Nicole Horton
San Antonio,US
Summary
Dynamic healthcare leader with extensive experience at Centene, excelling in project management and team leadership. Proven track record of enhancing patient care outcomes through innovative strategies and data-driven solutions. Skilled in compliance and stakeholder collaboration, fostering a culture of continuous improvement and achieving high employee satisfaction.
Overview
31
31
years of professional experience
Work History
Manager, Care Management - LTSS (MMP)
Centene
San Antonio
09.2022 - 11.2024
- Lead and train a team of 12+ in care management, ensuring 97-100% employee satisfaction.
- Manage complex projects with precision, consistently meeting deadlines and achieving goals.
- Cultivate strong relationships with stakeholders, enhancing collaboration and communication.
- Expert in CMS audit processes, ensuring compliance and operational excellence.
- Leverage extensive knowledge of Medicare/Medicaid to improve care management outcomes.
- Led care management team for LTSS program, optimizing Medicare/Medicaid services.
- Streamlined processes, enhancing client satisfaction and operational efficiency.
- Fostered cross-functional partnerships to improve LTSS care delivery.
- Implemented innovative strategies, resulting in better patient outcomes and reduced costs.
- Analyzed complex healthcare data to identify trends and opportunities in LTSS program.
- Developed data-driven solutions to address gaps in care and service delivery.
- Spearheaded initiatives to modernize LTSS care management practices.
- Introduced cutting-edge technologies, significantly improving care coordination and patient engagement.
- Mentored and developed team members, fostering a culture of continuous learning.
- Implemented training programs that enhanced staff expertise in Medicare/Medicaid regulations.
- Optimized LTSS care management, enhancing client satisfaction and operational efficiency.
- Implemented data-driven solutions, addressing gaps in service delivery.
Service Coordinator II/ Case Manager (Star Plus/ MMP)
Centene
San Antonio
05.2014 - 08.2022
- Collaborated with stakeholders to enhance patient health outcomes through strategic planning.
- Developed and executed personalized care plans, ensuring comprehensive patient support.
- Consulted with healthcare professionals to maintain high-quality services for the community.
- Updated knowledge on patient care through continuous education and industry events.
- Utilized extensive Medicare/Medicaid expertise to optimize service delivery and compliance.
- Foster partnerships with stakeholders to address patient needs, developing strategies that significantly enhance health outcomes and quality of life.
- Conduct comprehensive assessments to create and implement personalized treatment plans, integrating LTSS, rehabilitative, and preventive care measures.
- Drive high-quality healthcare delivery through strategic consultation with medical professionals, case managers, and home care service providers.
- Continuously enhance expertise in patient care through active participation in workshops, conferences, and educational programs.
- Demonstrate in-depth knowledge of Medicare/Medicaid (Star Plus) regulations, ensuring compliance and optimal patient care management.
- Analyzed patient data to develop tailored care plans, resulting in improved health outcomes and enhanced quality of life for Medicare/Medicaid beneficiaries.
LVN/ Charge Nurse
Parklane West
01.2013 - 05.2014
- Managed nursing staff, ensuring compliance with healthcare standards.
- Coordinated patient admissions and discharges, streamlining processes.
- Monitored patient conditions, effectively communicating with doctors.
- Administered medications and therapies, enhancing patient care quality.
- Fostered a productive work environment, leading to improved outcomes.
- Led nursing team, oversaw patient care, and managed admissions/discharges.
- Ensured compliance with healthcare standards and regulations.
- Fostered teamwork among nursing staff, coordinated with doctors for optimal patient care, and facilitated smooth interdepartmental communication.
- Implemented efficient workflows, reducing patient wait times and improving overall care quality.
- Consistently met department KPIs.
- Mentored junior nurses, promoting professional growth.
- Created a positive work environment, boosting staff morale and productivity.
- Meticulously managed medication administration and IV therapy.
- Maintained accurate patient records, ensuring seamless continuity of care.
LVN/ Charge Nurse
Memorial Medical
11.2011 - 01.2013
- Led nursing team, ensuring compliance with healthcare standards and effective patient care.
- Managed patient admissions and discharges, optimizing workflow and enhancing patient experience.
- Monitored patient conditions, communicated with doctors, and administered treatments efficiently.
- Guided nursing staff, fostering a productive work environment and improving team collaboration.
- Implemented strategies for staff adherence to regulations, achieving consistent quality outcomes.
- Fostered teamwork among nursing staff, coordinating patient care efforts.
- Mentored junior nurses, promoting skill development and adherence to healthcare standards.
- Analyzed patient data to optimize care strategies.
- Developed streamlined reporting systems, improving communication between nurses and physicians.
