Myrnie Wortman
New Market
Summary
Experienced in case management with a strong focus on regulatory compliance and quality improvement. Collaborated with compliance and quality teams to establish reporting structures that ensure adherence to CMS standards across various programs. Led initiatives to conduct comprehensive risk assessments, successfully mitigating operational and reputational risks while overseeing a multidisciplinary team of direct reports. Implemented effective training and development strategies to enhance staff performance and engagement within high-risk and transitional care programs.
Overview
17
17
years of professional experience
Work History
Manager of Case Management and Population Health
Shared Health
2024.10 - Current
- Collaborates with Compliance and Quality teams to develop reporting structures ensuring CMS adherence across all Case Management programs
- Conducts comprehensive risk assessments to identify and mitigate operational, regulatory, and reputational risks within clinical and case management processes
- Spearheaded a comprehensive backlog clean-up initiative, successfully completing over 800 overdue Individualized Care Plans (ICPs) to bring programs into full regulatory compliance; maintained ongoing regulatory monitoring
- Leads internal auditing initiatives to ensure compliance with federal and state regulations, contract requirements, and company policies
- Leads a multidisciplinary team of 6 direct reports within the High-Risk Case Management and Transitions of Care programs
- Has direct oversight of the non-clinical support team of 9 additional direct reports within the Low-Risk Case Management program
- Assumed responsibility of an operations team within my first six months of hire; implemented compliance-focused oversight strategies to ensure continued regulatory adherence during the transition
- Supported a successful upgrade of our documentation platform by collaborating with IT, training, and clinical teams to ensure system readiness, minimize user disruption, and enhance workflow efficiency
- Leads monthly Joint Operating Committee (JOC) meetings with external vendors to drive alignment, resolve barriers, and ensure accountability for clinical performance metrics
- Established and implemented team-level Objectives and Key Results (OKRs) to improve operational focus, and drive performance with our model of care in mind
- Directed an onsite pilot initiative aimed at improving Transition of Care workflows; led cross-functional readiness efforts and stakeholder engagement
- Participates in STARS performance meetings weekly, with a focus on reducing hospital readmissions and improving clinical outcomes in the D-SNP population
- Supported successful migration of enterprise phone system with minimal disruption to operations, contributing to improved system reliability and member service
Manager of Clinical Operations
Evolent
2020.11 - 2024.10
- Oversees and leads a multidisciplinary team of 20 direct reports within the Pregnancy and Transitional Care programs
- Implements and leads several pilot programs, including staffing nurses in local hospitals to manage high risk/high utilization members of our population
- Collaborates with the State of MD to improve Pregnancy Care engagement, including but not limited to OB provider engagement to increase PRA (Pregnancy Risk Assessment) completion and increasing doula access for our at-risk members
- Assist with workshops to increase quality performance for NCQA programs
- Strategizes with leaders and develops ways to improve engagements across Care Management programs by collecting and analyzing data
- Collaborates with Utilization Management team and Medical Director to manage high risk patients while hospitalized with the goal of achieving positive outcomes and preventing readmission
- Collaborates with the client to identify and support at-risk members (lead level outreaches, closing gaps in care, overcoming social determinants of health (SDOH) barriers) while using local resources
- Supports the development of new hires and existing staff to meet client needs with the ability to shift gears and prioritize when needed; employee retention and performance management.
- Facilitates monthly Interdisciplinary Rounds
- Conducts routine audits to ensure compliance with the State of Maryland and NCQA
- Develop and maintains Standards of Practice (SOPs)
- Proficient in Excel, PowerPoint, SharePoint, Word; collects and analyzes data to guide the team to successfully meet metrics
Registered Nurse Care Advisor- Lead
Evolent
2019.11 - 2020.11
- Facilitated successful launch of new contract with Evolent Health and Somos Medicaid Market in New York City
- Holistic management of members within the New York City Medicaid population within Complex Care (pediatric and adults), Pregnancy Care, HIV care, Catastrophic care (adult and pediatric), Condition care (adult and pediatric), and Transitional care programs (pediatric and adults)
- Maintained and supported NCQA population health and case management accreditation
- Developed and maintained care plans with the support of an interdisciplinary care team
- Provided ongoing education to assist in chronic and acute disease management
- Assumed a preceptor/mentor role for multiple new hire clinical support staff in collaboration with Somos dedicated training team
- Organized team touch base meetings to review program requirements and guidelines
Registered Nurse Care Advisor- Lead
Evolent
2015.12 - 2019.11
- Assisted in developing and implementing the Advanced Illness Care program within Medstar as one of the first Care Advisors to manage patients referred to this program by their Primary Care Physicians
- Holistically managed members within the Medicare, Medicaid, Dual SNP, and Commercial population within multiple programs including Pregnancy Care, Complex Care, Advanced Illness, and Transitional Care programs.
