Patricia Gusta
McDonough,GA
Summary
Highly analytical professional with a proven track record in supporting and streamlining healthcare management operations. Skilled in attracting and retaining diverse talent, delivering a positive employee experience, and cultivating team engagement. Consistently ensuring the delivery of optimum levels of clinical and therapeutic care while establishing strategic initiatives to drive and embed effective clinical practice. Expertise lies in building, leading, and training cross-functional teams to improve healthcare services efficiency. Instrumental in developing and executing the best health and safety practices for medical/patient care management. Excellent communicator, strengthening relationships with patients, staff, and management. Strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Collaborative approach and commitment to excellence are well-known in the industry.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Manager of Case Management
VillageMD
01.2023 - Current
- Leading a staff of twenty-two people to include Supervisors, Registered Nurses, Social Workers, Medical Assistants and Admin Personnel healthcare and social service needs by assisting in getting access to services
- Establish and maintain effective relationships with key stakeholders
- Enable patient health care needs and services in areas, such as long-term care, mental health, substance abuse, and geriatric care
- Achieved lowered re-admission rate from 13.5% to 10% which is goal
- Achieved lowered home health re-cert rate from 37% to 25% which is goal
- Developed and leveraged payer relationships to ensure care teams execute established goals across multiple payers
- Developed and maintained community-based relationships with Hospitals, Skilled Nursing Facilities, Home Health agencies and Community Based Organizations to provide the highest level of care for our patients
- Responsible for onboarding, training and continually evaluating new team members, in collaboration with central Care Management leadership, in alignment with national recognized, evidence-based care models
- Measured clinical outcomes by using internal and external benchmarking to build action plans and proactively address opportunities for improvement
- Collaborated with the population health operations and analytics teams to execute organizational strategy and quality metric outcomes
- Managed daily operations of care management employees, integrating workflows with physicians, and practice staff, to achieve outcomes and eliminate barriers to success
Clinical Utilization Review Preceptor
Emory Healthcare
06.2022 - 01.2023
- Managed and coordinated onboarding for Utilization Review nurses
- Executed Skills: Training
- And Quality Improvement projects for employees
- Achieved 100% employees trained on EPIC electronic medical record
- Achieved 100% employees trained on Milliman Care Guidelines and InterQual utilization system
Manager of Case Management
Optum
08.2021 - 06.2022
- Company Overview: Atlanta Metropolitan Area, GA
- Facilitate several people in managing healthcare and social service needs by assisting in getting access to services
- Establish and maintain effective relationships with key stakeholders
- Enable patient health care needs and services in areas, such as long-term care, mental health, substance abuse, and geriatric care
- Achieved 3.5 business performance score and 100% GTG (end of year engagement) through management approaches
- Supported global expansion initiatives by increasing NPS Scores from 60% to 85-100% for frontline staff by revising scripts and implementing engagement techniques
- Surpassed client expectations by demonstrating teamwork, managing contractual agreements, and delivering high quality results, to thirty-four clients and over 316k members during client assessments
- Atlanta Metropolitan Area, GA
Senior Case Manager
UnitedHealth Group
03.2018 - 08.2021
- Company Overview: Atlanta, GA
- Administered appropriateness of patient treatment across the continuum of care
- Guided individual patients and their clinicians on care coordination and medical management
- Led, trained, and mentored case management teams, while advising on technical skills, performance, and patient experience improvement
- Conceptualized complex/innovative outcomes and process improvements while analyzing team performance
- Decreased plan sponsor costs by educating case managers regarding evidence-based medicine principles
- Drove down cost efforts and nurtured physician-patient relationships by emphasizing primary care physician involvement in the continuum of care
- Created engagement techniques to improve NPS scores
- Atlanta, GA
Case Manager
