Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Timeline
Generic

Melisa Gartner

Summary

Accomplished RN/Educator/Coder who drives organizational improvements through leveraging expertise in research and 20 years critical care nursing background. Excellent reputation for resolving problems and improving customer satisfaction. Proven strengths in developing MRA education to support and build internal and external healthcare management teams. Dedicated to cost, process and resource optimization. Comprehensive healthcare training, excellent communications skills and self-directed prioritization will be an asset to the Case Management role.

Overview

20
20
years of professional experience
1
1
Certification

Work History

Sr. Manager, National Clinical Revenue Integrity

Aetna/CVS Health
05.2023 - Current
  • Lead a team of 4 educators who achieved operational excellence by streamlining processes and implementing best practices.
  • Developed detailed plans based on broad guidance and direction.
  • Developed strategic plans for business growth, resulting in increased revenue and market share.
  • Improved team performance by providing comprehensive training and fostering a collaborative work environment.

Clinical Performance-Quality Manager

Aetna/CVS Health
11.2021 - 05.2023
  • Provide detailed feedback and education to Keystone, NY/NJ and New England Markets after analyzing each Market's goals and initiatives.
  • Work with provider groups such as Yale, NYU, Delaware Valley, and Heritage Valley to understand RA needs and provide excellent service.
  • Compile monthly data and present executive presentations highlighting areas of opportunity and recommend optimizations to markets.
  • Coached business leaders on Medicare Advantage Risk Adjustment, HCC conditions, IOAs, ASMs and Annual Wellness Visits.
  • Developed customized training programs for clients, resulting in enhanced workforce productivity.

Corporate Nurse Educator

Aetna
11.2019 - 11.2021
  • Assessed educational needs of trainees and researched clinical instruction trends to develop educational curriculum and competency tools for clinical procedures.
  • Organized short-term educational programs such as lectures and workshops to address specific clinical topics.
  • Contributed educational and clinical expertise to help optimize training courses and boost Provider/Coder learning.
  • Remained up to date on clinical protocols, procedures and developments within Risk Adjustment to serve as informational resource to students.

Clinical Research Nurse Coordinator

Washington University School of Medicine
03.2017 - 10.2018
  • Coordinated clinical trials focused on disorders such as Influenza and STDs.
  • Collected data and followed research protocols, operations manuals and case report form requirements.
  • Worked with principal investigator and sponsors to facilitate daily trial activities and comply with research protocols.

Flight Nurse

CEN, Air Evac Lifeteam
12.2012 - 10.2016
  • Performed wide range of specialized functions and complex assessments, diagnoses, therapies and emergency treatment of patients transported by rotor-wing aircraft.
  • Assessed for and detected changes in status of patients and demonstrated proactive approach to solving patient problems.
  • Maintained flight medicine knowledge base by attending mandatory meetings, performing chart and equipment reviews, skills labs and clinical rotations and participating in continuing education sessions for care and transport of critically ill and injured patients.

Assistant Director of Nursing/Home Health RN

MedPlus Home Healthcare
02.2011 - 05.2016
  • Managed care from admission to discharge.
  • Provided direct patient care, stabilized patients and determined next course of action.
  • Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
  • Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use and disease management.

Trauma Nurse Specialist/Charge Nurse/Staff Nurse

St. Louis University Hospital
12.2003 - 02.2011
  • Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
  • Performed triage on incoming patients and determined severity of injuries and illnesses.
  • Accurately documented treatment, medications and IVs administered, discharge instructions and follow-up care.

Education

Associate of Applied Science - Nursing

Meramec Community College
12.2003

Skills

  • Organization and Time Management
  • Problem-Solving
  • Flexible and Adaptable
  • Analytical and Critical Thinking
  • Self-Motivated
  • Creative Questioning
  • Managing Deadlines
  • Documentation
  • Records review
  • Scheduling
  • Quality Management
  • Home Health Care
  • Legal Compliance
  • Quality Improvement Activities
  • Cross-Functional Team Leadership
  • Data-Driven Decision-Making

Certification

Certified Risk Adjustment Coder (CRC) Basic Life Support (BLS/CPR) Advanced Cardiac Life Support (ACLS) Pediatric Life Support (PALS) Certified Emergency Nurse (CEN) Trauma Nurse Specialist (TNS) Trained in providing In-services

Accomplishments

    Publication acknowledgment:

  • Decreased CD47 expression during spontaneous apoptosis targets neutrophils for phagocytosis by monocyte-derived macrophages

Timeline

Sr. Manager, National Clinical Revenue Integrity

Aetna/CVS Health
05.2023 - Current

Clinical Performance-Quality Manager

Aetna/CVS Health
11.2021 - 05.2023

Corporate Nurse Educator

Aetna
11.2019 - 11.2021

Clinical Research Nurse Coordinator

Washington University School of Medicine
03.2017 - 10.2018

Flight Nurse

CEN, Air Evac Lifeteam
12.2012 - 10.2016

Assistant Director of Nursing/Home Health RN

MedPlus Home Healthcare
02.2011 - 05.2016

Trauma Nurse Specialist/Charge Nurse/Staff Nurse

St. Louis University Hospital
12.2003 - 02.2011

Associate of Applied Science - Nursing

Meramec Community College

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