- Drove positive patient outcomes through proactive care management.
- Implemented new IV therapy techniques, resulting in faster recovery times.
- Pioneered a culture of continuous improvement in patient care.
- Introduced innovative physical therapy integration methods, enhancing overall treatment efficacy.
Jr. Escrow Officer
South Hills Escrow Corporation
West Covina
12.2005 - 01.2008
- Ensured accuracy in sales transactions and documentation processing for escrow closings.
- Facilitated property sales by managing funds, deeds, and legal documents as a neutral party.
- Audited closed files, safeguarding interests of both buyers and sellers in real estate deals.
- Reviewed reports and applications to check for liens and encumbrances, ensuring compliance.
- Prepared closing statements and calculated financial obligations, ensuring accurate payouts.
- Meticulously processed escrow documentation, ensuring accuracy in real estate transactions and safeguarding interests of all parties involved.
- Conducted thorough audits of closed files, reviewing title searches, inspections, and financial documents to identify and resolve potential issues.
- Acted as neutral intermediary, facilitating property sales by managing funds and legal documents, fostering trust between buyers and sellers.
- Streamlined closing processes, efficiently calculating amounts owed and managing debt payoffs in compliance with state regulations.
- Developed improved documentation system, enhancing accuracy and reducing processing time for escrow transactions.
- Scrutinized real estate transactions, identifying potential issues and ensuring compliance with state regulations to protect all parties involved.
Eligibility Team Lead (Acting-Supervisor)
Los Angeles County DPSS
Los Angeles
10.1993 - 11.2005
- Led team to assess eligibility for state programs, improving benefit issuance efficiency.
- Supervised and motivated 10+ staff, enhancing productivity and satisfaction.
- Resolved complex case complaints, fostering community relations and trust.
- Implemented staff training, ensuring adherence to AFDC guidelines.
- Promoted a positive work culture, resulting in increased employee satisfaction.
- Led eligibility team, overseeing 10+ staff.
- Determined program eligibility, issued benefits, and handled case complaints.
- Fostered positive work culture, boosting productivity.
- Guided and motivated staff in daily functions.
- Served as community liaison, completing special projects for administrators.
- Promoted humility while maintaining satisfaction.
- Analyzed and approved benefits according to AFDC guidelines.
- Resolved complex case issues, ensuring compliance with state and federal regulations.
- Implemented new training methods, enhancing staff performance.
- Streamlined intake processes, improving efficiency in eligibility determinations.
- Achieved consistent accuracy in benefit issuance.
- Reduced case processing time, significantly improving department productivity and client satisfaction.
- Streamlined benefit issuance process, significantly reducing processing time and enhancing client satisfaction while leading a team of 10+ staff members.
Education
BLS Healthcare Certification - American Heart Association
San Antonio, TX
San Antonio, TX09-2025
BS - HealthCare Management
University of Phoenix-Arizona
Phoenix01.2021
Licensed Vocational Nurse - San Antonio
St. Philips/ Alamo Colleges
San Antonio01.2011
Skills
- Project management
- Communication skills
- Critical and analytical thinking
- Technical expertise
- Problem-solving abilities
- Customer service excellence
- Leadership qualities
- Attention to detail
- Motivational techniques
- Team management
- Nursing care
- Case management
- Healthcare consulting services
- Patient care and assessment
- Educational instruction
Additional Information - Activities Leadership
Committed leader within the company, community and with others. Assisted with the development, implementation, and continued processing of work processes, policies, and rules within Star Plus, MMP as well as extensive experience with Aids to Families with Children (AFDC) Medicaid. Strong relationship builder with the community, employees, colleagues, and stakeholders. Collaborative leader and team player who can adapt to any situation while motivating others to yield maximum outcomes. Trained, mentored, educated, and assisted new hires/employees within the company and other organizations.
References
References available upon request.
Timeline
Manager, Care Management - LTSS (MMP)
Centene
09.2022 - 11.2024
Service Coordinator II/ Case Manager (Star Plus/ MMP)
Centene
05.2014 - 08.2022
LVN/ Charge Nurse
Parklane West
01.2013 - 05.2014
LVN/ Charge Nurse
Memorial Medical
11.2011 - 01.2013
Jr. Escrow Officer
South Hills Escrow Corporation
12.2005 - 01.2008
Eligibility Team Lead (Acting-Supervisor)
Los Angeles County DPSS
10.1993 - 11.2005
BLS Healthcare Certification - American Heart Association
San Antonio, TX
BS - HealthCare Management
University of Phoenix-Arizona
Licensed Vocational Nurse - San Antonio
St. Philips/ Alamo Colleges