- Developed and maintained care plans with the collaboration of patient, primary care physician, specialists, and other healthcare providers.
- Acute and chronic disease management/education
- Conducted home and provider visits; meeting patients and families where they need to be met. Reconcile medications, review discharge instructions, and ensure patients have appropriate appointments set. Address barriers to care and work towards resolving gaps in care.
- Assisted team managers in establishing and implementing improved ICT template to assist care advisors in presenting high risk special needs patients and to ensure these patients have their highest priority needs addressed
- Assumed a preceptor role for multiple new hire Care Advisors and assisted them on patient calls, as well as home and provider visits
- Performs peer chart audits to ensure NCQA Complex Care compliance
- Complete/organize monthly stratification lists independently
- Led biweekly Advanced Illness Care meetings with AIC manager, medical director, and population health managers
- Provides leadership and management coverage to team when manager is on planned time off
Local Care Coordinator
Healthways/Care First BCBS
2015.04 - 2015.12
- Identified members with needs for chronic care coordination. Developed, documented, and implemented care plans specific to each patient. Provided ongoing education to members on their disease process(es) (cause, risk factors, signs and symptoms, prevention, treatment, self-monitoring).
- Assisted the patient with mitigating issues and removing barriers to care.
- Assisted the patient with coordination of any additional tests, images, and consults with specialists.
- Assessed for efficacy and drug interactions/side effects.
- Used various teaching methods specific to each patient.
- Carried a case load of 40-50 patients.
- Located and assisted member with enrolling in applicable community resources.
- Documented weekly care calls electronically. Decreased the rate of hospital admissions and ER visits through advocacy and education.
- Developed and maintained strong working relationships with primary care physicians.
- Served as an extension of the PCP office. Provided on-site consultation to PCP offices and Care Coordination team providers.
- Developed clinical reports for PCP in regard to their patient population.
- Created seamless communication between the patient, PCP, specialists, and the care coordination team.
- Utilized and implemented strategies to engage physician and patients in case management.
PACU RN
Franklin Square Medical Center
Baltimore
2013.01 - 2015.01
IMC Step-Down RN
Greater Baltimore Medical Center
Baltimore
2008.01 - 2013.01
Education
Bachelor of Science - Nursing
Walden University
Minneapolis, MN2015-01
Associate of Science - Nursing
Harford Community College
Bel Air, MD2007-01
Skills
- Regulatory compliance
- Quality improvement
- Team leadership
- Interdisciplinary collaboration
- Operational oversight
- Patient advocacy
- Stakeholder engagement
- Process optimization
- Training and development
- Performance metrics
- Staff development
- Quality management
- Transitions of care
- Readmission reduction
- Adaptability and flexibility
- Program implementation
- Written and verbal communication
- Multitasking capacity
- Conflict resolution
- Staff supervision
- Risk management
Timeline
Manager of Case Management and Population Health
Shared Health
2024.10 - Current
Manager of Clinical Operations
Evolent
2020.11 - 2024.10
Registered Nurse Care Advisor- Lead
Evolent
2019.11 - 2020.11
Registered Nurse Care Advisor- Lead
Evolent
2015.12 - 2019.11
Local Care Coordinator
Healthways/Care First BCBS
2015.04 - 2015.12
PACU RN
Franklin Square Medical Center
2013.01 - 2015.01
IMC Step-Down RN
Greater Baltimore Medical Center
2008.01 - 2013.01
Bachelor of Science - Nursing
Walden University
Associate of Science - Nursing
Harford Community College