Summary
Overview
Work History
Education
Skills
Certification
Work Availability
Timeline
Generic

Rhonda McCartney

Summary

Versatile Senior Manager specializing in Utilization Management and Care Management and skilled at planning, implementing and overseeing key improvements to drive business growth and efficiency. History of cultivating an open culture with free exchange of information. Pursuing new professional challenges with a growth-oriented company.

Overview

18
18
years of professional experience
1
1
Certification

Work History

Senior Manager, Complex Case Management

MHS/Centene
11.2019 - Current
  • Management and oversight for NCQA adherence, readiness, and presentation for regulatory agencies.
  • Developed proposals and presentations for internal and external audiences.
  • Implemented and developed operational standards, policies and procedures.
  • Managed large-scale projects and introduced new systems, tools, and processes to achieve challenging objectives.
  • Developed and implemented new filing systems to improve organizational efficiency and productivity.
  • Conducted performance evaluations, compensations and hiring to maintain appropriate staffing requirements.
  • Provided strong leadership to enhance team productivity and morale.
  • Boosted team member productivity by enhancing performance monitoring and instituting motivational approaches.
  • Evaluated hiring, firing, and promotions requests.
  • Initial position was contingent Case Manager, promoted to Supervisor, then FTE status Supervisor of Complex Case Management.

Director, Psychiatric Nursing

Assurance Health
05.2018 - 07.2019
  • Assured compliance with all State and Federal regulatory agencies for survey readiness.
  • Worked closely with organizational leadership and board of directors to guide operational strategy.
  • Established departmental performance goals and provided feedback for underperforming areas.
  • Oversaw operations and provided corrective feedback to achieve daily and long-term goals.
  • Monitored and coordinated workflows to optimize resources.
  • Spearheaded innovative approaches to resource allocation and strategic planning.
  • Leveraged professional networks and industry knowledge to strengthen client relationships.
  • Oversaw supply chain functions to verify inventory levels and budget adherence.
  • Drafted and distributed reports to assist board members with critical business decisions.
  • Monitored expenditures to mitigate risk of overages.
  • Remained highly composed and calm in very fast-paced, stressful and constantly changing environments to provide optimal leadership and achieve desired results.

Manager, Infirmary

Wexford Health
07.2017 - 05.2018
  • Managed infirmary nursing staff in correctional institution.
  • Oversaw healthcare of inmates and advocated for their healthcare needs.
  • Performed State regulatory adherence audits.
  • Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.

Quality Practice Advisor

WellCare
11.2016 - 06.2017
  • Developed and implemented quality assurance improvements for Medicare HEDIS and STARS program.
  • Evaluated data collection, content, and quality for hospitals, medical groups and private physician groups providing strategic solutions for enhanced reimbursement and regulatory compliance.

Quality Specialist, III Interventions

Molina Healthcare
09.2014 - 10.2016
  • Collaborated in the monitoring, procurement, and validation of medical record data of third-party vendors and providers.
  • Liaised with vendors and end-users to uncover system optimization opportunities.
  • Assisted with NCQA accreditation.
  • Promoted from previous position of Care Review Clinician III, Utilization Management, Behavioral Health

Care Manager

Advocate Health Care
01.2012 - 09.2014
  • 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.
  • Educated clients and families on community resources, treatment options and health care services to better manage conditions.
  • Established and maintained relationships with clients, families and community partners to coordinate services to meet client's needs.
  • Communicated with healthcare providers to facilitate continuity of care.
  • Evaluated clients progress and adjusted discharge plans to ensure safe transition to next level of care.


Legal Nurse Consultant

The William A. Shelby Law Office
07.2011 - 09.2016
  • Supported malpractice litigation through case review and analysis for determination of case viability applicable to healthcare law.

Senior Medical Analyst

Anthem
05.2005 - 06.2011
  • Liaised between Utilization Management staff and Medical Directors for medical necessity determination.
  • Preformed intradepartmental work for Appeals and Grievances.
  • Promoted to Disease Management Consultant at PBM specialty drug division.
  • Provided client disease management education.
  • Led campus trainings for new hires on specialty drugs and disease.

Education

Bachelor of Science - Nursing

Indiana University Kokomo
Kokomo, IN

Associate of Science - Nursing

Indiana University Kokomo
Kokomo, IN

Skills

  • Regulatory preparedness
  • Cross departmental collaboration
  • Operational Procedures
  • Project Implementation
  • Readmission Reduction
  • Optimize Staff Performance
  • Motivational Leadership
  • Interdisciplinary Care
  • Quality Improvement
  • Communications Strategies

Certification

  • CCM -Certified Case Manager
  • CMCN -Certified Managed Care Nurse (in process)
  • Six Sigma Green Belt (in process)

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse

Timeline

Senior Manager, Complex Case Management

MHS/Centene
11.2019 - Current

Director, Psychiatric Nursing

Assurance Health
05.2018 - 07.2019

Manager, Infirmary

Wexford Health
07.2017 - 05.2018

Quality Practice Advisor

WellCare
11.2016 - 06.2017

Quality Specialist, III Interventions

Molina Healthcare
09.2014 - 10.2016

Care Manager

Advocate Health Care
01.2012 - 09.2014

Legal Nurse Consultant

The William A. Shelby Law Office
07.2011 - 09.2016

Senior Medical Analyst

Anthem
05.2005 - 06.2011

Bachelor of Science - Nursing

Indiana University Kokomo

Associate of Science - Nursing

Indiana University Kokomo
Rhonda McCartney