Summary
Overview
Work History
Education
Skills
Timeline
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Ruth (Rikki) Moye, RN

Tulsa,OK

Summary

Skilled in developing strong internal and external relationships to facilitate collaborative achievement of organizational goals. Confident in ability to thrive in fast-paced settings. Objective [Industry] leader with demonstrated success leading financial systems and programs. Knowledgeable about regulatory requirements and successful strategies for maintaining optimal controls. Well-organized, proactive and adaptable to changing markets.

Overview

11
11
years of professional experience

Work History

Assistant Vice President of Case Management

Ardent Health
12.2022 - 10.2024
  • Senior executive case management leader creating and assisting in planning, managing, directing, and evaluating the activities, functions, and personnel of the Case Management program across the 30 hospital Ardent Health enterprise
  • Skilled in developing strong internal and external relationships to facilitate collaborative achievement of organizational goals
  • Confident in ability to thrive in fast-paced settings
  • Current and ongoing works include: Worked with Ardent Case Management leaders to complete the goal of standardized utilization review hubs for workflow, denials management and appeals management
  • This work increased the bargaining power for Ardent with the eventual transition to a third-party revenue cycle vendor
  • Current and ongoing work with Ardent managed care team to identify and isolate managed care contract issues and impact outcomes
  • Worked with senior Ardent financial leadership to transition hospital-based utilization review activities to third-party revenue cycle vendor
  • Led focus group of hospital case management leaders in the creation of enterprise-level standard case management education system and competencies
  • Developed Scope of Work for enterprise-wide Case Management compliance program
  • Developed Scope of Work for enterprise-wide Case Management education program
  • Oversee hospital length of stay goals to ensure critical indicators are reached in each hospital
  • Working with individual campuses to address specific concerns from administration teams
  • Orthopedic surgeries inpatient versus outpatient
  • Readmission reductions
  • Denials mitigation
  • Length of stay outcomes
  • Provider education
  • Established a high-performance culture within the team by setting clear expectations and providing regular feedback on individual performance contributions.
  • Collaborated closely with executive leadership to align department goals with overall company objectives, resulting in stronger organizational cohesion.

Vice President of Case Management

Hillcrest Healthcare System
04.2016 - 12.2022
  • Company Overview: Oklahoma market of Ardent Health, Tulsa, Oklahoma and Amarillo market of Ardent Health, Amarillo, Texas
  • Worked with 12 individual hospital administrations and Case Management leaders to develop and implement standardized tools, roles, and systems to support Case Management Services inclusive of case management, social work, and utilization review
  • Established and standardized process for compliance with CMS 2 midnight rule that reduced hospital observation rates between 10%-25% based on individual hospital historical performances while ensuring audit compliance of 82-96% from government auditors
  • Created vision and led team to develop and pilot 'Right Care' Case Management model for largest hospital in the Hillcrest system
  • The 'Right Care' Case Management model is an interdisciplinary hourglass model designed to manage the flow of resources needed by a patient proactively versus 'chasing' to review and validate the use of resources after they have been consumed
  • It is an innovative, non-traditional process that moves away from the triad cylindrical structure that leads to risks of silos
  • After successful implementation, the model has been featured in two national presentations including a podcast presentation for the American Case Management Association in August 2021
  • Authored 82-page training and reference manual, Introduction to Case Management: Resources and Tips
  • Led key hospital Case Management department leaders in the development and standardization of Case Management orientation tools, competencies, classes, and outcomes measurements for the Hillcrest Health System division, entitled 'Case Management College.'
  • The California Board of Registered Nursing has awarded Case Management College 10 CEUs
  • Ardent Health adopted this orientation package across the enterprise
  • Establish metrics and achieve targets for care coordination services to meet regulatory requirements, system goals, and respective local campus goals
  • Work with individual campuses to integrate Case Management strategies and operations to meet a hospital’s strategic plan
  • Performed deep dive assessment of each hospital’s Case Management programs and regulatory compliance
  • Work with division Compliance officer to ensure standard processes are followed in each and assist in any corrective action plans
  • Create vision, strategy, structure, policies, and standardization of leading practice care coordination services across the health system to achieve clinical and operational excellence and support organizational financial sustainability
  • Established policies, specific to Case Management operations and regulatory compliance that have been adopted by Ardent Health as the standard for all Case Management departments within the company
  • Promote interpersonal relationships that engage stakeholders and drive/support change
  • Work across divisions with other Case Management leaders to ensure consistency with policies and standardization throughout the enterprise
  • Work with other Ardent leaders such as HIM, Coding, CDI, Revenue Cycle on strategic initiatives
  • Offer support and guidance for any hospital requesting assistance and information anywhere in the Ardent Health enterprise of hospitals
  • Work collaboratively with medical and advanced practice provider staff, nursing staff, service line leaders, patient financial services, system, and campus executive leadership, local case management staff and Ardent Health corporate staff
  • Worked with the division CFO to achieve and lead Hillcrest Health System pilot for Xsolis Cortex software UR program
  • Ardent Health adopted the UR program for the enterprise after HHS pilot results delivered an annualized value of $1.9 million dollars equaling 4.5x the ROI
  • Two-year ROI currently of $8.31 million dollars equaling 9x the return
  • Worked with managed care director to achieve a national payer Medicare Advantage contract to use Xsolis Cortex Care Level Scores for authorizations
  • Hillcrest Healthcare System is the first in the Xsolis database of 250 systems to achieve this goal
  • This doubled this payer contribution margins and brought them up to Medicare rates while achieving a 50% improvement in productivity for both the hospitals and the payer within the first 3 months after implementation
  • Working with division CFO, CMO and palliative care provider to develop market-wide palliative model to include all 8 hospitals
  • Goals of this project is to enhance goals of care discussions to mitigate extended and costly lengths-of-stay, overuse of resources, and improve inpatient hospice transitions
  • Oklahoma market of Ardent Health, Tulsa, Oklahoma and Amarillo market of Ardent Health, Amarillo, Texas

