Nicole Jeffries
Wilmington,DE
Summary
- Registered Nurse with over 17 years’ experience in multiple disciplines, with 11 years in managed health care, Medicare Advantage. Adept at bridging the gap between healthcare and business, through strategic leadership and innovative solutions. Thorough knowledge of industry changes and trends paired with a strong grasp of regulatory requirements. Recipient of multiple performance awards and Summa Cum Laude (BSN). In-depth knowledge of regulatory frameworks and industry advancements, honored with multiple performance awards and Summa Cum Laude distinction in BSN.
Knowledgeable Desired Position with proven history of leading high-performing teams and executing strategic initiatives that drive organizational growth. Successfully directed cross-functional projects that resulted in significant process improvements and operational efficiencies. Demonstrated leadership and communication skills in fostering collaborative environments and delivering impactful results.
Overview
18
18
years of professional experience
Work History
Stars Director, West Mid America Market
Aetna
10.2022 - 04.2025
- Use quantitative & qualitative analysis to identify trends and opportunities for STAR rating improvement.
- Direct the resolution of complex strategic business problems to improve STAR ratings and mitigate business impact.
- Partnered with risk management in developing a structured approach to foster a culture of performance improvement across the organization.
- Work with service line leaders to finalize, track, and submit data ensuring accurate and timely reporting of quality measures.
RN Case Management Team Manager
Absolute Care
01.2021 - 06.2022
- Managed 16 RN Case Managers based in a freestanding clinic setting.
- Followed at risk set of patients and completed treatments as needed and care plan management.
- Coordinated patient centered team rounds and maintained optimal staffing ratios for clinic CM team.
- Developed programs to support staff education on quality and compliance.
Regional Stars Manager-ISNP, Complex Care Management
Optum
01.2021 - 01.2022
- Planned, executed, and reported key performance indicators within multiple markets.
- Provided strategic direction and function as the STAR’s SME for multiple ISNP plans.
- Identified risks and barriers to achieving STAR rating improvement and instituted corrective action plans.
Stars Program Advisor Mid Atlantic
Cigna
09.2017 - 01.2021
- Provided direction on strategic and baseline opportunities on cost, efficiency, effectiveness/value, contractual, legal and compliance perspectives.
- Collaborate with provider engagement teams implement operating models and organizational enhancements that sustain improvements in quality of care and boost cost effectiveness.
- Identified and worked to remove barriers that slowed or prevented the successful attainment of quality goals, aiding in the successful achievement of the MAPA STAR Ratings increase in 2020.
Stars Senior Specialist Hybrid (Stars/P4Q)
Cigna
05.2016 - 09.2017
- Collaborated with multiple markets to cultivate initiatives to improve STAR ratings.
- Provided education and training for internal and external customers/vendors increase compliancy ratings in the following: STAR, HOS, CAHPS, HEDIS.
- Identified gaps in quality metrics for members and providers to achieve optimal health outcomes.
RN Case Manager (P4Q) Quality Program
Cigna
12.2013 - 12.2016
- Monitored and assisted Value Based Physician Groups to increase STAR ratings and patient satisfaction outcomes.
- Positioned in Primary care physician office as a value-based clinic coordinator.
- Manage patient scheduling, coordinating vendor services and focusing on Medicare and Medicaid compliance.
- Utilized an interdisciplinary approach to improve population health outcomes.
- Analyzed member reports to identify trends/opportunities to close gaps in care.
RN Rehabilitation Charge Nurse
Christ Home
08.2013 - 04.2014
- Maintained rounds with floor staff to observe and evaluate the physical and emotional status of residents.
- Supervised the care provided to residents by the direct care and nursing staff.
LPN/Agency Charge Nurse
General Healthcare Resources
04.2007 - 08.2013
- Provided nursing care in LTC, LTAC and Assisted Living facilities on all shifts.
- Completed admission, transfer, and discharge planning of residents.
- Provided accurate documentation of activities and treatments according to facility and PA State standards.
- Monitored, recorded, reported symptoms and changes in resident's conditions.
LPN/Charge Nurse
Aristacare at Meadow Springs
10.2008 - 07.2011
- Provided skilled nursing care in sub-acute setting for residents with various medical conditions including Parkinson's, Multiple Sclerosis, Spinal Cord Injury, and Traumatic Brain Injury.
- Maintained supervision of all paraprofessional floor support
- Care planed patient care, including multidiscipline therapies.
Education
BSN - undefined
Colorado Technical University
ASN - undefined
Montgomery County College
LPN - undefined
Eastern Center for Arts and Technology
Skills
- Relationship development
- Strategic planning and execution
- Communication proficiency
- Decision-making abilities
- Operations oversight and management
- Leadership in teams
- Project execution and delivery
- Strategy formulation and goal setting
- Change facilitation and management
- Resolution of issues and conflicts
- Program administration and management
- Contractual agreements and vendor relations management
Timeline
Stars Director, West Mid America Market
Aetna
10.2022 - 04.2025
RN Case Management Team Manager
Absolute Care
01.2021 - 06.2022
Regional Stars Manager-ISNP, Complex Care Management
Optum
01.2021 - 01.2022
Stars Program Advisor Mid Atlantic
Cigna
09.2017 - 01.2021
Stars Senior Specialist Hybrid (Stars/P4Q)
Cigna
05.2016 - 09.2017
RN Case Manager (P4Q) Quality Program
Cigna
12.2013 - 12.2016
RN Rehabilitation Charge Nurse
Christ Home
08.2013 - 04.2014
LPN/Charge Nurse
Aristacare at Meadow Springs
10.2008 - 07.2011
LPN/Agency Charge Nurse
General Healthcare Resources
04.2007 - 08.2013
BSN - undefined
Colorado Technical University
ASN - undefined
Montgomery County College
LPN - undefined
Eastern Center for Arts and Technology
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