Rosie Fields, BSN, RN, CCM
Frisco,TX
Summary
Strategic-thinking and experienced clinical director with a proven track record in effectively managing personnel, clients, budgets, vendors, and regulatory compliance. Analytical problem-solver with talents for team building, leadership, motivation, customer relations, and relationship-building. Proficient in independent decision-making and sound judgment to positively impact company success. Dedicated to applying training, monitoring, and morale-building abilities to enhance employee engagement and performance. Documented strengths in building and maintaining relationships with diverse stakeholders in dynamic, fast-paced settings to drive excellence throughout all operations.
Overview
25
25
years of professional experience
1
1
Certification
Work History
DIRECTOR, CLINICAL SERVICES
ZELIS HEALTHCARE, INC
01.2021 - Current
- Accountable for Precertification, Utilization Review, Case Management, and Disease Management programs oversight, growth, and development.
- Responsible for client strategy to capitalize on revenue opportunities for clinical services products.
- Responsible for developing and maintaining healthy business partnerships with program clients.
- Boosted client satisfaction rates by 30% through exceptional relationship management and prompt resolution of issues.
- Developed sales collateral to drive sales of clinical services products.
- Increased YOY sales by 10% of clinical services products.
- Responsible for all program regulatory, compliance, and accreditation.
- Managed budgets effectively to ensure optimal use of resources while maintaining financial stability.
- Developed and implemented best practices, training, quality audits, KPIs, MITs, performance metric implementation, and best practices development.
- Enhanced team collaboration through regular quarterly communication, goal setting, and performance evaluations.
- Managed all clinical services vendors to optimize contracts, revenue, and quality.
- Proactively identified potential risks and implemented mitigation strategies to minimize negative impacts on projects or business operations.
- Negotiated favorable contracts with vendors for reduced costs and improved service quality.
- Cultivated and strengthened lasting client relationships using strong issue resolution and dynamic communication skills.
DIRECTOR, MEDICAL MANAGEMENT
GROUP & PENSION ADMINISTRATORS, INC
01.2009 - 01.2021
- Consecutive promotions are based upon consistent superior performance.
- Accountable for 130+ staff combined with program development implementation and ongoing client strategy application.
- Strategic leader of multidisciplinary clinical programs, including Wellness, Disease Management, Utilization Management, Case Management, Prior Authorization, and Specialty Pharmacy.
- Developed award-winning Nurse Navigator Patient Concierge Reference Based Pricing Call Center using data-driven strategies.
- Spearheaded successful product launches that resulted in increased brand visibility and customer acquisition.
- Increased revenue by growing Nurse Navigator Patient Concierge from 1% to 98% (≈100K employees) of all clients with Reference Based Pricing.
- Collaborated with technical team to build and implement new automations in medical management software resulting in $40K cost reduction over 12 months.
- Established specialized programs including ER Reduction, Opioid Reduction, Adolescent Mental Health, and Accelerated Diabetes Management Program with cellular technology.
- Pioneered adoption of sustainable practices, leading to industry recognition and awards.
- Leveraged data and analytics to make informed decisions and drive business improvements.
- Collaborated with organizational executive leadership to strategically affect direction of operations.
- Implemented customer service protocols resulting in 30% increase in customer satisfaction and 10% increase in client retention.
- Partnered with Implementation to perfect new client experience.
- Led successful projects including collaborating with technology vendors to develop, build, test, train & implement updated clinical software platforms.
- Developed and delivered training, quality audits, performance metric implementation, and policy & procedure development.
- Provide performance reviews with action plans, hiring, and termination decisions.
- Expert knowledge of Reference Based Pricing Model.
- Streamlined and monitored quality programs to alleviate overdue compliance activities.
- Launched quality assurance practices for each phase of development.
- Reduced waste and pursued revenue development strategies to keep the department aligned with sales and profit targets.
RN CASE MANAGER
REGENCY HOSPITAL
01.2007 - 01.2009
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Performed medical necessity reviews using clinical guidelines for funding sources, including uninsured, commercial, Medicare, and Medicaid, with proactive discharge planning to optimize length of stay.
