Summary
Overview
Work History
Education
Skills
Websites
Licenses And Technology
Timeline
Generic

Priscilla Glidewell

Tipp City

Summary

Healthcare executive with extensive leadership experience in health plan performance, clinical operations, and reimbursement optimization. Recognized for enhancing operational efficiency and payer relationships while leading multidisciplinary teams. Expertise in value-based care initiatives, utilization management, and aligning clinical strategies to improve organizational outcomes.

Overview

15
15
years of professional experience

Work History

Director of Health Plan Performance

Management and Network Services (MNS)
03.2026 - Current
  • Provide executive leadership for health plan performance initiatives focused on operational efficiency, quality outcomes, and payer performance optimization.
  • Partner with organizational leadership to develop and implement strategic initiatives supporting growth, compliance, and reimbursement improvement.
  • Analyze performance metrics, utilization trends, and operational data to drive informed decision-making and continuous improvement efforts.
  • Strengthen payer relationships and support initiatives that enhance network performance and organizational outcomes.

Director of Clinical Services

Management and Network Services (MNS)
01.2022 - 03.2026
  • Directed clinical operations and organizational service delivery initiatives across multidisciplinary teams.
  • Led performance improvement strategies focused on quality outcomes, regulatory compliance, and operational effectiveness.
  • Collaborated with executive leadership, providers, and external stakeholders to improve clinical workflows and patient care coordination.
  • Oversaw staff development, clinical oversight, and implementation of best practices supporting organizational goals.

Care Coordination Manager

Management and Network Services (MNS)
04.2019 - 01.2022
  • Managed care coordination operations designed to improve patient outcomes, continuity of care, and resource utilization.
  • Supervised interdisciplinary care coordination teams while supporting population health and utilization management initiatives.
  • Facilitated collaboration among providers, payers, and internal departments to address care gaps and improve service delivery.
  • Assisted with strategic initiatives aimed at reducing readmissions and enhancing patient engagement.

Regional Director of Clinical Reimbursement

Premier Health Care Management
10.2016 - 04.2019
  • Directed regional reimbursement operations across multiple healthcare facilities with responsibility for MDS oversight, compliance, and revenue optimization.
  • Served as a subject matter expert in clinical reimbursement, documentation integrity, and regulatory compliance.
  • Led training and operational support initiatives to improve reimbursement accuracy and organizational performance.
  • Partnered with facility leadership teams to strengthen clinical documentation practices and maximize reimbursement opportunities.

Director of Nursing

Premier Health Care Management
03.2016 - 10.2016
  • Oversaw nursing operations, staffing, clinical compliance, and quality assurance initiatives within a post-acute care setting.
  • Led nursing teams in delivering high-quality patient care while maintaining adherence to state and federal regulations.
  • Supported operational and clinical improvement initiatives designed to enhance patient outcomes and staff performance.

MDS Coordinator

Premier Health Care Management
01.2011 - 02.2016
  • Managed MDS assessment processes and coordinated care planning and reimbursement documentation to ensure compliance with CMS guidelines.
  • Collaborated with interdisciplinary teams to enhance quality care delivery and ensure reimbursement accuracy.
  • Ensured compliance with regulatory standards and completed clinical assessments on time to support effective patient care.

Education

Bachelor of Science - Nursing

Western Governors University
Salt Lake City, UT
01-2017

Associate of Science - Nursing

Fortis College
Centerville, OH
01-2013

High School Diploma -

Stebbing High School
Dayton, OH
01-2005

Skills

  • Managed Care & Payer Relations
  • Reimbursement Optimization
  • Utilization Management
  • Value-based initiatives
  • Regulatory & CMS Compliance
  • Quality improvement
  • Care coordination
  • Plan performance strategy
  • Clinical Operations Leadership
  • Interdisciplinary Team Leadership
  • Workflow optimization
  • Provider Collaboration
  • Regulatory compliance
  • Contract and vendor management

Licenses And Technology

  • Registered Nurse (RN), RN.401561
  • Multiple EMR Systems
  • Multiple Payer Portals including third party vendors and AI document review/extraction.
  • Microsoft Office Suite
  • Canva

Timeline

Director of Health Plan Performance

Management and Network Services (MNS)
03.2026 - Current

Director of Clinical Services

Management and Network Services (MNS)
01.2022 - 03.2026

Care Coordination Manager

Management and Network Services (MNS)
04.2019 - 01.2022

Regional Director of Clinical Reimbursement

Premier Health Care Management
10.2016 - 04.2019

Director of Nursing

Premier Health Care Management
03.2016 - 10.2016

MDS Coordinator

Premier Health Care Management
01.2011 - 02.2016

Bachelor of Science - Nursing

Western Governors University

Associate of Science - Nursing

Fortis College

High School Diploma -

Stebbing High School
Priscilla Glidewell