Summary
Overview
Work History
Education
Skills
Certification
Additional Information
Timeline
Generic

Rachel Svatek, MSN, BSN, RN, USN-Ret.

Registered Nurse & United States Naval Officer Veteran
Newport,NC

Summary

Highly motivated and detail-oriented healthcare professional with a strong background in benefits coordination, client service, and healthcare operations. Demonstrates exceptional organizational and program management skills, with a proven ability to manage multiple priorities and meet tight deadlines. Passionate about delivering high-quality, patient-centered solutions and driving improvements in service accuracy and satisfaction. Known for professionalism, reliability, and a collaborative approach. Licensed RN in California, Hawaii, New York, Alaska, Illinois and North Carolina with experience supporting Medicare and Medicaid populations

Overview

14
14
years of professional experience
17
17
years of post-secondary education
8
8
Certificates

Work History

Nurse Case Manager

Aetna
01.2024 - Current


  • Managed a high volume of client accounts, prioritizing critical cases and ensuring all benefit changes and pricing adjustments were accurately processed.
  • Coordinated across internal teams and external stakeholders—including healthcare providers, social workers, and payers—to ensure seamless benefit plan implementations and continuity of care.
  • Conducted detailed assessments of client plans and claims data to identify gaps and discrepancies, driving targeted interventions and improving overall client satisfaction.
  • Led quality assurance and audit processes to verify accuracy of pharmacy benefit plan changes and resolve claim discrepancies proactively.
  • Evaluated trends in claims and utilization data, recommending process improvements that enhanced operational efficiency and reduced errors.
  • Served as a key liaison between clients and support teams, facilitating communication and resolving complex benefit and coverage issues.
  • Educated clients and internal partners on benefit plan features and changes, empowering stakeholders to understand and navigate plan complexities.
  • Advocated for clients by addressing claims disputes and benefit concerns with internal teams and external vendors to ensure optimal service delivery.
  • Collaborated with multidisciplinary teams to design and implement workflow improvements that streamlined benefits administration and improved client outcomes.
  • Supported new technology adoption to enhance data tracking, reporting, and communication efficiency across client services.
  • Reduced client escalations by closely monitoring claims and benefits, intervening early to resolve potential issues.
  • Improved documentation and reporting processes to ensure timely and accurate communication with clients and internal departments.

Surgical Services Clinic Manager-Department Head

US Navy-NMRTC
01.2020 - 10.2023
  • Provided Coding and Medical Billing for clinical and surgical appointments and surgeries
  • Reported to various medical staff members including surgeons, anesthesia, and nurses in order to offer observational notes and additional support for patients requiring surgery
  • Screened all patients requiring surgery utilized advanced clinical skills to educate patients
  • Due to COVID -19 Pandemic, ensured all patients were properly triaged and treated
  • Fostered network between Naval Hospital Camp Lejeune to ensure all Active-Duty Members, Retirees and Dependents were able to get care during clinic closures. Successfully placed referrals to t network when needed.
  • Monitored duties assigned to personnel to promote high levels of patient care and job efficiency.
  • Leveraged patient feedback and performed continuous process improvements to streamline day-to-day business operations and patient satisfaction.
  • Conducted frequent clinic walk-throughs to maintain safe work environment.
  • Developed marketing strategies to increase visibility and patient base.
  • Created and implemented policies to improve operational efficiency and patient care quality.
  • Enforced adherence with HIPAA regulations and other relevant laws and regulations to maintain compliance.
  • Attended regular meetings with hospital administrators to discuss clinic operations and policies.
  • Enforced maintenance of clean and organized work environment in compliance with safety and sanitation regulations.
  • Provided direct care to patients by assessing, diagnosing and treating illnesses.
  • Hired, trained and supervised employees to maintain team of high performers.
  • Monitored number of patients and wait times to create efficient flow of patients from check-in to check-out.
  • Developed and implemented team building activities to foster collaboration and improve employee morale.
  • Budgeted for resources to control expenditure and maximize profits.
  • Liaised with health insurance companies to process insurance claims and maximize reimbursements.
  • Analyzed and reported patient data to identify areas of improvement and facilitate decision-making.
  • Coordinated with healthcare professionals to verify proper implementation of patient treatment plans.
  • Successfully negotiated client contract renewals to create increased revenue.
  • Collaborated with store manager to maintain daily operations.
  • Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
  • Ordered all pharmacy supplies and kept check on inventory levels.
  • Monitored and inspected staff processes to eliminate hazards posed for both residents and staff while ensuring continuous compliance with regulations.
  • Scheduled surgeries, managed pre-certifications and verified insurance coverage.
  • Developed policies and procedures for effective pharmacy management.
  • Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
  • Removed trash and straightened counters to keep pharmacy area clean and neat.
  • Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
  • Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
  • Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
  • Communicated with patients, ensuring that medical information was kept private.
  • Spearheaded and implemented new projects to expand scope of engagement.
  • Discussed medical histories with patients in effort to provide most effective medical advice.
  • Created customized care plans, working with hospital staff and families to assess and meet individual needs.
  • Defined testing protocols, quality assurance initiatives and clinic policies and procedures.
  • Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
  • Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
  • Maintained confidentiality of all medical records and sensitive information to comply with HIPAA regulations.
  • Developed and maintained organized filing system for medical records to adhere to HIPAA regulations.
  • Analyzed complex medical records to identify discrepancies in accuracy and completeness.Managed a high volume of client accounts, prioritizing critical cases while ensuring all benefit changes, pricing adjustments, and coverage details were accurately processed.
  • Coordinated with internal teams, healthcare providers, social workers, and payers to ensure smooth benefit plan implementations and continuity of care for clients.
  • Conducted thorough assessments of client plans and claims data, identifying gaps, discrepancies, and opportunities for targeted interventions that enhanced client satisfaction.
  • Led quality assurance audits and claim reviews to verify accuracy of pharmacy benefit plan configurations and resolve discrepancies proactively.
  • Evaluated clinical and claims data trends over time, recommending and implementing process improvements that increased operational efficiency and reduced errors.
  • Acted as a liaison between clients and support services, facilitating clear communication and prompt resolution of complex benefit and coverage issues.
  • Educated clients and internal partners on benefit plan features, changes, and disease management strategies, empowering stakeholders to make informed decisions.
  • Advocated for client needs by addressing claims disputes and benefit concerns with healthcare providers, insurance companies, and internal teams.
  • Collaborated with multidisciplinary teams to design and implement workflow improvements that streamlined benefit administration and improved client outcomes.
  • Supported adoption of new technology solutions to enhance data tracking, reporting accuracy, and communication efficiency across client services.
  • Reduced client escalations and hospital readmissions by monitoring claims and benefits closely, intervening early to resolve potential issues.
  • Improved documentation and reporting processes, saving time while maintaining accuracy and ensuring timely communication with clients and internal departments.

