Shana Dorsey
Converse,TX
Summary
Results-driven professional with extensive experience implementing and operating value-based care programs focused on improving patient outcomes and delivering exceptional client satisfaction. Sound, ethical and independent decision-making ability consistent with medical protocols. Detail-oriented, strong work ethic, team spirit, and natural leadership ability.
Overview
36
36
years of professional experience
1
1
Certification
Work History
Associate Director of Clinical Operations
Optum
09.2019 - Current
- Led teams of up to 85 personnel 6 direct report managers and 80 indirect care coordinators, supervising daily performance as well as training and improvement plans.
- Fostered a culture of continuous improvement by encouraging staff to share innovative ideas and providing resources for professional development.
- Establish trusted relationships both internally and externally with new contract implementation
- Analyze reporting data to look for trends and areas of opportunity
- Prioritized tasks and allocated resources appropriately to keep teams focused and productive.
- Implemented data-driven decision-making strategies, leading to more informed business choices and positive outcomes.
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Established team priorities, maintained schedules and monitored performance.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
Clinical Team Manager
NaviHealth (purchased by OPTUM)
10.2018 - 09.2019
- Manager for all clinical staff for the San Antonio market
- BPCI bundled payment initiative with Medicare
- Value based care model
- Fostered a culture of accountability by setting clear performance expectations and providing constructive feedback to team members.
- Support for senior clinical manager with executive teams with clients
- Enhanced teamwork and collaboration among staff members by implementing regular team meetings and open communication channels.
- Streamlined daily operations for increased efficiency with effective scheduling and resource allocation strategies.
- Monitored key performance indicators, utilizing data-driven decision-making to optimize performance.
Utilization Review Manager
NaviHealth (purchased by OPTUM)
01.2017 - 10.2018
- UM position obtaining pre-authorizations for post-acute care settings
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
Care Coordinator/Case Manager
NaviHealth (purchased by OPTUM)
07.2015 - 01.2017
- BPCI bundled payment initiative with Medicare value based program
- Work in conjunction with hospital case manager to make best discharge plan for patient
- Used company software and databases to maintain records of services performed and patient conditions.
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
- Maintained accurate and up-to-date documentation of patient records in accordance with HIPAA regulations.
- Assessed patient needs and connected them with appropriate resources to ensure optimal health outcomes.
Onsite Hospital Case Manager
MCCI Medical Group
12.2011 - 07.2015
- Discharge planning on hospitalized patients to include SNF, ARU, LTAC or hospice
- Provide authorization for the alternate level of care after hospitalization
- Round daily with physicians at multiple hospitals
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
RN – Concurrent Review Nurse
Coventry Healthcare
01.2011 - 12.2011
- Monitored all inpatient care provided to members
- Along with and under the supervision physicians, evaluates and provides feedback to treating physicians regarding a member's discharge plans and available covered services
- The ongoing review is directed at keeping costs as low as possible and maintaining effectiveness of care
- Coordinated, directed, and performed concurrent and retrospective reviews
RN – Nurse Educator
Caremark RX
01.2003 - 01.2011
- Educator for disease management program
- Telephonic education of patients with chronic conditions including but not limited to Coronary Artery Disease, Diabetes, COPD, Asthma, Heart Failure and Pediatric Asthma
RN – Office Nurse
San Antonio Heart Associates
01.1999 - 01.2003
RN – Clinical Supervisor
Raytel Medical Corp
01.1995 - 01.1999
RN – Nurse Preceptor
Baptist Medical Center
01.1991 - 01.1995
RN – Staff Nurse Cardiac ICU
Baptist Medical Center
01.1989 - 01.1991
Education
Diploma of Nursing -
Baptist Memorial Hospital System School of Nursing
Skills
- Strategic leadership
- Analytical thinking
- Coaching and mentoring
- Relationship building
- Process improvement
- Performance evaluations
- Staff coordination
- Team leadership
- Computer skills
- Team collaboration and leadership
Certification
CCM – Certified Case Manager
Timeline
Associate Director of Clinical Operations
Optum
09.2019 - Current
Clinical Team Manager
NaviHealth (purchased by OPTUM)
10.2018 - 09.2019
Utilization Review Manager
NaviHealth (purchased by OPTUM)
01.2017 - 10.2018
Care Coordinator/Case Manager
NaviHealth (purchased by OPTUM)
07.2015 - 01.2017
Onsite Hospital Case Manager
MCCI Medical Group
12.2011 - 07.2015
RN – Concurrent Review Nurse
Coventry Healthcare
01.2011 - 12.2011
RN – Nurse Educator
Caremark RX
01.2003 - 01.2011
RN – Office Nurse
San Antonio Heart Associates
01.1999 - 01.2003
RN – Clinical Supervisor
Raytel Medical Corp
01.1995 - 01.1999
RN – Nurse Preceptor
Baptist Medical Center
01.1991 - 01.1995
RN – Staff Nurse Cardiac ICU
Baptist Medical Center
01.1989 - 01.1991
Diploma of Nursing -
Baptist Memorial Hospital System School of Nursing
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