UnitedHealth Group
11.2016 - 03.2018
- Company Overview: Atlanta, GA
- Evaluated diagnosis, orchestrated individual treatment plans, and manages application while maximizing cost containment
- Ensured compliance with HIPAA confidentiality requirements
- Communicated with physicians, nurses, hospital administrators, and patient-members on regular basis
- Empowered patients’ by offering independent choices on all aspects of care and quality of life
- Achieved Master Coach Certification and promoted to senior case manager within two years by delivering quality performance
- Atlanta, GA
Education Coordinator
Kindred Healthcare
06.2013 - 10.2016
- Company Overview: Atlanta, GA
- Devised and conducted all staff education and training programs on clinical, technological, administrative, and patient experience subjects
- Regularly analyze hospital staff’s educational training needs and recommended training solutions to senior hospital and individual department leadership
- Conducted annual hospital-wide in-services
- Achieved 100% retention of newly employed nurses by introducing a three-month Nurse Residency Program
- Decreased wound care rate cut from 67% to 30% by following wound care principles training for Nurses
- Slashed medication errors by enhancing the computer documentation process and steering significant efforts
- Trained staff on hospital’s electronic medical record (EMR) and Microsoft Office Suite as well as other software in use
- Atlanta, GA
Staff Nurse | RN
Piedmont Henry Medical Center
10.2010 - 06.2013
- Company Overview: Stockbridge, GA
- Prioritized multiple patients, stabilized conditions, and coordinated further care, while quickly assessing patients received by Emergency Department
- Adhered to physician orders while discharging treated patients and arranging longer hospital stays
- Assisted patients and families with post-discharge care and medication management by providing effective advice
- Evaluated Emergency Department staff training needs while serving as a member of the hospital Education Committee
- Reduced emergency cardiac catheterization time from one hour to 45 minutes by collaborating with ED Physicians
- Stockbridge, GA
Education
Master of Science - Nursing Education
Excelsior College
Albany, NYSkills
- Inpatient Case Management
- Physicians’ Support
- Leadership Development
- Clinical Nursing & Cost Controls
- Relationship Building
- Operational Management
- Training & Staff Development
- Problem Resolution
- Inpatient Utilization Management
- Patient Filing & Documentation
- Program Management & Emergency Care
- Care Coordination
Certification
- Registered Nurse, State of Georgia License
- Certified Case Manager (CCM), Commission for Case Manager Certification
- Critical Care Registered Nurse Certification (CCRN), American Association of Critical-Care Nursing (AACCN)
- Progressive Care Certified Nurse (PCCN), AACCN
- Certified Basic Life Support (BLS) Instructor, American Heart Association (AHA)
- Advanced Cardiac Life Support (ACLS) Instructor, AHA
- Master Certified Coach (MCC), UnitedHealth Group
Affiliations
- American Association of Critical-Care Nurses
- Sigma Theta Tau International Nurse Honor Society
- National League of Nursing
Awards
Georgia Case Management Nurse of the Year, 2017
Accomplishments
2017 March of Dimes award winner for Georgia for category care management. Awarded the Army Accommodation Metal for expert clinical service during a Mass hospital trauma and the Army Achievement Medal for honorable service in the US Army.
Timeline
Manager of Case Management
VillageMD
01.2023 - Current
Clinical Utilization Review Preceptor
Emory Healthcare
06.2022 - 01.2023
Manager of Case Management
Optum
08.2021 - 06.2022
Senior Case Manager
UnitedHealth Group
03.2018 - 08.2021
Case Manager
UnitedHealth Group
11.2016 - 03.2018
Education Coordinator
Kindred Healthcare
06.2013 - 10.2016
Staff Nurse | RN
Piedmont Henry Medical Center
10.2010 - 06.2013
Master of Science - Nursing Education
Excelsior College
Similar Profiles
Anita PittmanAnita Pittman
Clinical Quality Improvement Specialist/CPC at VillageMDClinical Quality Improvement Specialist/CPC at VillageMD
Lelia JohnsonLelia Johnson
Executive Assistant to C-Suite Executives at VillageMDExecutive Assistant to C-Suite Executives at VillageMD
Nicholas HopkinsNicholas Hopkins
Cloud Security Engineer at VillageMDCloud Security Engineer at VillageMD
Jenny Morris, CPC, CRC, CPMAJenny Morris, CPC, CRC, CPMA
Clinical Documentation Quality Integrity Coder (Auditor) at VillageMDClinical Documentation Quality Integrity Coder (Auditor) at VillageMD
Harrison DilfieldHarrison Dilfield
Operations Manager at Superior Pool ProductsOperations Manager at Superior Pool Products