Summary
Work History
Education
Skills
Websites
Additional Information
Timeline
Generic
Tamara Reid RN

Tamara Reid RN

Newbury Park,CA

Summary

Innovative Clinical Program Manager, Nurse and Leader. Provides in-depth understanding of developing and implementing organizational strategies. Well-versed in spearheading new initiatives to support operations. 10+ years experience in healthcare, 5+ years patient care, 5+ years program and project management and 5+ years in Utilization Management.

Work History

Manager, Utilization Management

CenCal Health
Santa Barbara , CA
2021 - 2023
  • Recruited to direct a Utilization Management team of 20+ nurses and non-clinical staff for care transitions.
  • Fast track promotion from Supervisor to Manager in 9 months.
  • Leader handling both Supervisor and Manager roles for 9 months.
  • Led UM team which completed 60,000+ case reviews and answered 60,000+ provider phone inquiries in 3 years.
  • Created Cancer Biomarker Testing Medical Policy.
  • Educated and and mentored new UM Supervisor for 1.5 years.

Clinical Program Manager, Value Solutions

Blue Shield of California
Woodland Hills , CA
2018 - 2020
  • Spearheaded company's first enterprise-wide Emergency Department re-direction strategy and saved $10 Million and decreased inappropriate Emergency Department use by 5+%.
  • Established and facilitated new Emergency Department Task Force with 70+ members including Vice Presidents and Medical Directors.
  • Collaborated with marketing and created new healthcare journey flyers, and e-mail/mail campaigns in Q3, 2019 to 2 million members.
  • Panel speaker at 2019 Blue Cross Blue Shield Association National Summit on Emergency Care Re-Direction.
  • Collaborated with free lance writer to produce Blue Shield news article, Don't Want to End Up in the Emergency Room? Chances Are You Don't Have to.

Clinical Program Manager, Quality Improvement

Blue Shield of California
Woodland Hills , CA
2017 - 2018
  • Headed Covered California project and earned 1 M in performance guarantees by executing a quality improvement strategy which resulted in re-certification on the exchange.
  • Created Individual and Family Plan and Rhythm of the Business Clinical Quality Improvement Committee reports for Senior Director of Quality.
  • Collaborated with Heal Program Manager and Heal company to obtain supplemental data for HEDIS 2018.

Clinical Project Manager, Population Health

Kaiser Permanente
Woodland Hills , CA
2016 - 2017
  • Developed project plans identifying key issues, problems, and approaches to improve HEDIS metrics and close care gaps for Diabetes and Hypertension.
  • Planned and facilitated all physician meetings for the Diabetes Recognition and Diabetes Champion Program, Hypertension Teleconference, and Medical Office monthly check-ins.
  • Coordinated 2-3 weekly Diabetes clinics in the evenings and on weekends for Diabetic patients to close health care gaps by providing HgA1c lab tests, blood pressure, height, weight, Body Mass Index, and urine protein tests.

Manager, Clinical Quality Interventions

Anthem Inc. 15 years (Reduction in Force)
Thousand Oaks , CA
2015 - 2016
  • Reported to the Director of Clinical Quality Interventions and managed operations of 10+ quality programs related to HEDIS and NCQA accreditation.
  • Promoted from Clinical Program Manager to Manager in 1 year.
  • Executed multiple extremely complex programs including Hallmark and innovative online wellness programs for Medicare.
  • Nominated and selected from 300 hundred high performers for 12 mos. long Future Leadership Program.

Clinical Program Manager, Health Solutions

Anthem Inc.
Thousand Oaks , CA
2011 - 2015
  • Reported to the Director of Comprehensive Health Solutions.
  • Designed, developed, and implemented enterprise-wide clinical interventions for Commercial, Medicare, and Medicaid members.
  • Composed and transformed four different innovative and culturally tailored engagement programs to improve health equity for breast cancer screenings.
  • Collaborated with the Arthritis Foundation to develop walking programs for Seniors.
  • Received impact award from Vice President for excellent work on Medicare Advantage Targeted Clinics for Glaucoma and Breast Cancer.
  • Wrote provider and member newsletters titled, Health Care Effectiveness Date and Information Set - Measures for Prenatal and Postpartum Care and Prenatal Care and Your Check Up Helps Keep You and Your Baby Healthy.