Senior Director of Case Management, Central Group

LifePoint Health
04.2014 - 04.2016
  • Company Overview: Nashville, Tennessee
  • Worked with the corporate Vice President of Case Management to build and lead implementation of a standardized Case Management program for a 70-plus hospital corporation to improve effectiveness of hospital case management
  • Was directly responsible for 26 hospitals in 8 states and served as a resource for other two groups
  • Original part of four-person team for mission to envision and create new Case Management model for 70 hospital enterprise
  • Worked with corporate Revenue Cycle leaders to create system of denial assessments for each hospital and action plans to reduce denial rates in each facility, reducing overall denials rates to less than 2% of net revenue
  • Tasked by corporate Vice President of Human Resources to establish corporate-wide Case Management competencies and orientation plan
  • Operationalized the plan across the enterprise
  • Created the system and tools used to perform onsite, deep dive assessments of CM programs in individual hospitals
  • Worked with corporate CM leadership team to develop yearly national conferences; leading, teaching and coordinating for approximately 250 participants yearly
  • Represented LifePoint Health at Tennessee Hospital Association committee for payors and contract issues
  • Provided direct and indirect oversight and onsite support to hospitals within the LifePoint Health system that required more focused attention to achieve their goals
  • Key speaker at yearly LifePoint Case Management conference on various topics including denials management and CMS payment regulations, compliance
  • Nashville, Tennessee

Education

Associate Degree - Nursing

Charleston Southern University
Charleston, SC
06.1980

Skills

  • Utilization management
  • Denials management
  • Length of stay reductions
  • Outpatient Observation management
  • Visionary thinking
  • Case Management operations efficiency
  • Productivity
  • Leading
  • Mentoring
  • Talent development
  • Education
  • Growth of Case Management leaders and staff
  • Hospital policy development
  • Corporate policy development

Timeline

Assistant Vice President of Case Management

Ardent Health
12.2022 - 10.2024

Vice President of Case Management

Hillcrest Healthcare System
04.2016 - 12.2022

Senior Director of Case Management, Central Group

LifePoint Health
04.2014 - 04.2016

Associate Degree - Nursing

Charleston Southern University

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Ruth (Rikki) Moye, RN