Nicole Smith
Slidell,LA
Summary
As an experienced healthcare professional with over 15 years of expertise in Medicaid and Medicare managed care, I excel in adult learning, people management, client engagement, and quality planning. My knowledge spans across HEDIS, CAHPS, NCQA Accreditation and Ratings, CMS, and State regulatory requirements, as well as quality program structuring.
I am skilled at developing strategies to improve efficiency and performance. Furthermore, I am passionate about fostering employee growth, providing training opportunities, and staying abreast of artificial intelligence advancements.
Overview
9
9
years of professional experience
Work History
Associate Director, Quality Review Operations
Optum
04.2023 - Current
- Assisted senior leadership in managing all aspects of operations.
- Managed cross-functional teams for multiple large-scale projects, successfully completing each on time and within budget constraints.
- Trained and guided team members to maintain high productivity and performance metrics.
- Formed strategic partnerships and connected with potential clients to drive business development.
Clinical Manager
Optum
09.2022 - 05.2023
- Enhanced staff performance through regular training, mentoring, and professional development opportunities.
- Fostered a positive work culture by recognizing employee achievements and addressing any concerns proactively.
- Tracked project and team member performance closely to quickly intervene in mistakes or delays for IOA and HEDIS.
- Monitored project progress, identified risks and took corrective action as needed.
Clinical Operations Manager
United Healthcare
08.2021 - 09.2022
- Promoted high morale and staff retention through dynamic communication, prompt problem resolution, proactive supervisory practices and facilitation of positive work environment.
- Oversaw a successful abstraction of our HEDIS project for the LTSS and Custom State Measures per NCQA guidelines.
- Delivered effective onboarding and training to new and existing employees and cross-trained staff members in other job roles to maximize coverage.
- Selected, promoted and terminated staff members.
Clinical Training Consultant
United Healthcare
02.2019 - 08.2021
- Developed an online learning module for claim systems training, HEDIS measure learning, and new employee onboarding.
- Evaluated client needs and expectations, establishing clear goals for each consulting engagement.
- Recorded videos and wrote instructions to facilitate online and remote training programs.
- Built constructive trainer and vendor relationships for successful program delivery.
- Evaluated success of training programs and recommended improvements to upper management to enhance effectiveness.
Clinical Manager
Meridian Health Plan, A WellCare
02.2017 - 01.2019
- Developed and maintained relationships with clients to facilitate quality and timely delivery of charts.
- Generated standard and custom reports to provide insights into business performance.
- Improved Star ratings by analyzing care-gap reports and educating providers on preventative care measures in an effort to improve patient care for breast cancer screenings, diabetic eye exams, and colorectal cancer screenings
- Created proposals to incentivize patients to complete their prenatal prenatal and postpartum visits in an effort to reduce complications associated with at risk populations.
- Assisted with planning and budgeting of over 300 employees for the HEDIS audit.
Quality Improvement Coordinator
WellCare- Contractor
02.2016 - 12.2016
- Documented and reported issues with compliance, standards of care and quality assurance requirements.
- Developed quality improvement plans, policies and operational guidelines.
- Assisted with abstraction for the HEDIS audit.
- Completed site visits to conduct assessments of provider practices to ensure they were meeting ADA requirements.
Education
LPN -
Trumbull Career And Technical Center Adult Training Center
Warren, OHBachelor of Science - Project Management
Capella University
Minneapolis, MN06.2026
Skills
- Servant Leadership
- Six Sigma Champion
- Data Analytics
- Adult Education and Training
- Consulting
- Client/Delivery Management
- Project Management
- Work Planning and Prioritization
Accomplishments
Project Management:
- Successfully managed multiple projects simultaneously, delivering all projects on time and within budget
- Fostered strong relationships with other departments, leading to improved communication and collaboration across the departments
Team Leadership:
- Certified as a just-in-time coach to provide mentoring and coaching to staff in order for them to achieve their highest potential across the organization
- Led a team of 300+ employees, improving team quality scores by 15% through effective training and development programs
Timeline
Associate Director, Quality Review Operations
Optum
04.2023 - Current
Clinical Manager
Optum
09.2022 - 05.2023
Clinical Operations Manager
United Healthcare
08.2021 - 09.2022
Clinical Training Consultant
United Healthcare
02.2019 - 08.2021
Clinical Manager
Meridian Health Plan, A WellCare
02.2017 - 01.2019
Quality Improvement Coordinator
WellCare- Contractor
02.2016 - 12.2016
LPN -
Trumbull Career And Technical Center Adult Training Center
Bachelor of Science - Project Management
Capella University
Similar Profiles
Dawnda CookDawnda Cook
Associate Clinical Administrative Coordinator at OptumAssociate Clinical Administrative Coordinator at Optum
Patricia ApodacaPatricia Apodaca
Medical Assistant at OptumMedical Assistant at Optum
Nowelle HoweNowelle Howe
Quality Specialist at OptumQuality Specialist at Optum
Rushik Reddy GangamRushik Reddy Gangam
Software Engineer - Remote at OptumSoftware Engineer - Remote at Optum
Jerry ByingtonJerry Byington
Mobile Mechanic Assistant at C and C AutomotiveMobile Mechanic Assistant at C and C Automotive