Susan O'Dwyer

• Drive clinical excellence through consultative services and improve provider and payer organization collaboration
• Work collaboratively with Regional Sales Directors and National Strategic Sales Directors to ensure that MCG clinical solutions are demonstrated effectively and positioned appropriately
• Support Sales Team from a clinical aspect in discovery to help align clinical solutions with what best meets needs of client/prospect
• Collaborate with Strategic Alliances, Account Management, Product and International Sales teams to provide overview of appropriate clinical products
• Serve as subject matter experts for evidence-based clinical guidelines and solutions
• Provide ongoing feedback, suggestions, and client recommendations for solution enhancements to internal MCG teams
• Successfully partner with sales representatives to increase visibility and licensing opportunities to community access hospitals.

• Operational and clinical leadership management of Medicare, Medicaid, and dual eligible demonstration product (MMP) case management department with oversight of 74 clinical and non-clinical employees
• Consistently complied with applicable laws and regulations and ensure case management program adherence to CMS, State, Medicare, and Medicaid contract requirements
• Planned, developed, and implemented new programs or projects to expand scope of engagement
• Assisted in resolving and satisfying corporate requests and internal operation issues
• Analyzed data elements to assess and document outcomes, impact of program, unit productivity, and engagement; implement process improvement and quality initiatives when needed to improve effectiveness and quality of the program
• Identified trends through population assessment
• Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.
• Managed daily operations while overseeing multiple locations to foster increased productivity

• Leadership oversight of case management program for BlueCross BlueShield and BlueChoice HealthPlan, including 65 clinical and non-clinical employees
• Quality management oversight of case management to include HEDIS measures, case review audit, evaluation of outcomes and program implementation to improve HEDIS scores
• Development, coordination, implementation, and oversight of new programs to enhance case management program and increase value to customers and ROI
• Monthly, quarterly, bi-annual and annual reporting on program outcomes and statistics to internal and external customers
• Analyzed qualitative and quantitative data for metric and outcome reporting
• Ensured adherence to URAC case management standards, SC Department of Insurance regulations, SC Nurse Practice Act and all state and federal regulations and laws
• Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
• Communicated corporate initiatives, strategic direction, and executive leadership direction as needed.
• Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.

• Direct supervision of 19 Registered Nurse Case Managers to include workflow, case assignments, leave approval, performance reviews, and hiring new employees
• Maintained compliance with URAC standards for case management to include maintenance of employee URAC personnel folders
• Identified training deficiencies and develop action plans for improvement
• Maintained unit and division desk procedures to include development, review, and revision
• Developed and communicated annual quality improvement projects to staff and monitor compliance through monthly audits
• Promoted effective communication with other company departments
• Prepared and submitted monthly, quarterly, and annual reports as requested by groups and management
• Measured employee productivity and compliance with development goals and performance; Provide monthly feedback and action plan when performance or productivity falls
• Administered progressive discipline under guidance from Human Resources, when necessary
• Fostered an environment conducive to health and well-being of employees and members served
• Assisted supervisors and managers to maintain department, corporate, Department of Insurance, and Department of Labor standards
• Monitored complaints, contact member, provider or appropriate department, and submit monthly and quarterly reports.
• Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows

Maintained compliance with URAC standards for case management

• Ensured compliance with privacy and confidentiality regulations
• Facilitated client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation
• Assisted clients in acquisition of community and financial resources; monitor plans of care and appropriate use of benefits
• Used time management skills to complete workload and tasks in Department of Labor mandated time frames
• Participated in organizational professional development and quality improvement
• Assumed responsibility for and coordination of 299 Employee Disability Case Management project to facilitate return to work of organization employees.

• Responsible for clinical operation of 4-physician family practice office including 11 clinical staff, full functioning laboratory, and immunization/allergy clinic
• Maintained JCAHO standards and OSHA regulations of clinical area
• Audited physician and staff charting in patient record
• Provided education of patients on disease states, medication management, and availability of public programs
• Completion of annual employee evaluations and staff education.

• Responsible for management of assigned clinical area
• Educated patients on medications, diagnostic testing procedures, cardiac interventional measures, and prevention of cardiac related concerns
• Communicated with physicians, hospitals, family members, peers, and other disciplines in a manner leading to positive patient outcome
• Assessed client health status via phone triage or upon patient presentation to office with treatment decisions made based on patient acuity.
• Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions

• Responsible for immediate triage and ongoing assessment of clients presenting with acute and chronic illnesses, trauma injuries, cardiac and neurological emergencies, and psychiatric issues
• Complied with all OSHA, JCAHO, and hospital mandated policies and procedures regarding patient safety, standards of care, and corporate compliance
• Communicated with physicians, hospitals, Emergency Medical Services, family members, peers, and other disciplines in a manner that led to positive patient outcome
• Performed bedside nursing functions and duties associated with cardiac resuscitation team.

• Responsible for management and skilled nursing care of pediatric and medical-surgical patients by identifying problems as related to needs of each patient and family member
• Accountable for proper education of clients and their families of disease management and health maintenance
• Performed direct patient care within scope of the Registered Nurse Practice Act
• Utilized therapeutic communication in daily practice, including communicating with non-English speaking patients and families
• Administered IV medications, monitoring and documenting patient responses to address complications
• Provided patient-centered discharge planning and education to reduce complications and readmissions