- Coordinated care conferences with patients, family, treating physicians, and interdisciplinary care teams to achieve ideal patient outcomes.
- Enhanced patient care by developing comprehensive care plans and coordinating with interdisciplinary healthcare teams.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
ONSITE NURSE PROGRAM REGIONAL MANAGER
UNITED HEALTHCARE
01.2006 - 01.2007
- Managed Onsite Nurse teams performing Utilization Review and Discharge Planning across multiple states for commercial and managed Medicare products.
- Implemented policy and procedures, and conducted recruitment, retention, and performance reviews.
- Developed and maintained relationships with customers and suppliers through account development.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Reduced operational costs through comprehensive process improvement initiatives and resource management.
RN DISCHARGE PLANNER
BAYLOR ALL SAINTS HOSPITAL
01.2004 - 01.2006
- Performed Utilization Review and Complex Discharge Planning for payer funding sources, including uninsured, commercial, Medicare, and Medicaid.
- Proficient in MCG and InterQual evidence based clinical guideline criteria.
- Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
- Managed complex patients, ensuring optimal discharge plans were executed effectively optimizing patient outcomes while decreasing readmissions.
- Improved patient satisfaction by carefully evaluating patient needs and developing personalized discharge plans.
RN NURSE SUPERVISOR
AETNA
01.2000 - 01.2004
- Managed RN staff performing Utilization Management, Onsite Review, Case Management, and Discharge Planning.
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
- Implemented policy and procedures, coaching, auditing, recruitment, retention, and performance reviews.
- Cross-trained existing employees to maximize team agility and performance.
- Reduced operational costs through comprehensive process improvement initiatives and resource management.
Education
Bachelor of Science - NURSING
The University of Texas
Arlington, TX08.2024
Associate of Science - NURSING
Washtenaw College
Ann Arbor, MI10.1996
Skills
- Budget Oversight
- Case/Utilization Management
- Client Strategy
- Evidence-Based Criteria (MCG & InterQual) Expert
- Marketing Initiatives
- New Product Development & Implementation Quality Improvement
- Service Line Growth
- URAC Accreditation Expert
Accomplishments & Awards
- Zelis IMPACT Award | 2022
- Decision Health Platinum Award Engagement & Education for Nurse Navigator and Wellness | 2017
- Pat McGreevy Leadership Excellence Award | 2015
- Nurse Navigator Doyle Award Finalist for Innovation in Healthcare & Speaker at Client Forum | 2014
- Aetna Professional Achievement Award | 2002
Organizational Affiliations
- URAC Accreditation Committee National Member
- Self-Insurance Institute of America, Inc. (SIIA)
- Health Care Administrators Association (HCAA)
- Free Market Medical Association (FMMA)
- Society of Professional Benefit Administrators (SBMA)
- Case Management Society of America (CMSA)
- Health Rosetta
Certification
- Certified Case Manager, Commission for Case Management Certification - Expires 5/31/25
- Licensed Registered Nurse State of Texas Compact License - 1/31/25
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Far and away the best prize that life offers is the chance to work hard at work worth doing.
Theodore Roosevelt
Timeline
DIRECTOR, CLINICAL SERVICES
ZELIS HEALTHCARE, INC
01.2021 - Current
DIRECTOR, MEDICAL MANAGEMENT
GROUP & PENSION ADMINISTRATORS, INC
01.2009 - 01.2021
RN CASE MANAGER
REGENCY HOSPITAL
01.2007 - 01.2009
ONSITE NURSE PROGRAM REGIONAL MANAGER
UNITED HEALTHCARE
01.2006 - 01.2007
RN DISCHARGE PLANNER
BAYLOR ALL SAINTS HOSPITAL
01.2004 - 01.2006
RN NURSE SUPERVISOR
AETNA
01.2000 - 01.2004
Bachelor of Science - NURSING
The University of Texas
Associate of Science - NURSING
Washtenaw College