PENNY AUTEN
Anderson,SC
Summary
Talented Manager with expert team leadership, planning and organizational skills built during successful career. Smoothly equip employees to independently handle daily functions and meet customer needs with exceptional management abilities and results-driven approach. Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success. Dedicated Medicare Advantage professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
16
16
years of professional experience
Work History
UM Nurse Manager- Auditing/Delegation
Humana Inc.
12.2020 - Current
- Managed 15-23 nurses and utilization activities in HSO by providing comprehensive nursing guidance and maintaining outstanding utilization management APTs and KPI standards.
- Supervised, directed, and motivated high-quality performance from associates.
- Developed auditing program and standards to improve regulatory compliance in region and presented outcomes to senior and executive leadership.
- Presented and created staff meetings to keep team informed of departmental changes and provide opportunities for nurses to share ideas and concerns.
- Supervised, directed, and motivated high-quality performance from associates.
- Fostered improvement in staff development, personnel training, and standards of patient care.
- Developed and implemented quality improvement initiatives to provide best possible patient care and identify and address areas of concern and presented to senior and executive leadership.
- Promoted professional development opportunities to encourage associates to pursue continuous training.
- Responsible for evaluating, auditing, and maintaining compliance of evidence-based standards based on NCQA, CMS and MCG guidelines to improve and enhance quality of care and medical needs of our members. Presented finding to senior leadership.
- Determine focal points of gaps in care and presented outcomes to senior leadership and provide education/training of staff to optimize care of services creating effective and premium outcomes for members.
- Comprise systems and processes to maximize positive evidence-based care results and reduce admission rates to acute setting.
- Assisted senior leadership in and policy validation.
- Manage and create delegation standards for delegated groups and plans.
- Worked with senior and executive leadership to create ISNP program and facility list.
Acute Short Stay Auditor
Humana Inc.
04.2018 - 12.2020
- Responsible for evaluating, auditing, and maintaining compliance of evidence-based standards based on NCQA, CMS and MCG guidelines to improve and enhance quality of care and medical needs of membership.
- Analyzed data and findings to prepare reports detailing financial information.
- Planned audits and audit activities to allocate necessary resources and determine consistency of plans with audit objectives.
- Identified control gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
- Coordinated, managed and implemented auditing projects and prepared for evaluation.
- Planned and executed follow-up audits at appropriate intervals.
- Comprise systems and processes to maximize positive evidence-based care results and reduce admission rates to acute setting.
- Assist leadership in and policy validation.
- Obtained MCG Trainer Certification in 2016
- Developed MCG training program to include new associate onboarding education for MCG guideline standards in Southeast Region.
- Participated in MCG IRR question writing and validation in 2019 and became IRR question writer lead assisting with writing and validation processes for 2020 HSO IRR test.
Skilled Care Facility Onsite Liaison
Humana Inc.
08.2016 - 04.2018
- Successfully communicated with multiple entities inside and outside of business.
- Solved conflicts and addressed issues that occurred between other entities and business.
- Monitored, communicated and coordinated objectives of Humana.
- Collected and analyzed data and feedback to identify opportunities to improve relationship between other entities and business.
- Liaised between internal departments and external partners to promote efficient communication and collaboration.
- Facilitated meetings and conferences between various parties, enabling better collaboration and efficient decision-making.
- Collaborated with senior leadership and other departments, identifying and addressing areas needing improvement.
- Prepared and delivered presentations and reports to senior leadership on liaison activities for internal and external stakeholders.
- Responsible to manage visits to ensure proper choice facility needs and direction of SNF Choice Facility initiative to increase outcomes for Humana Inc.
- Effectively promoted positive outcomes for our membership.
- Input data into appropriate databases and analyzed data for senior leadership.
- Assist with SNF/LTAC/IRF compliance and workflow audits and monitor dashboards.
Utilization Management/ Transition of Care Nurse
Humana Inc.
02.2015 - 08.2016
- Fostered relationships to develop rapport with 8 of markets more abrasive facilities to improve outcomes and member's perfect experience.
- Fostered strong relationships with clients and families to support comprehensive social, mental and physical care.
- Assess and manage up to 100 Medicare member's skilled care admissions and continued stay for required criteria and medical necessity.
- Review care criteria and guidelines daily managing up to 100 authorizations weekly.
- Review member criteria according to CMS/ MCG Guidelines.
- Collaborate with 8 to 10 facilities simultaneously on Humana expectations and care of service models.
RN MDS Coordinator/ Utilization Manager
Seneca Health Center
08.2012 - 09.2014
- Responsible for QM Measure Reviews for Quality and Performance
- ADL and Rug monitoring and management for 132 residents
- Utilization Review Management for 132 residents
- MDS assessments: successfully led, trained, and implemented processes to 135 associates and 132 residents while maximizing resident benefits through appropriate resource utilization.
Nurse Manager/ ADON/ MDS Coordinator
Cross Keys Village
01.2008 - 02.2012
- Perform administrative and managerial functions for team of 235 nurses.
- Responsible for staffing, budget, planning, and long-range goal targets for 252-bed facility.
- Manage nursing personnel and monitor productivity for over 300 nursing associates.
- Maintain accurate, detailed reports and records, and policy validation.
Education
Bachelor of Science - Health Information Technology
Walden University
Minneapolis, MN12.2024
Associate of Science - Nursing Science
Pennsylvania College of Nursing
Lancaster, PA06.2003
Bachelor of Science - Chemistry
Pennsylvania State University
York, PA05.1992
Associate of Science - Business Administration And Management
York College of Pennsylvania
York, PA05.1992
Skills
- Process Improvement
- Quality Assurance
- Risk Management
- Task Delegation
- Compliance Oversight
- Policy Implementation
- Project Tracking
- Work Flow Planning
- Contract Management
- Strategic Planning
- Performance Management
- Staff Development
Licensure And Certifications
- Board Certified - Geriatric Nursing, ANCC 2011-2025
- MCG Trainer Certified 2016-2024
- CMS Certification - 2012-2026
- Registered Nurse, South Carolina Board Of Nursing, South Carolina 2012
Timeline
UM Nurse Manager- Auditing/Delegation
Humana Inc.
12.2020 - Current
Acute Short Stay Auditor
Humana Inc.
04.2018 - 12.2020
Skilled Care Facility Onsite Liaison
Humana Inc.
08.2016 - 04.2018
Utilization Management/ Transition of Care Nurse
Humana Inc.
02.2015 - 08.2016
RN MDS Coordinator/ Utilization Manager
Seneca Health Center
08.2012 - 09.2014
Nurse Manager/ ADON/ MDS Coordinator
Cross Keys Village
01.2008 - 02.2012
Bachelor of Science - Health Information Technology
Walden University
Associate of Science - Nursing Science
Pennsylvania College of Nursing
Bachelor of Science - Chemistry
Pennsylvania State University
Associate of Science - Business Administration And Management
York College of Pennsylvania
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