TERESCA TERRY
Columbus,US
Summary
Dynamic operational leader with a proven track record in driving efficiency and compliance at Columbus Dublin Springs. Skilled in managing diverse departments, implementing strategic improvements, and leveraging expertise in MEDIK, EPIC, and EMR systems to enhance operational performance. Successfully achieved substantial advancements in regulatory compliance and consistently met company objectives through a deep understanding of market trends and financial metrics.
Overview
24
24
years of professional experience
Work History
Director of Quality, Risk & Compliance Manangment
Columbus Dublin Springs Behavorial Health Hospital
Dublin, Ohio
05.2024 - Current
- Directed the organization's daily operations, ensuring compliance with applicable laws and regulations.
- Collaborated with senior leadership to set long-term objectives for the company.
- Identified opportunities for improvement in operational performance metrics.
- Conducted regular meetings with department heads to review progress on strategic initiatives.
- Reviewed internal reports and identified areas of risk or potential cost savings.
- Coordinated resources across departments to maximize productivity levels.
- Analyzed customer feedback data to identify trends in product performance or customer service issues.
- Prepared presentations for board meetings summarizing key developments within the company.
- Assessed employee performance against established benchmarks or targets.
- Implemented systems for tracking progress on key initiatives or projects.
- Coordinated activities with other departments to expedite work and improve collaboration.
- Led cross-functional teams to drive project completion deadlines.
- Analyzed data to inform decision-making and strategic direction.
- Coordinated with regulatory bodies to ensure compliance with laws and standards.
- Delegated work to staff, setting priorities and goals.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
Market Director of Utilization Management Operations
Columbus Springs Dublin Behavioral Hospital
Columbus
04.2022 - Current
- Leads and directs the utilization review staff and functions for the Dublin, East Hospitals and entire Springstone Market
- Determines policies and procedures that incorporates best practices and ensures effectiveness utilization reviews
- Manages and monitors both concurrent, retrospective reviews to ensure that the patient is getting the right care in a timely and cost effective way
- Maintains productive relationships with all insurance companies and third party agencies
- Provide analysis and reports of significant trends, patterns, and impacts to resources, additionally, consults with physicians, multifunctional department to improve sub-functions within a broader infrastructure including Medicare/Medicaid, and commercial insurances
- Assists in the development and implementation of on-going educational programs for professional and support staff which include new employee orientation, in-service continuing education, and new equipment and/or systems training which enables the staff to perform on the basis of current policy/procedures and state-of-the-art practices
- Provides ongoing feedback to employees concerning job performance through goal development, peer evaluation, and performance evaluations
- Counsels and disciplines employees
- Monitors on a continual basis all personnel and current expense budgets providing information and/or justification of variances
- Serves as a resource to appropriate QI teams
- Participates in various activities (i.e Staff meetings, in-services, etc.) For the dissemination of necessary information to staff, physicians, and others by written and/or verbal means
Director of Nursing
Columbus Springs East Behavorial Health Hosptial
Dublin, Ohio
01.2024 - 08.2024
- Oversaw the daily operations of the nursing department including staffing, scheduling, budgeting, and resource allocation.
- Provided clinical guidance and direction to nursing staff to ensure quality care was provided in a timely manner.
- Ensured compliance with state regulations regarding nurse-to-patient ratios and other safety guidelines.
- Participated in interdisciplinary teams to discuss patient care issues or concerns and develop solutions as needed.
- Monitored changes in laws and regulations related to healthcare delivery services to ensure compliance with all applicable standards.
- Attended meetings with senior management personnel to provide updates on progress of projects and initiatives being undertaken by the nursing team.
- Reviewed incident reports submitted by nurses related to any adverse events that occurred during their shift.
- Established solid relations with leadership and staff by attending board meetings and coordinating interdepartmental information exchanges.
- Monitored inpatient bed use, facilities and staff to provide optimal use of resources.
- Maintained communication and transparency with governing boards, department heads and medical staff.
