Julie Jennings, RN, MBA
Healthcare Adminstration
Milton,FL
Summary
Results-driven healthcare leader offering 15+ years of clinical, administrative and patient care experience. Proficient in best practices, market trends and regulatory requirements of industry operations. Gifted in building and implementing approaches to increase quality and streamline procedures. Significant leadership background directing multidisciplinary healthcare teams to achieve care objectives and outperform business targets.
Overview
10
10
years of professional experience
6
6
years of post-secondary education
1
1
Certification
Work History
Director, Clinical Programs
Brighton Health Plan Solutions
05.2023 - Current
- Designed and implemented a multifaceted clinical program oversight model focused on monitoring and analyzing performance gaps, establishing measurable program outcomes, and setting progressive quality objectives.
- Implemented multiple strategic initiatives to enhance efficiency and quality while ensuring compliance with various regulatory bodies and accreditation standards.
- Spearheaded successful cross-departmental preparations and application submission that led to the organization achieving re-accreditation with URAC (Utilization Review Accreditation Commission).
- Conducted in-depth analysis of high utilization trends and identified opportunities to enhance the involvement of Case Management in managing complex members. This strategic approach aimed to optimize cost management while improving outcomes for members.
- Partnered with internal and external clinical program teams to produce seamless operations and communication avenues streamlining operations and boosting operational excellence.
- Created reporting mechanisms to analyze and communicate essential data and trends.
- Primary resource person for complaints received from legal department to investigate and create a response on behalf of the clinical team for any clinically related complaints or inquiries.
- Assist with FWA identification concerns within the utilization management space including education to the clinical review team on identifying possible abuse by providers and escalation pathways.
Manager, Clinical Performance
Bright Health Group
08.2021 - 12.2022
- Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions and common goals, accomplished competing tasks within established timelines
- Onboarded new employees with training and new hire documentation, created ongoing training for skill maintenance and development
- Maximized performance by monitoring daily activities and mentoring team members, positive performance management
- Developed and implemented multiple process and quality improvement initiatives
- Oversaw day-to-day operations of utilization management team by fostering professional relationships with internal and external stakeholders
- Worked in tandem with peers to better understand business process and initiate improvements
Manager, Transitional Housing, Language, and Employment
YW Calgary, Client Services
02.2020 - 06.2021
- Created, supported, and maintained programming that reduced vulnerability of women through housing and community-based initiatives
- Actively contributed to organizational strategic planning and fostered excellent organizational culture that was visionary, creative and hope-filled
- Hired, developed and lead engaged and high performing teams that delivered on program results in safe and collaborative environments
- Compiled financial and performance reports for internal and external stakeholders; Coordinated and reviewed new funding proposals
- Formed and maintained strong relationships with internal and external stakeholders
Manager
CareSource, Utilization Management
09.2016 - 05.2019
- Proven leadership in forming engaged and highly functioning teams
- Strategic planning incorporating technological advancements and progressive ideology supporting organizational mission and vision goals
- Engaged in multidisciplinary committees evaluating organizational goals, financial stability, and clinical outcomes of lives served
- Independent problem solving and conflict resolution of member concerns and regulatory inquiries
Team Lead
CareSource, Utilization Management
12.2014 - 09.2016
- Directed and supervised team of 20+ engaged in clinical and non-clinical tasks.
- Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
- Audited team performance and compliance with contractual, state and NCQA accreditation standards.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
Education
Master of Science - Business Administration in Healthcare
Indiana Wesleyan University
Marion, IN 08.2014 - 07.2016
Bachelor of Science - Management Science
Indiana Wesleyan University
Marion, IN 09.2011 - 09.2013
Associate of Applied Science - Nursing
Sinclair Community College
Dayton, OH 03.2005 - 07.2007
Skills
Compliance Oversight
Clinical Quality Improvement
Policy and Procedure Management
Improvement Initiatives
Coaching and Mentoring
Accreditation Expertise
Operations management
Strategic planning
Creativity and innovation
Certification
In Process - Certified Professional in Healthcare Quality
Timeline
In Process - Certified Professional in Healthcare Quality
02-2024
Director, Clinical Programs
Brighton Health Plan Solutions
05.2023 - Current
Manager, Clinical Performance
Bright Health Group
08.2021 - 12.2022
Manager, Transitional Housing, Language, and Employment
YW Calgary, Client Services
02.2020 - 06.2021
Manager
CareSource, Utilization Management
09.2016 - 05.2019
Team Lead
CareSource, Utilization Management
12.2014 - 09.2016
Master of Science - Business Administration in Healthcare
Indiana Wesleyan University
08.2014 - 07.2016
Bachelor of Science - Management Science
Indiana Wesleyan University
09.2011 - 09.2013
Associate of Applied Science - Nursing
Sinclair Community College
03.2005 - 07.2007
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