Rebecca Rouvier, RN
Mount Orab,Ohio
Summary
Highly-analytical Registered Nurse with a strong background in Optum Payment Integrity, Facility Inpatient claims, as well as Inpatient Behavioral Health Nursing, strengths include over 25 years of experience in a multitude of nursing areas, coding, education, project management, training, Compliance and Fraud, Waste & Error investigations. Proven to be reliable and professional in dealing with highly sensitive employee/physician situations, as well as a dedicated and a flexible team player.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Senior Clinical Informatics Consultant
OptumInsight Clinical Operations
04.2022 - Current
- Leveraged clinical knowledge and informatics expertise to improve healthcare outcomes and operational efficiency, this role requires a blend of clinical expertise, informatics skills, and the ability to work collaboratively across different teams and departments.
- Excellent communication skills, both verbal and written.
- Proven ability to learn quickly and adapt to new situations.
- Proved successful working within tight deadlines and a fast-paced environment.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Assisted in the selection and procurement process of new clinical informatics technologies, ensuring compatibility with existing systems and meeting organizational needs.
Program Consultant, Registered Nurse
OptumInsight Clinical Operations
04.2020 - 04.2022
- Collaborated with a multidisciplinary team to triage, investigate, and medically review instances of health care fraud, waste, abuse and error and prepared comprehensive written summaries with actionable recommendations..
- Identified potential risks within programs early on, implementing mitigation strategies to minimize negative impact on project goals.
- Delivered impactful presentations to stakeholders, highlighting key program achievements and outcomes.
Sr. Clinical Analyst, Payment Integrity
Optum
04.2016 - 04.2020
- Collaborated within Payment Integrity Clinical Operations teams to plan, build and implement new savings opportunities.
- Collaborated with multidisciplinary teams to design and implement improvements in clinical processes, leading to improved savings and audit outcomes.
- Developed comprehensive reports for matrix partners, highlighting key insights from clinical data to improve decision making.
- Assisted in the development of education and analytic development/refinement by providing guidance on data collection methods and analytic outcomes.
- Collaborated with multidisciplinary teams to design and implement improvements in clinical processes, leading to improved savings and accuracy.
M&R Facility Pre-Pay Clinical Investigations
Optum Shared Services
01.2015 - 04.2016
- Examined, assessed, and documented facility claims in appeals, conducting investigations to review medical history and records, presented cases to the Medical Director for final determination.
- Streamlined case management processes, resulting in a significant reduction of backlog cases.
- Ensured payment integrity, data security, and process optimization while investigating, recovering, and resolving all types of claims.
- Contributed to organizational growth by identifying areas for process improvement within the investigation department.
Senior Regulatory Adherence Analyst
UnitedHealthcare
01.2014 - 01.2015
- Ensured consistent documentation and compliance standards for business operations across multiple lines of business for Community & State Medicaid and Medicare state grids.
- Aligned procedural content to state, federal, and NCQA standards, updating UHC state grids accordingly.
- Analyzed, understood, and articulated regulatory and contractual requirements, coordinating operational changes with business operations.
- Managed multiple projects and implementations while collaborating across various business segments.
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Improved internal knowledge sharing by developing comprehensive documentation outlining standard operating procedures for various tasks.
- Enhanced team collaboration by providing clear communication of complex findings through visualizations and reports.
Senior Clinical Quality Analyst, Document Oversight
UnitedHealthcare
01.2013 - 01.2015
- Created and maintained documents such as Standard Operating Procedures and Job Aids for E&I and M&R Inpatient Care Management teams.
- Demonstrated strong business and technical writing skills, ensuring alignment of procedural content with state, federal, and NCQA standards.
- Updated documentation in collaboration with business operations to apply necessary changes.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
Disease Management Nurse, Case Manager
UMR/Optum/UnitedHealth Group
01.2011 - 01.2013
- Identified and addressed member gaps in care for Disease Management Programs.
- Served as a key resource for nursing staff by providing ongoing education and training on evidence-based practices in chronic disease management.
- Maximized communication effectiveness within interdisciplinary team meetings promoting a cohesive approach to disease management across departments.
