Rachel Byrd
Oakland,TN
Summary
Looking to utilize my knowledge in health care policy to make a difference in the lives of the individual's we serve. Insightful Manager with experience directing and improving operations through effective employee motivational strategies. Proficient in best practices, market trends and regulatory requirements. Talented leader with analytical approach to business planning and day-to-day problem-solving and is well-known for creating positive workplace culture and high-performing teams.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Director LTSS Choices
Elevance Health/Wellpoint
10.2024 - 07.2025
- Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Strengthened internal controls by reviewing existing policies and procedures, ensuring compliance with regulatory requirements.
- Managed budgets effectively to ensure optimal use of resources while maintaining financial stability.
- Optimized staff performance by designing comprehensive training programs tailored to individual needs.
- Boosted client satisfaction rates through exceptional relationship management and prompt resolution of issues.
- Collaborated with State Customer to ensure regulatory compliance and efficiency of regulatory requirements.
Manager II GBD Special Services
Amerigroup
06.2018 - 10.2024
- Built a new team that supported clinical staff.
- Managed a diverse team with responsibilities that included utilization management, adverse benefit determinations, collaboration with vendors.
- Collaborated with clinical staff to find solutions to social determinants of health and mitigate risks that led to potential gaps in care.
- Tasked to head optimization cost of care initiative, saving over $10M during tenure.
- Developed processes and job aides to improve efficiency and provide frontline staff with consistent workflows.
- Hires and trains new staff.
- Provides training for ongoing staff to new processes and annual refreshers. Frequently provides training for team meetings, Statewide care coordination college training sessions, new hire training.
- SME for IRR to ensure consistency among staff utilization of assessment tools.
- Complete regulatory reports for our state customer.
- Participated in the RFP process.
Manager I GBD Special Services
Amerigroup
01.2017 - 06.2018
- Supervise, direct and evaluate a diverse group of healthcare professionals to ensure the effectiveness of care coordinators' activities.
- Onboarded new employees, including training, mentoring, and new hire documentation.
- Monitor performance of staff including service performance and adherence to establish utilization and care coordination benchmarks.
- Additional responsibilities included completing reports for our state customer and meeting state-mandated compliance.
- Under my leadership, employee turnover was reduced and the region became stable.
TN Medicaid LTSS Service Coordinator
Amerigroup
10.2014 - 01.2017
- Responsible for initial and annual assessments of both HCBS as well as nursing facility members.
- Engage family, caregivers, and health care providers to ensure an appropriate plan of care which allows HCBS members to remain safely in the community.
- Identify social determinants of health and work to mitigate risks that cause potential gaps in care.
- Encouraging care that meets HEDIS measures to help meet goals.
- Reduced care costs without sacrificing quality through service coordination and multidisciplinary collaboration.
- Provide education, information, and support related to the goals of members.
- Coordinate acquisition of medical equipment as needed. Document assessments, interventions, and follow-ups on disease management activities.
- Collaborate with attending physicians and Medical Director to revise treatment plans as needed.
- Complete all required TNCare paperwork to prepare for submission into TPAES.
- Transitioning members from nursing facilities to community safely.
- Consistently met cost of care goals in the region as well as other goals.
- Appointed team lead and assisted manager with work assignments, reports, and covered while the manager was out.
- Worked closely with new hires, precepting them into their new roles.
Field Coordinator
UnitedHealth Group
08.2011 - 10.2014
- Initial and annual assessments of both HCBS as well as nursing facility members.
- Engaging family, caregivers and health care providers to ensure an appropriate plan of care which allow HCBS members to remain safely in the community.
- Identify social determinants of health to mitigate risks that can lead to gaps in care.
- Initiate face to face visits or telephonic visits with members and caregivers to ensure member’s needs and goals are being met through the services provided.
- Provide education, information, and support related to care goals of members. Coordinate acquisition of medical equipment as needed.
- Document assessments, interventions, and follow-ups on disease management activities as needed.
- Collaborate with attending physicians and Medical Director to revise treatment plans as needed.
- Complete all required TNCare paperwork and submit into TPAES.
Registered Nurse, Emergency Department
Baptist Memorial Hospital
04.2006 - 08.2011
- Required skills include excellent assessment abilities, triaging patients, caring for patients with a wide variety of illnesses including acutely ill patients requiring resuscitation, patients with exacerbation of chronic illnesses, acute traumatic injuries, and patients with minor ailments.
- Other skills include IV therapy, wound care, patient education, EKGs, venipunctures and maintaining mechanically ventilated patients.
- Responsibility included pediatric and obstetric patients.
- Quick thinking, flexibility and strong time management skills with the ability to work with a wide variety of people is required.
- Remained calm during high-stress, critical situations, demonstrating sustained focus and problem-solving in real-time.
Registered Nurse
TLC Home Health Care
08.2005 - 04.2006
- Collected blood and other laboratory specimens and prepared for lab testing.
- Taught patients how to improve lifestyle choices, dramatically reducing the chance of symptom reoccurrence.
- Educated patients, families, and caregivers on diagnosis and prognosis, treatment options, disease process and management, and lifestyle options.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Implemented interventions, including medication and IV administration, catheter insertion, wound care.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
Case Manager
Senior Services
04.1996 - 04.2005
- Managed cases for the Tennessee H.O.M.E. Medicaid waiver program.
- Provide assessments of long term care patients in the home setting, home supervisory visits, patient and family education, referrals to appropriate community services, coordination of care between a multi-disciplinary team, appropriate documentation and completed re-certifications in a timely manner.
- Skills included time management, computer use, the ability to work independently and strong patient assessment skills.
- Provided direct services to clients, including safety planning, crisis intervention, case management and advocacy.
- Identified gaps in care and social determinants of health and worked to find community resources to bridge gaps and meet these SDOH.
Education
Master of Science - Healthcare Policy
Chamberlain College of Nursing
Chicago, IL12.2020
Bachelor of Science -
Chamberlain College of Nursing
Chicago, IL07.2018
Diploma of Nursing -
St. Joseph School of Nursing
Memphis, TNSkills
- Policies and procedures
- Strategic planning
- Staff Management
- Verbal and written communication
- Coaching and mentoring
- Word, Excel, Power Point proficient
- Time management, organized
- Critical Thinking
Accomplishments
- Exceeded performance goals annually.
- High employee satisfaction.
- High employee retention with minimal turnover.
- Leads a high performing team who continues to meet annual goals.
Affiliations
American Nurses Association/Tennessee Nurses Association
Certification
Registered Nurse
Timeline
Director LTSS Choices
Elevance Health/Wellpoint
10.2024 - 07.2025
Manager II GBD Special Services
Amerigroup
06.2018 - 10.2024
Manager I GBD Special Services
Amerigroup
01.2017 - 06.2018
TN Medicaid LTSS Service Coordinator
Amerigroup
10.2014 - 01.2017
Field Coordinator
UnitedHealth Group
08.2011 - 10.2014
Registered Nurse, Emergency Department
Baptist Memorial Hospital
04.2006 - 08.2011
Registered Nurse
TLC Home Health Care
08.2005 - 04.2006
Case Manager
Senior Services
04.1996 - 04.2005
Master of Science - Healthcare Policy
Chamberlain College of Nursing
Bachelor of Science -
Chamberlain College of Nursing
Diploma of Nursing -
St. Joseph School of Nursing
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