Special Projects Administrator
Columbus Springs Behavioral Health Hospitals
Columbus, US
06.2023 - 01.2024
- Maintaining a process of same day next day stepdown continuity of behavioral health programming
- Created detailed reports outlining project status updates using MS Excel spreadsheets
- Monitored budgets associated with special projects ensuring costs remain within allocated limits
- Analyzed data to identify trends and suggest improvements in processes related to special projects administration
- Provided administrative support to the Special Projects Manager by scheduling meetings and preparing agendas
- Assisted with the development of presentations for internal stakeholders concerning special projects initiatives
- Conducted research to identify best practices for special projects administration
- Managed calendars for multiple team members to ensure deadlines are met in a timely manner
- Drafted correspondence such as memos, emails, letters, related to special projects initiatives
- Assisted with developing metrics and KPIs related to tracking progress of special projects initiatives
RN Staff Nurse
Ultimate Home Health Care
Columbus
09.2011 - 12.2022
- Maintained accurate documentation of all assessments, treatments, interventions and evaluations performed according to facility policies and procedures
- Exhibited excellent organizational skills while managing multiple tasks simultaneously within a fast-paced environment
- Delivered compassionate care that was tailored to meet the emotional needs of each patient
- Documented patient care plans, treatments, and progress notes in medical records
- Utilized critical thinking abilities in making decisions related to patient care in both emergent and non-emergent situations
- Performed resuscitative and CPR techniques during emergency situations
- Adhered to hospital and departmental policies and regulatory requirements, maintaining safe work environment
- Assisted in orienting new staff members to the unit and providing them with guidance throughout their transition period
- Performed treatments and administered injections according to physician instructions
- Demonstrated strong clinical assessment skills by accurately assessing patient's physical and mental health status
- Collaborated with interdisciplinary healthcare team to provide comprehensive patient care
- Travels throughout Columbus area territory to provide home-health care services to adult, and elderly patients diagnosed with chronic/terminal conditions
Director of Intake and Assessments
River Vista Behavioral Health Hospital
Columbus
05.2021 - 04.2022
- Facilitated response to request for services, including the initial response, the assessment and referral process, the designation of appropriate level of care, admission into services, and appropriate follow-up activity
- Conducted initial evaluation, initiate the assessment, document patient symptomology, functioning, needs, and provide information to the MD for LOC determination
- Demonstrated excellent customer service skills in assisting patients, physicians, visitors, and co-workers in a prompt and courteous manner
- Possessed clear knowledge of Emergency Detention paperwork and processes and EMTALA
- Maintained all preadmission and admission paperwork with accuracy
- Completed all pre-certification with insurance companies
- Ensured appropriate staffing for shift
- Minimized use of overtime
- Monitored attendance
- Educated and coach staff and act as a point person for clinical decisions
- Ensured staff has completed all needed documentation, call logging, insurance calls, and additional tasks prior to the end of shift
- Participated in all leadership meetings including FLASH, Quality, and others as assigned
- Kept informed about Joint Commission and State regulations
- Kept and build community relationships and partner with business development team to ensure a positive experience for referral sources and patients/families
- Provided training and orientation for all staff and departmental staff as needed
- Worked collaboratively with facility leadership team and participate in system-wide trainings and initiatives as requested
Director of Utilization Management
River Vista Behavioral Health Hospital
Columbus
06.2020 - 04.2022
- Oversaw the Utilization Review department, ensuring staff has completed all assignments and monitors performance
- Ensured all pre-certifications are completed for inpatient and outpatient services
- Monitor hospital LOS, reports appropriately, and educates other departments regarding their role in maintaining appropriate length of stay for all patients
- Assisted with creation of treatment team agenda and participates to ensure team is aware of coverage info as well as collecting information for communication with insurance or other funding source
- Interfaced with managed care organizations, external reviews, and other payers
Lead Utilization Review Case Manager
Mount Carmel Behavioral Hospital
Columbus
07.2019 - 06.2020
- Collaborates with various insurance providers, including Medicare, commercial and managed payers to complete concurrent reviews for approval of inpatient days
- Notifies payers of discharges and collaborates with discharge planners to determine appropriate length of stay and discharge plan
- Coordinates peer reviews, monitors quality data related to denied days and look at potential process improvements
- Reviews medical records and prepares clinical appeals (when appropriate) on medical necessity level of care, length of stay, and authorization denials for hospitalized patients
- Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient
- Works with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process of such findings
Medical Health Assessor / Case Management
Molina Insurance Company
Columbus
06.2016 - 07.2019
- And evaluation to engage, educate, and promote members' decisions related to achieving and maintaining optimal health status
- Worked with members with moderate to complex clinical needs