- Developed targeted nursing interventions based on analysis of data from electronic health records, leading to improved patient outcomes.
Health Educator - Preventative Health Analyst
Optum/UMR
01.2006 - 01.2011
- Identified population healthcare needs, developed educational materials about related health & wellness issues.
- Developed and implemented health education strategies to reach target audiences.
- Developed and distributed health education materials to increase awareness and understanding.
- Raised awareness of public health issues through organizing workshops, seminars, and presentations.
RN, Charge Nurse, Behavioral Health
Mercy Health - Clermont Hospital
01.1995 - 01.2006
- Managed patients and staff in a Psychiatric nursing unit, providing inpatient care to adults and adolescents.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
- Administered medications accurately and safely, reducing medication errors and adverse reactions.
Various Roles Within Enterprise
Mercy Health Partners
04.1993 - 01.2006
- Supervising the medical department for 260 employees, responsible for immediate first aid, industrial physicals, Workers Compensation Coordinator, case management, utilization review, chart auditing, health and wellness promotion.
Nursing Coordinator, Employee Health Nurse
Mercy Health - Clermont Hospital
01.1995 - 01.2003
- Managed patients and staff in a Psychiatric nursing unit, providing inpatient care to adults and adolescents on a 30-bed unit.
- Served as a liaison between nursing staff, physicians, ancillary services, patients, families ensuring clear communication throughout the course of care.
- Optimized resource allocation by monitoring staffing levels, supplies, and equipment availability.
- Managed conflict resolution among nursing staff to maintain a positive work atmosphere and foster teamwork.
- Ensured regulatory compliance by maintaining accurate documentation and staying current on industry best practices.
- Promoted a safe and healthy work environment by enforcing infection control protocols and safety guidelines.
Education
Certified Coding Specialist (In Process) - Medical Coding
AAPC
2024
Certification of Completion - Licensed Massage Therapist
Cincinnati School of Medical Massage
Cincinnati, OH06.1997
Associates Degree - Nursing Certification And Associates of Applied Science
Southern State Community College - Central Campus
Hillsboro, OH01.1995
Skills
- Data Analysis Expertise
- Medical coding proficiency, Coding Certification pending
- Clinical Decision Support
- Clinical process knowledge
- Experienced in health care training & education
- Excellent problem-solving abilities
- Soft Skills - Excel, Outlook, PowerPoint, SharePoint, WebEx, Web Strat, Word
- Clinical Workflow Optimization
- Clinical Documentation Improvement
- Quality Assurance
Certification
- Wellcoaches Certified Wellness Coach and Health Coach
- Certified in Non-Violent Crisis Intervention
- NPS Champion
- UHG Culture Ambassador
Timeline
Senior Clinical Informatics Consultant
OptumInsight Clinical Operations
04.2022 - Current
Program Consultant, Registered Nurse
OptumInsight Clinical Operations
04.2020 - 04.2022
Sr. Clinical Analyst, Payment Integrity
Optum
04.2016 - 04.2020
M&R Facility Pre-Pay Clinical Investigations
Optum Shared Services
01.2015 - 04.2016
Senior Regulatory Adherence Analyst
UnitedHealthcare
01.2014 - 01.2015
Senior Clinical Quality Analyst, Document Oversight
UnitedHealthcare
01.2013 - 01.2015
Disease Management Nurse, Case Manager
UMR/Optum/UnitedHealth Group
01.2011 - 01.2013
Health Educator - Preventative Health Analyst
Optum/UMR
01.2006 - 01.2011
RN, Charge Nurse, Behavioral Health
Mercy Health - Clermont Hospital
01.1995 - 01.2006
Nursing Coordinator, Employee Health Nurse
Mercy Health - Clermont Hospital
01.1995 - 01.2003
Various Roles Within Enterprise
Mercy Health Partners
04.1993 - 01.2006
Certified Coding Specialist (In Process) - Medical Coding
AAPC
Certification of Completion - Licensed Massage Therapist
Cincinnati School of Medical Massage
Associates Degree - Nursing Certification And Associates of Applied Science
Southern State Community College - Central Campus
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