Melissa Nunez, MSN, RN
Naperville,IL
Summary
With 26 years of healthcare experience, an exceptional leader skilled in creating and integrating business plans, strategies, and procedures. Dedication lies in setting goals focused on performance and growth, while also building long-lasting relationships with business partners. Proven track record of maximizing client bases, enhancing performance, and increasing efficiency. Focused Operation Manager excelling in contract negotiation and process improvement, remaining calm and poised even in high-pressure situations. Leveraging in-depth knowledge of industry trends and shifts to offer valuable insights on opportunities for new growth and expansion. Over 15 years of experience in maintaining seamless business operations, a diligent Operations Manager who smoothly administers budgets, trains staff, and monitors procedures to maximize efficiency and balance objectives with operational requirements. Exceptional performance in inventory management, loss prevention, and vendor negotiation adds to skill set. Over 10 years of compliance management experience and a comprehensive understanding of OSHA, state, and federal regulations.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Director of Clinical Operations
Beyond Podiatry
11.2022 - Current
- Train 100+ staff per board requirements as well as national, state and local regulations.
- Collaborate with Quality Team to develop outcomes statistics.
- Head clinical oversight to devise and establish policies, procedures and best practices in alignment with regulatory requirements.
- Implement new hire training to further develop skills and initiate discussions on task prioritization.
- Reduced operational costs through efficient resource allocation and budget management.
- Oversaw clinical studies focused on quality assessment, financial health and customer relations.
- Optimized scheduling procedures, reducing wait times for patients while maximizing resource utilization within the clinic setting.
- Implemented innovative technology solutions to increase efficiency in data collection and analysis for clinical trials.
- Ensured regulatory compliance by staying informed of industry standards and maintaining thorough documentation practices.
- Facilitated knowledge sharing among staff through organized training sessions, workshops, and conferences on best practices in clinical operations management.
- Developed comprehensive risk management plans to minimize potential issues in clinical operations.
- Collaborated with interdisciplinary teams to develop integrated care plans tailored to individual patient needs.
- Developed systems and procedures for effective project management and clinical operations.
- Implemented new policies and educated staff on changes.
- Developed, implemented, revised, and evaluated policies and procedures.
- Participate in Committee meetings with department heads to discuss census information and issues.
- Resolve conflicts promptly among physicians, nurses and other healthcare employees to keep workflows on task.
- Communicate with patients with compassion while keeping medical information private.
Utilization Review Nurse
Blue Cross Blue Shield of Illinois
09.2019 - 11.2022
- Performed admission reviews based for medical necessity
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Resolved insurance reimbursement issues, reducing financial barriers to necessary treatments.
- Enhanced patient care coordination by effectively communicating review outcomes to healthcare teams.
- Enhanced patient satisfaction by collaborating with interdisciplinary teams to develop individualized care plans, ensuring appropriate level of care.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Streamlined the case management process by effectively prioritizing high-risk cases for timely intervention and followup.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
Registered Nurse
Presbyterian Medical Group
06.2016 - 09.2019
- Took active role in patient and family planning process, detailing instructions and responding appropriately and effectively to question and concerns.
- Addressed disruptions in patient care, including delays in discharge, postponed procedures and discharge equipment unavailability.
- Worked with different disciplines to provide cohesive care to patients.
- Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented all patient interactions and interventions in electronic charting systems.
- Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
Regional Manager
Smiles for Kids Dentistry
06.2010 - 06.2016
- Developed and executed successful business plans that resulted in improved market share and profitability within the region.
- Established and maintained operational standards for 5 locations.
- Collaborated with executive leadership to establish long-term objectives, drive growth initiatives, and align regional efforts with corporate goals.
- Implemented cost-cutting measures across the region that led to significant savings without compromising service quality or employee satisfaction.
- Facilitated seamless integration of new acquisitions into existing operations while maintaining positive company culture and high levels of morale among employees.
- Enhanced team performance by providing regular coaching, training, and performance feedback to staff members.
- Optimized inventory management systems for reduced stock discrepancies, minimizing losses due to shrinkage or obsolescence.
- Supervised various locations, enforcing high-quality standards of operation.
Education
Master of Science - Nursing Leadership And Administration
Capella University
Minneapolis, MN01-2019
Bachelor of Science - Nursing Science
Chamberlain College of Nursing
Chicago, IL01-2018
Associate - Science in Nursing
Carrington College
Albuquerque, NM01-2012
Skills
- EMR
- Policy Development
- Implementation
- Leadership Experience
- Strategic Planning and Development
- Managed KPI Dashboard
- Training
- Practice management
- Primary Care Experience
- Contract Negotiation
- Billing, Negotiating, Workflow
- Continuous improvements
- Profit and loss accountability
Accomplishments
- Promoted from Manager of Operations to Director of Clinical Operations
- Medicare Shared savings Program earned an additional $100k to $500k in total earnings annually
- Developed systems to optimize compliance and increase reimbursement
- Educated and trained Providers and staff to maximize compliance which included ICD10/CPT specificity coding, medically necessity documentation, usages of structured fields for reporting purposes
- Devised effective policies and protocols resulting in 100% compliance with audit requirements.
- Established, lead and managed company Compliance Committee
Certification
- Registered Nurse
- MSN focused on Leadership and Administration
- Currently obtaining Health Care Compliance Certification Program Certificate Holder(HCCP)- Compliance Certification Board.
Timeline
Director of Clinical Operations
Beyond Podiatry
11.2022 - Current
Utilization Review Nurse
Blue Cross Blue Shield of Illinois
09.2019 - 11.2022
Registered Nurse
Presbyterian Medical Group
06.2016 - 09.2019
Regional Manager
Smiles for Kids Dentistry
06.2010 - 06.2016
- Registered Nurse
- MSN focused on Leadership and Administration
- Currently obtaining Health Care Compliance Certification Program Certificate Holder(HCCP)- Compliance Certification Board.
Master of Science - Nursing Leadership And Administration
Capella University
Bachelor of Science - Nursing Science
Chamberlain College of Nursing
Associate - Science in Nursing
Carrington College
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