Pre-Operative Nurse Manager

US Navy-NMRTC
01.2020 - 10.2023
  • Collaborated with internal teams, healthcare providers, social workers, and payers to facilitate smooth implementation of pharmacy benefit plans and maintain continuity of care.
  • Performed comprehensive assessments of client plans and claims data to identify gaps, discrepancies, and actionable opportunities to improve client satisfaction.
  • Directed quality assurance audits and claim reviews to validate pharmacy benefit plan configurations, proactively resolving discrepancies and ensuring compliance.
  • Analyzed clinical and claims data trends to recommend and implement process enhancements that increased operational efficiency and reduced errors.
  • Served as a key liaison between clients and support services, fostering clear communication and timely resolution of complex benefit and coverage challenges.
  • Educated clients and internal stakeholders on benefit plan features, changes, and disease management, empowering informed decision-making.
  • Advocated effectively for clients by managing claims disputes and addressing benefit concerns with healthcare providers, payers, and internal teams.
  • Partnered with multidisciplinary teams to develop and implement workflow improvements that streamlined benefits administration and enhanced client outcomes.
  • Facilitated adoption of new technology tools to improve data tracking, reporting accuracy, and communication efficiency across client services.
  • Proactively reduced client escalations and hospital readmissions through vigilant claims monitoring and timely intervention.Offered high-quality medical support to clinical patients presenting wide variety of medical symptoms with various health care concerns
  • Managed clinic schedules for 10 Providers providing care in three specialties including General Surgery, Orthopedics and Podiatry
  • Network Management for all specialty referrals in Coastal Carolinas DHA area
  • Facilitates strategic and tactical planning for quality improvement program, including needs assessments, evaluations, root cause analysis and interventions
  • Knowledge and distribution of education for managed care program policies and procedures
  • Preoperative and postoperative teaching and triage for Orthopedics, Podiatry, General Surgery, Dental and OBGYN market wide.
  • Assessed patients to determine individual needs and develop care plans in coordination with multidisciplinary healthcare professionals.
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Remained calm during high-stress, critical situations, demonstrating sustained focus and problem-solving in real-time.
  • Participated in development of guidelines for Orthopedic, Podiatry and General Surgery care.
  • Participated in development of guidelines for Pre-Surgical Guidelines care.
  • Prepared and sanitized rooms before surgical procedures and assisted surgeons during operations with medical equipment.
  • Assisted patients in performance of routine recovery and mobility exercises, providing support when getting in and out of bed as well as walking and stretching.
  • Performed routine wound care and dressing changes on schedule.
  • Came up with treatment plans and communicated with patients about options, medications and self-management.
  • Documented nursing services provided and uploaded to comprehensive tracking systems for health records and billing.
  • Protected confidentiality of information related to patient care activities and EMS operations.
  • Met with and patients to discuss and distribute information on health maintenance and disease prevention.
  • Helped patients eat and drink when necessary for safe consumption of food consistent with recovery guidelines.
  • Evaluated charting procedures for adherence to best practices.
  • Followed proper procedure for installation and removal of catheters, IVs and PIC lines.
  • Identified and assisted with opportunities for performance improvement activities on unit and with other service areas.
  • Provided didactic and clinical instructions to orient new nurses and potential student nurses to achieve training outcomes.
  • Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
  • Provided direct patient care, stabilized patients, and determined next course of action.
  • Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
  • Oversaw delivery of care for patients on medical-surgical unit, providing direct care, delegating nursing assignments and supervising team comprised of nurses, LPNs, technicians, and unit clerks.
  • Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
  • Managed care from admission to discharge.
  • Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
  • Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
  • Audited charts and reviewed clinical documents to verify accuracy.
  • Organized and managed care of patients undergoing various therapies and procedures.
  • Collected blood, tissue, and other laboratory specimens and prepared for lab testing.
  • Implemented medication and IV administration, catheter insertion, and airway management.
  • Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
  • Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
  • Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Maintained quality care and comfort for patients with heart failure, pulmonary hypertension, and other conditions.
  • Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.

