization cases efficiently.
- Facilitated and monitored treatment plans from pre-certification through discharge planning.
- Resolved provider, claims, and service issues to enhance operational efficiency.
- Served as resource for team leaders, members, insureds, and healthcare professionals.
- Managed approximately 50 first-level appeals daily with decision-making authority.
- Trained new RN medical reviewers on best practices in utilization management.
- Conducted educational sessions for providers on Utilization Management processes.
Education
Master of Science - Nursing, concentration in Health Systems Management
University of Virginia
Charlottesville, VABachelor of Science - Nursing, Summa cum laude
Radford University
Radford, VADiploma - Nursing
Roanoke Memorial Hospital, School of Professional Nursing
Roanoke, VASkills
- Microsoft Office Suite
- Claim investigation and case review
- Performance improvement strategies
- Effective communication
- Conflict resolution
- Problem solving
- Leadership
- Incident management
- Medical malpractice prevention
- Legal documentation
- Interdisciplinary collaboration
- Medical record analysis
- Deposition preparation
- Litigation support
- Injury assessment
- Courtroom testimony
Certification
- Certified Professional in Healthcare Risk Management (CPHRM), 2020-01-01 to present
- Certified Legal Nurse Consultant (LNCC), 2014-01-01 to 2024-01-01
- Certified Professional in Utilization Review (CPUR), 1996-01-01 to 2010-01-01
- Certified Post-Anesthesia Nurse (CPAN), 1993-01-01 to 1998-01-01
- Basic Life Support (American Heart Association) current until 2027
Professional License
Registered Nurse, Georgia, #RN187638
Additional Health Care Experience
- Staff/Charge Nurse, ER & Post-Anesthesia Care Unit, Lewis-Gale Hospital, Salem, VA
- Staff Nurse, Post-Anesthesia Care Unit, Department of Veterans Affairs Medical Center, Salem, VA
- Head Office Nurse/Conscious sedation/Hospital O.R. private scrub nurse, Dr. John Gardner, Roanoke, VA
- Charge Nurse, ICU, Roanoke Memorial Hospital, Roanoke, VA
Timeline
Clinical & Operational Risk Manager/Legal Nurse
WELLSTAR HEALTH SYSTEM
01.2011 - 05.2023
Quality Improvement Manager
WELLSTAR HEALTH SYSTEM
03.2010 - 01.2011
Clinical Project Manager
WELLSTAR HEALTH SYSTEM
06.2009 - 03.2010
Quality Improvement Coordinator, Cobb Hospital
WELLSTAR HEALTH SYSTEM
06.2007 - 06.2009
Nurse Case Manager/Senior Nurse Case Manager
Anthem Blue Cross & Blue Shield/Blue Cross & Blue Shield of Georgia
07.1999 - 05.2007
Master of Science - Nursing, concentration in Health Systems Management
University of Virginia
Bachelor of Science - Nursing, Summa cum laude
Radford University
Diploma - Nursing
Roanoke Memorial Hospital, School of Professional Nursing
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