Nancy Kent Kruper
Pittsburgh,PA
Summary
Results-driven health care professional with over 40 years of expertise in clinical and management positions, as well as a strong background in managed care. Skilled in developing and implementing key clinical business initiatives, strategic planning, and overseeing utilization and care management activities for diverse product lines including Medicaid, Commercial, and Medicare. Recognized for adaptability, effective collaboration, and consistently delivering measurable outcomes in dynamic environments. Demonstrates strong communication and problem-solving abilities, with a focus on fostering a productive and positive team culture.
Overview
44
44
years of professional experience
1
1
Certification
Work History
Director of Utilization Management
UPMC Health Plan
06.2018 - 11.2024
- Provided direct oversight of 3 separate business units including 2 Clinical Managers and a staff of 30 nurses in the Insurance Services Division of UPMC Health Plan, with a network of more than 140 hospitals and 29,000 physicians in a multi-state region.
- Reported to the Associate Vice-President of Medical Management. Responsibilities included clinical leadership, strategic plan development and implementation, regulatory compliance, vendor management and business operations.
- Leveraged professional networks and industry knowledge to strengthen local and national client and vendor relationships.
Manager, Medical Management
UPMC Health Plan
01.2008 - 06.2018
- Responsible for managing Case Management, Utilization Management and Disease Management teams.
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
- Cross-trained existing employees to maximize team agility and performance.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
Supervisor, Medical Management
UPMC Health Plan
01.2004 - 01.2007
- Oversaw development and implementation of a capped rental initiative for DME with resulting ROI of over $3 million; developed DME training seminars now conducted annually with member and provider customer service representatives and clinical staff
Discharge Coordinator, Medical Management
UPMC Health Plan
01.2001 - 01.2004
- Worked with network hospitals, skilled nursing facilities, families and members to provide discharge planning and case management services to individuals with complex discharge needs to ensure timely, cost effective transition to the next level of care.
Triage Nurse and Charge Nurse in Outpatient Surgi-Center
Health America
01.1988 - 01.2000
- Provided triage and oversight of the surgical team performing outpatient ob-gyne, medical-surgical and plastic surgery procedures in the outpatient surgery facility of the region’s largest managed care HMO.
Staff Nurse
Magee Women’s Hospital
05.1981 - 01.1984
- Provided post-partum care and teaching on a 25 bed maternity unit with a 30 bed newborn nursery at the region’s largest women’s hospital
- Awarded Magee Women’s Hospital Nurse of the Month Award in 1982
Education
Master of Science - Nursing Administration
California University of Pennsylvania
California, PA06-2018
Bachelor of Science in Nursing - Nursing
Duquesne University
Pittsburgh, PA01.1981
Skills
- Clinical Initiatives
- Policy Development and Implementation
- Corporate Compliance
- Process Improvement
- Quality Performance Measures
- Budget Management
- CMS, NCQA and DHS Regulatory Standards
Accomplishments
- Developed and implemented a Clinical Initiative for Private Duty Nursing that reported over $30 million in ROI in 2023-2024.
- Led Utilization Management teams to 100% compliance on DHS, CMS and NCQA accreditation audits in 2024.
- Developed and implemented a utilization review process for Behavioral Health using new technology and software resulting in improved staff efficiencies and cost savings in 2024.
- Earned a Six Sigma Green Belt with a re-design of the Out of Network Utilization Review and Claims Payment Process.
- Developed, implemented and managed a 24/7 Nurse Triage Line and Web Nurse Tool for Health Plan membership.
Certification
- Registered Nurse License-Commonwealth of Pennsylvania
- Nationally Certified Case Manager (CCM)
Awards and Certifications
- UPMC Diversity Mentor 2022-2023
- Nurse Scholar-California University of Pennsylvania MSN Program 2018
- Six Sigma Green Belt-2011
- UPMC's Award for Commitment and Excellence in Service (ACES)-2008. Award is given to fewer than 1% of staff across UPMC Health System.
- UPMC Health Plan Superstar Award-2007
Presentations
- Poster presentation "Positive Partnerships: A Collaborative Care Model for Management of Medically Fragile Pediatric Members", Annual summit of the Pennsylvania Organization of Nurse Leaders; Nemacolin, Pennsylvania, 2018.
Timeline
Director of Utilization Management
UPMC Health Plan
06.2018 - 11.2024
Manager, Medical Management
UPMC Health Plan
01.2008 - 06.2018
Supervisor, Medical Management
UPMC Health Plan
01.2004 - 01.2007
Discharge Coordinator, Medical Management
UPMC Health Plan
01.2001 - 01.2004
Triage Nurse and Charge Nurse in Outpatient Surgi-Center
Health America
01.1988 - 01.2000
Staff Nurse
Magee Women’s Hospital
05.1981 - 01.1984
Master of Science - Nursing Administration
California University of Pennsylvania
Bachelor of Science in Nursing - Nursing
Duquesne University
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