Case Management Division Officer

US Navy-NMRTC
01.2020 - 10.2023
  • Case Management/HEDIS for over 7,000 Beneficiaries: Followed Women’s Health: Screenings, Colonoscopies, Immunizations Hypertension, and Diabetic Trackers
  • Compassionate and efficient RN Case Manager with expertise in Surgical, step-down unit, medical, surgical, and home health
  • Developed patient care plans, including assessments, evaluations, and nursing diagnoses
  • Submitted insurance authorization for inpatient payers
  • Coordinated home care, home infusion, and durable medical equipment to reduce stress for patients and wait time
  • Obtained recommendations for inpatient or outpatient level of care by discussing cases with physician advisor
  • Updated and maintained discharge plan of care with physician, members of health care team, patients, and families ensured accuracy of patient treatment plan
  • Highly proficient in providing patient care, physician support, case research, and attention to detail
  • Excellent communication skills with knowledge of Medicare health regulations and JCAHO standards
  • Worked with Military/Veteran, diverse and low-income populations to assist in coping with mental health, substance abuse and recovery issues.
  • Completed intakes and assessments on clients to determine needs and eligibility for services and public benefits.
  • Coordinated community integration activities for clients, teaching life skills and independent living skills necessary for succeeding in permanent housing.
  • Maintained up-to-date and accurate contacts and progress note records.
  • Attended regularly scheduled case management and staff meetings.
  • Coordinated with local government to provide resources to clients.
  • Developed and implemented strategies to enhance quality of social services.
  • Implemented and developed programs to address poverty and inequality.
  • Assisted in conducting needs assessments to identify key areas of service needs.
  • Collaborated with various stakeholders to promote social services.
  • Administered and tracked client service payments.
  • Participated in meetings with stakeholders to discuss program objectives and strategies.
  • Developed and maintained relationships with community organizations and agencies.
  • Improved clients' coping with routine life activities such as food budgeting and rental payments.
  • Spoke with senior citizen groups to expand community engagement and program outreach.

