Rebecca Lynn Ames
Magnolia
Summary
Healthcare leader with extensive experience at Elevance Health, specializing in cost of care initiatives and affordability enhancement. Demonstrated success in program development and team leadership, implementing strategies that improved market competitiveness. Expertise in strategic thinking and effective communication, focused on achieving measurable outcomes in case management.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Cost of Care Director
Elevance Health
05.2022 - Current
- Directed multiple cost of care initiatives across enterprise, ensuring effective execution and alignment.
Implemented measures to control healthcare costs, enhancing affordability for customers.
Developed and executed innovative initiatives to manage rising costs and improve market competitiveness.
Analyzed trends to predict healthcare expenses and adjust strategies accordingly. - Program lead for the ER Diversion SMS campaign, leveraging Amazon Web Services, providing education to members on access to points of care.
- Project Manager for a digital member-facing application targeting members with a recent inpatient stay to prevent readmissions.
Manager I/II
Anthem BCBS/Amerigroup
02.2014 - Current
- Texas High Risk OB Case Management program oversite and management. The program supports 32K pregnancies annually with primary goals of: reducing premature births, avoiding adverse maternal and/or neonatal outcomes, supporting pregnant members to connect with community based organizations to address needs surrounding social determinants of health.
- Manage twenty four direct reports (RN/SW/LVN): provide leadership training and support to promote their continued growth and success.
- Texas Subject Matter Expert (SME) for Complex Case Management and National Committee for Quality Assurance (NCQA)
- Presented case management cases to on-site NCQA audit team during the 2016 and 2019 accreditation time periods.
- Participation in corporate workgroups responsible for developing predictive models designed to proactively identify pregnant women at risk for adverse maternal outcomes or NICU admissions.
- Instrumental in development of Cost of Care tracking tool to demonstrate the positive impact of the predictive model in conjunction with Case Management interventions on maternal health and NICU outcomes.
- Supported the transition of new health plans to the Anthem Enterprise Case Management model by providing Case Management Training. Training included software applications, Case Management program descriptions and processes, reporting and tracking tools, and NCQA documentation requirements.
- Member of the Request for Procurement (RFP) team responsible for oral presentation to represent Case Management for the Texas Health plan.
- Developed and presented training to Texas RN clinical staff related to NCQA accreditation audit outcomes with a focus on new indicators for the coming year.
- Designed templates and clinical processes which minimized/eliminated duplicative documentation while ensuring all required NCQA elements were met.
- Business Owner responsible for fulfilling Texas Health and Human Services Commission (HHSC) regulatory reporting requirements.
Team lead
Anthem BCBS/Amerigroup
12.2011 - 02.2014
- Completion of RN quality audits, based on NCQA documentation requirements
- Calculating monthly productivity reports
- Ongoing process improvement, supportive of the case management process with goal of increased member engagement/satisfaction
- Coordinating services with vendors
- Mentoring and coaching RN CM staff
Sr Case Manager
Amerigroup
10.2005 - 11.2011
- Coordination of care for Medicaid eligible high-risk pregnant women; average case load of 70-100 members
- Educating members on high risk obstetrical and medical health conditions
- Authorizing programs and services for members based on clinical guidelines/InterQual
- Facilitating DME requests thru providers and vendors
- Provider outreach and education regarding Case Management, including CM services and covered benefits
Staff Registered Nurse III
Baylor All Saints Fort Worth & Memorial Hermann Southwest Hospital
06.1997 - 10.2005
- Providing nursing care to patients during active labor and delivery
- Management of pregnant women with high-risk obstetrical and medical health issues
- Preceptor for new hires
- Participation in unit committees
- Initial triage of incoming patients
- Management of pregnant women with high-risk obstetrical and medical health issues
Education
Bachelor of science - Nursing
Texas Christian University
Fort Worth, TXSkills
- Case management and program coordination
- Program development and management
- Team leadership and staff development
- Effective communication skills
- Strategic thinking and process optimization
- Training and development strategies
- Process improvements and project management
Activities
Member of the Texas March of Dimes workgroup focused on improving the health of pregnant women and improving maternal and fetal outcomes.
Certification
C
Timeline
Cost of Care Director
Elevance Health
05.2022 - Current
Manager I/II
Anthem BCBS/Amerigroup
02.2014 - Current
Team lead
Anthem BCBS/Amerigroup
12.2011 - 02.2014
Sr Case Manager
Amerigroup
10.2005 - 11.2011
Staff Registered Nurse III
Baylor All Saints Fort Worth & Memorial Hermann Southwest Hospital
06.1997 - 10.2005
Bachelor of science - Nursing
Texas Christian University
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