MARY STONE
Marion,Ohio
Summary
Strategic leader with deep expertise in driving business growth and fostering high-performance teams. Demonstrates strong ability to navigate complex challenges and deliver impactful results. Adept at building collaborative environments and leveraging analytical skills to meet evolving demands. Recognized for exceptional communication, leadership, and problem-solving abilities.
Overview
8
8
years of professional experience
Work History
ACO Manager for Clinical Health Services
CVS Health
11.2022 - Current
- Coordination with operations to discuss meeting the financial, operational, and quality objectives for providers
- Oversees the implementation of healthcare management services for assigned functional area
- Implements clinical policies & procedures in accordance with applicable regulatory standards (e.g., CMS, state and federal standards and mandates as applicable)
- Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
- Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
- May act as a liaison with other key business areas
- May develop/assist in development and/review new training content
- May collaborate/deliver inter and intra-departmental training sessions
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality
- Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care
- Develop, initiate, monitor and communicate performance expectations
- Ensures the team's understanding and use of information system capability and functionality
- May act as a single point of contact for the customer and the Account Team including participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers
- Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
- Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
- Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
- Consistently demonstrates the ability to serve as a model change agent and lead change efforts
- Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
- Accountable for maintaining compliance with policies and procedures and implements them at the employee level
- Developed strong professional relationships with industry stakeholders, fostering collaboration and enhancing business opportunities.
- Maintained up-to-date knowledge of industry standards and regulations to ensure the company''s compliance in all aspects related to P&L management.
Associate Manager for Clinical Health Services
Aetna Better Health of Ohio
03.2022 - 11.2022
- Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards
- Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
- Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
- Act as a liaison with other key business areas
- Develop/assist in development and/review new training content
- Collaborate/deliver inter and intra-departmental training sessions
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality
- Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care
- Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes
- Develop, initiate, evaluate, monitor, and communicate performance expectations
- Ensures the team's understanding and use of information system capability and functionality
- Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
- Assesses developmental needs and collaborates with others to identify and implement action plans
RN Case Manager
Aetna Better Health of Ohio
03.2019 - 03.2022
- Assessing, planning, coordinating, and implementing case management with members to evaluate each medical need
- Understands and complies with the Ohio 3-way agreement with CMS and ODM and program audit requirements
- Developing proactive courses of action to address and prevent issues that could affect member’s wellness
- Applying clinical judgment to reduce risk factors and barriers that affect member’s health and wellbeing
- Creating member-specific care plans with reasonable goals and interventions to achieve maximum wellness
- Utilizing community resources and educational tools for member specific needs
- Complying with regulatory and company policies and procedures
- Ensuring maximum member engagement in regard to their health status and needs through motivational interviewing
- Interacting with other medical professionals and building relationships to ensure members have an abundance of resources available to live a health life
- Dedicated member of a POD which allows for peer discussion, support, and information sharing
Manager of Staff Development, Wound Nurse, RN
The Arbors at Delaware
05.2017 - 03.2019
- Weekend manager
- On call for staffing issues and building concerns
- Worked Directly with Director of Nursing and Unit managers on conducting interviews and completing the hiring process
- Utilized the Ohio Board of Nursing website for license verification
- Assisted with leading staff meetings for nurses, and aides
- Nurse in charge of documenting and following infections and implementing infection control measures
- Ensuring employees receive compliance training and education necessary to perform job duties in accordance with Code of Conduct
- Ensuring documentation for all training is completed in accordance with state, federal, and compliance requirements
- Monitoring employee performance by auditing skills on the floor and providing positive feedback and education
- Managing the employee health program
- Providing hands-on clinical orientation and instruction to licensed and unlicensed personnel
- Conducting annual competency assessments for staff and ensuring clinical competency through observation
- Assisting in department budget preparation and containing expenditures within budget
- Conducting and coordinating OSHA/RISH Management program with oversight of documentation requirements
- Planning and conducting state and federal in-service program
- Conducting certification of training programs for nursing assistants
- Initiating and leading team conferences in development of nursing care plans
- Assessing and documenting the residents’ condition and nursing needs
- Supervising RN, LPNs, and CNAs
- Assisting physicians with special tests and procedures
- Assigning nursing care to team members in accordance with qualifications
- Assessing and implementing the ostomy care for patients
- Providing advanced clinical guidance to physicians and nursing staff for complex wound drainage, skin protectant, and prevention of pressure necrosis
- Developing and conducting educational programs for staff
- Developing patient care plans and determining the equipment, materials, and resources needed to successfully implement the care plan
Education
Bachelors - Science of Nursing
Capella University
Columbus, Oh08.2022
ASSOCIATES OF APPLIED SCIENCE -
AMERICAN INSTITUTE OF ALTERNATIVE MEDICINE / ITT TECHNICAL INSTITUTE
Columbus, Ohio01.2017
HIGH SCHOOL GRADUATE -
MARION CATHOLIC HIGH SCHOOL
Marion, OH05.2007
Skills
- Proficient in multiple charting databases
- Proficient in Microsoft Office applications
- Proficient in Power Bi
- Proficient in Telephony
- Experienced in educating others in various health-related competencies
- Committed to providing competent patient care
- Partnership development
- Staff development
- Customer service
- Task delegation
- Relationship building
Activities
- Kidney Camp Counselor, 2016, The Jewish Community Center, Columbus, Ohio
- Light the Night, Leukemia Lymphoma Society
- Volunteer Efforts, MARCA industries, Marion, Ohio
- IMPREM Food Drive, Columbus, Ohio
Timeline
ACO Manager for Clinical Health Services
CVS Health
11.2022 - Current
Associate Manager for Clinical Health Services
Aetna Better Health of Ohio
03.2022 - 11.2022
RN Case Manager
Aetna Better Health of Ohio
03.2019 - 03.2022
Manager of Staff Development, Wound Nurse, RN
The Arbors at Delaware
05.2017 - 03.2019
Bachelors - Science of Nursing
Capella University
ASSOCIATES OF APPLIED SCIENCE -
AMERICAN INSTITUTE OF ALTERNATIVE MEDICINE / ITT TECHNICAL INSTITUTE
HIGH SCHOOL GRADUATE -
MARION CATHOLIC HIGH SCHOOL
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