Manager, Care Management

Anthem Inc.
Thousand Oaks , CA
2006 - 2011
  • Reported to the Director of Care Management and optimized a $ 1 million dollar budget.
  • Led team of 16 clinical and non-clinical staff and a call center handling 2,000-4,000 calls monthly and quality audits for a health and wellness program. across 40 provider offices and hospitals.
  • Advanced from Senior UM Nurse to Manager
  • Decreased sessions held by 50% for 15 providers resulting in cost savings of $17,555 monthly and $300,000 annually.
  • Conceptualized a new colorectal cancer screening program and tools and increased member compliance from 30% to 90%

Utilization Management Nurse

Anthem Inc.
Thousand Oaks , CA
2003 - 2006
  • Performed medical necessity reviews for 30,000+ cases, conducted discharge planning and case management referrals.
  • Advanced from UM Nurse to UM Nurse II to Senior UM Nurse.
  • Only nurse on team to obtain a 100% Inter-rater reliability score.
  • Designated trainer and auditor of RN cases for the department.

Grievance and Appeals Nurse Specialist

Anthem Inc.
Woodland Hills , CA
2002 - 2003
  • Resolved 2,000+ grievances and appeals, assessed cases, and advocated to the advisory committee for optimal outcomes.
  • Received personalized thank you letter from a member for resolving her appeal which approved needed diagnostic test for treatment.

National Quality Investigations Nurse

Anthem Inc.
Thousand Oaks , CA
2000 - 2002
  • Evaluated medical records, and researched complex cases of fraud
  • Promoted from Medical Review Nurse to Grievance and Appeals Specialist

Registered Nurse, Vascular Surgery/Family Practice

Buenaventura Medical Clinic
Ventura , CA - 5 Years
  • Provided nursing care to 30+ patients daily.
  • Created and executed new narcotic tracking and inventory system.

Registered Nurse, Rheumatology and Gastroenterology

Loma Linda University Medical Center
Loma Linda , CA - 1+ Years
  • Assessed patient needs, prioritized treatment and assisted physicians with procedures for a 30 bed medical unit.

Education

MBA - Healthcare Leadership

Regis University
Denver, CO
05.2019

Bachelor of Science - Nursing

University of Phoenix
Woodland Hills

Skills

  • Six Sigma Champion
  • Complex Problem-Solving
  • Cross-Functional Team Management
  • Efficient in Microsoft Office Suite
  • Medi-Cal, Medicare, Commercial Products
  • Data Analysis

Additional Information

  • CenCal Health, Blue Shield of California SPOT Awards, and Anthem "Putting a Face on Healthcare Award"
  • Active California Registered Nursing
  • Active Public Health Nurse Certificate

Timeline

Manager, Utilization Management

CenCal Health
2021 - 2023

Clinical Program Manager, Value Solutions

Blue Shield of California
2018 - 2020

Clinical Program Manager, Quality Improvement

Blue Shield of California
2017 - 2018

Clinical Project Manager, Population Health

Kaiser Permanente
2016 - 2017

Manager, Clinical Quality Interventions

Anthem Inc. 15 years (Reduction in Force)
2015 - 2016

Clinical Program Manager, Health Solutions

Anthem Inc.
2011 - 2015

Manager, Care Management

Anthem Inc.
2006 - 2011

Utilization Management Nurse

Anthem Inc.
2003 - 2006

Grievance and Appeals Nurse Specialist

Anthem Inc.
2002 - 2003

National Quality Investigations Nurse

Anthem Inc.
2000 - 2002

Registered Nurse, Vascular Surgery/Family Practice

Buenaventura Medical Clinic

Registered Nurse, Rheumatology and Gastroenterology

Loma Linda University Medical Center

MBA - Healthcare Leadership

Regis University

Bachelor of Science - Nursing

University of Phoenix

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Tamara Reid RN