Perinatal Special Care-Clinical Department Head

NAVAL MEDICAL CENTER SAN DIEGO
01.2017 - 01.2020
  • Managed high risk pregnancies and co-morbidities in the antepartum, intrapartum, and postpartum periods
  • Supported multiple code purple emergencies through rapid transport to OR for emergent delivery and stabilization of postpartum patients during
  • Hemorrhage and hypertensive crisis
  • Provided nursing care for post-operative GYN patients
  • Actively participated in multidisciplinary teams by floating to the Neonatal Intensive Care Unit, Labor and Delivery and Post-Partum to optimize teamwork and meet staffing needs
  • Initiated department wide process improvement process to streamline the discharge process leading to improved patient satisfaction scores, decreased time spent on administrative tasks related to discharge, and a significant decrease in HIPAA errors
  • Functioned as patient advocate between patient, family, healthcare providers and administration to help patient make informed health decisions and navigate complex medical system.
  • Directed patient care by initiating and following through with plan of care, continuing care, and discharge instructions.
  • Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
  • Precepted student nurses and oriented new hires, providing guidance and mentorship when teaching on hospital policies, emergency procedures, and nursing best practices.
  • Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
  • Coordinated patient discharge planning to provide post-discharge patient care, promoting healing and recovery.
  • Implemented medication and IV administration, catheter insertion, and airway management.
  • Assessed physical, psychological, physiologic, and cognitive status of patients.
  • Assisted with delivery of newborns, providing care and support for successful transition to motherhood.
  • Collected blood, tissue, and other laboratory specimens and prepared for lab testing.
  • Participated in hospital committees to recommend quality improvement initiatives.
  • Developed and implemented individualized patient care plans for optimal outcomes.
  • Collaborated with physicians, pharmacists and therapists to deliver quality, evidence-based care.
  • Documented and maintained accurate nursing records to facilitate provision of care and nursing management of patient.
  • Participated in unit-specific quality improvement efforts to enhance patient satisfaction with quality of care and service through research and evidence-based practices.
  • Administered medications to patients under physician orders in accordance with nursing knowledge and competency.
  • Initiated diagnostic, preventive and rehabilitative nursing procedures to support patient care and safety.
  • Performed complete patient assessments and communicated findings and results to providers to establish plan of care.
  • Managed care from admission to discharge.
  • Provided direct patient care, stabilized patients, and determined next course of action.
  • Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Provided direct patient care, stabilized patients, and determined next course of action.
  • Monitored patient reactions to drugs and carefully documented findings.
  • Assessed, evaluated, and cared for neonate and pediatric patients.
  • Triaged patients and delegated treatment needs to qualified staff and specialized departments.
  • Conducted patient assessments, recorded vitals, and analyzed records and charts to define care requirements.
  • Trained and coached new employees on protocols and best practices to promote ideal patient outcomes.
  • Administered medications and treatments as ordered by physician.
  • Coordinated with healthcare staff from various disciplines to devise, carry out, and manage personalized care plans to benefit patient health and recovery.
  • Evaluated patient histories, complaints, and current symptoms.
  • Guided patients, caregivers, and family members on plans of treatment and helpful resources available locally to support care.
  • Delivered outstanding patient care in Perinatal, Post Partum and Neonatal critical care units.
  • Provided professional services and support in a dynamic work environment.
  • Assessed and documented changes in patient's condition and prepared patient for transfer to higher level of care.

Hospital Corpsman-RN Assistant

NAVAL HOSPITAL LEMOORE
01.2013 - 01.2015

Hospital Corpsman

NAVAL HOSPITAL NAPLES, ITALY
01.2011 - 01.2013

Education

Duke University Masters of Science - NURSING EDUCATION

DUSON
Durham, NC
01.2023 - Current

Bachelor of Science - Nursing

NATIONAL UNIVERSITY SCHOOL OF NURSING
SAN DIEGO, CA
01.2014 - 01.2017

Leadership - Microbiology And Immunology

Walter Reed School of Immunizations And Allergy
Washington, D.C.
05.2001 - 08.2012

Skills

Strong clinical judgment

Certification

Basic Life Support

Additional Information

  • MOST RECENT AWARDS: Patient Safety Award for Nursing, Medical Inspector General Inspection Certificate of Recogintion
  • PROFESSIONAL CREDENTIALS: Registered Nurse Licensed in the State of California Registered Nurse Licensed in the State of North Carolina, BLS, ALS, NRP, Intermediate Management and Leadership
  • PERSONAL AWARDS AND HONORS: Navy Achievement Medal Humanitarian Service Medal Global War on Terrorism Service Medal Good Conduct Service Medal-2 National Defense Service Medal Marksmanship Ribbon

Timeline

Nurse Case Manager

Aetna
01.2024 - Current

Duke University Masters of Science - NURSING EDUCATION

DUSON
01.2023 - Current

Surgical Services Clinic Manager-Department Head

US Navy-NMRTC
01.2020 - 10.2023

Pre-Operative Nurse Manager

US Navy-NMRTC
01.2020 - 10.2023

Case Management Division Officer

US Navy-NMRTC
01.2020 - 10.2023

Perinatal Special Care-Clinical Department Head

NAVAL MEDICAL CENTER SAN DIEGO
01.2017 - 01.2020

Bachelor of Science - Nursing

NATIONAL UNIVERSITY SCHOOL OF NURSING
01.2014 - 01.2017

Hospital Corpsman-RN Assistant

NAVAL HOSPITAL LEMOORE
01.2013 - 01.2015

Hospital Corpsman

NAVAL HOSPITAL NAPLES, ITALY
01.2011 - 01.2013

Leadership - Microbiology And Immunology

Walter Reed School of Immunizations And Allergy
05.2001 - 08.2012

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Rachel Svatek, MSN, BSN, RN, USN-Ret.Registered Nurse & United States Naval Officer Veteran