- Conducted standardized Health Risk Appraisals (HRA) and applicable assessments, including the verification of medical history and current health and wellness needs
- Expected to meet daily production standards in terms of member outreach
- Utilized a web based software system to document all assessments, activities and education provided
- Developed a problem list and individualized care plan using program protocols based on the members needs and preferences
- Conducted telephonic education to promote self-management strategies for all applicable conditions
- All under the leadership of a Registered Nurse
Financial Manager / Patient Revenue Cycle Specialist
The Ohio State University
Columbus
11.2011 - 06.2016
- Demonstrated the basic functions of: Cash posting, balancing, interpreting and understanding remittance advices OR Billing, CPT codes utilization, working and resolving accounts utilizing hospital systems; followed up on unpaid accounts and responding to 3rd party inquiries included all insurance companies OR Contacting / responding to / resolving / patient inquiries and assisting / completing patients requests in a timely manner OR Identifying, following up on and resolving claim payment discrepancies; coordinated the admission process from preregistration to patients arrival in the area focusing on accurate data collection while emphasizing quality service and customer satisfaction
- Was responsible for initial triage of Financial services
- During financial counseling, responsibilities included understanding and verifying coverage for outpatient services and making recommendations to customers or family for third party financial assistance
Patient Relations Coordinator
The Ohio State University
Columbus
06.2007 - 11.2011
- Evaluated program activities according to standards; Interpreted noncompliance issues relative to complaints and report findings
- Implemented the development of programs and services that promoted Patient Satisfaction; including advocated for consistent HIPAA law maintenance, Provided consultation/technical assistance in targeted Units
- Provided patient advocacy; Provided information interpreting patient's rights and responsibilities; Documented complaints, service recovery, and property Loss; Collaborated with Multidisciplinary teams to build rapport and resolve complex issues among multiple entities with conflicts interests
- Conducted in-service training for best practices; Performed related administrative work and provided advice and consultation on records/information management to department administrators
Case Manager
Franklin County Department of Jobs and Family Services
Columbus
03.2001 - 06.2007
- Managed 300-400 caseload; Conducted interviews to determine eligibility for financial assistance, JOBS, school, food stamps, medical, etc.; Acted as an employment advocate in the development of an employability plan and provided linkage with prospective employers; Established time frames for meeting incremental and self-sufficiency goals identify barriers with adult and single family populations, Investigated technical and case discrepancies and complaints; Acted as agency representative at state hearings processes
Education
Master of Business Administration (M.B.A.) - Health Care Candidate
Franklin University
Columbus, OH, US12.2024
Certification - Healthcare Finance And Accounting
Franklin University
Columbus, OH09-2024
BACHELOR OF SCIENCE OF NURSING -
Ohio University
US12-2019
ASSOCIATES OF APPLIED SCIENCE OF NURSING -
Columbus State Community College
US01.2001
BACHELOR OF ARTS -
The Ohio State University
US12-2000
CERTIFICATION LPN - IV THERAPY -
Columbus State Community College
US01-1999
Skills
- Advocacy
- Collaboration
- Values Commitment
- Ability to Inspiration
- Effective Communication
- Decision Making
- Medik, Epic, and EMR Systems
- JACHO Regulations
- Medicare and Medicaid Regulation
- Inventory Accuracy
- Market planning, support, and execution
- Strategic Networking
- Customer Satisfaction
- Program Monitoring
- Data Collection, Trend Analysis,
- Strategic Recommendations
- Special Assignments
- Profit Target Achievement
- Conflict resolution
- Legal and regulatory compliance
- Risk management
- Performance management
- Operations management
- Process improvement
- Project coordination
- Corporate communications
- Task delegation
Awards
Life Point Health Mercy Award, 2023
Languages
English
Referencesavailable
Yes
Timeline
Director of Quality, Risk & Compliance Manangment
Columbus Dublin Springs Behavorial Health Hospital
05.2024 - Current
Director of Nursing
Columbus Springs East Behavorial Health Hosptial
01.2024 - 08.2024
Special Projects Administrator
Columbus Springs Behavioral Health Hospitals
06.2023 - 01.2024
Market Director of Utilization Management Operations
Columbus Springs Dublin Behavioral Hospital
04.2022 - Current
Director of Intake and Assessments
River Vista Behavioral Health Hospital
05.2021 - 04.2022
Director of Utilization Management
River Vista Behavioral Health Hospital
06.2020 - 04.2022
Lead Utilization Review Case Manager
Mount Carmel Behavioral Hospital
07.2019 - 06.2020
Medical Health Assessor / Case Management
Molina Insurance Company
06.2016 - 07.2019
Financial Manager / Patient Revenue Cycle Specialist
The Ohio State University
11.2011 - 06.2016
RN Staff Nurse
Ultimate Home Health Care
09.2011 - 12.2022
Patient Relations Coordinator
The Ohio State University
06.2007 - 11.2011
Case Manager
Franklin County Department of Jobs and Family Services
03.2001 - 06.2007
Master of Business Administration (M.B.A.) - Health Care Candidate
Franklin University
Certification - Healthcare Finance And Accounting
Franklin University
BACHELOR OF SCIENCE OF NURSING -
Ohio University
ASSOCIATES OF APPLIED SCIENCE OF NURSING -
Columbus State Community College
BACHELOR OF ARTS -
The Ohio State University
CERTIFICATION LPN - IV THERAPY -
Columbus State Community College
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