Tiffany Risner
Summary
Proven leader in building and leading high-performance case management teams, utilizing strategic planning and relationship-building to enhance care coordination. Demonstrated success in implementing effective solutions that improve patient care and operational efficiency. Adept at driving positive outcomes through a combination of strong leadership skills and a deep understanding of healthcare industry best practices.
Overview
12
12
years of professional experience
Work History
Director of Case Management
Aetna
11.2023 - Current
- Reviewed and developed intake and discharge planning strategies to encourage client engagement and retention.
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
- Created care plans that addressed clinical and financial challenges, family requirements and facilitated patient quality of life.
- Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.
- Managed and monitored program activities and evaluated quality for improvement recommendations.
- Fostered professional networks and relationships with service and resource providers to promote continuity and quality of care for clients.
- Served as corporate resource for compliance and audits to facilitate legal process and appeals.
- Developed and administered budgets, authorized expenditures and monitored financial indicators to improve profitability.
- Reduced healthcare costs by streamlining case management protocols and maximizing resource utilization.
- Analyzed trends and data to inform decision-making and program development.
Senior Manager of Case Management
Aetna
01.2022 - 11.2023
- Provided strong leadership to enhance team productivity and morale.
- Led cross-functional teams to achieve project milestones and deliver high-quality results.
- Established strong relationships with clients and stakeholders, ensuring long-term partnerships and repeat business.
- Improved team performance by providing comprehensive training and fostering a collaborative work environment.
- Reduced costs, optimized resource allocation, and improved efficiency in managing projects.
- Managed large-scale projects and introduced new systems, tools, and processes to achieve challenging objectives.
- Implemented and developed operational standards, policies and procedures.
- Conducted performance evaluations, compensations and hiring to maintain appropriate staffing requirements.
- Utilized data-driven insights to make informed decisions that resulted in higher returns on investments.
- Spearheaded change management efforts for seamless adoption of new systems or processes among employees.
- Negotiated high-value contracts with new suppliers, securing better pricing and terms, which improved profit margins.
Administrative Nurse Manager- PRN
Hardin Memorial Hospital
10.2022 - 12.2022
- Facilitated regular staff meetings to encourage open communication, maintain high morale, and address concerns promptly.
- Collaborated closely with executive leadership to develop long-term strategic goals for the nursing department''s continued success.
- Streamlined budget management, identifying cost-saving opportunities without compromising patient care quality or staff satisfaction.
- Implemented data-driven performance evaluation systems, promoting ongoing professional growth for nursing staff.
LTSS (Long Term Support Services) Manager
Aetna
10.2018 - 01.2022
- Conducted regular performance evaluations for team members, identifying areas for improvement and providing constructive feedback.
- Managed vendor contracts, optimizing resource allocation and cost savings.
- Assisted with the recruitment process by interviewing potential candidates, evaluating skills fit for open positions within the Support Services department.
- Enhanced customer satisfaction by implementing efficient support services strategies.
- Analyzed and solved multi-faceted problems that effected executive leaders and business initiatives.
- Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
- Improved office operations by automating client correspondence, record tracking and data communications.
- Built and managed processes for tracking and monitoring department performance.
- Cultivated strong relationships with vendors and partners supporting administrative operations.
- Negotiated and executed contracts on behalf of department.
- Developed internal requirements and standards to minimize regulatory risks and liability across programs.
Supervisor of Case Management
Buckeye Health Plan
10.2013 - 10.2018
- Optimized resource allocation by analyzing caseload data and adjusting staff assignments accordingly.
- Developed and maintained comprehensive policies and procedures for the case management department, ensuring consistency in practice across all team members.
- Created a supportive work environment that encouraged open communication among team members, fostering collaboration and continuous improvement efforts.
- Reduced backlog of pending cases by implementing efficient triage procedures and prioritizing high-need clients.
- Led a team of case managers to achieve higher success rates in client outcomes through regular training and performance evaluations.
- Structured standardized case management processes to comply with regulatory agency statutes and standards.
Education
Bachelor of Science - Nursing
Herzing University
Milwaukee, WI06-2021
Skills
- Clinical assessment
- Care coordination
- Quality improvement
- Quality management
- Budget management
- Utilization management
- Transitions of care
- Readmission reduction
- Clinical quality incentives
- Strategic planning
- Risk management
- Contract management
Timeline
Director of Case Management
Aetna
11.2023 - Current
Administrative Nurse Manager- PRN
Hardin Memorial Hospital
10.2022 - 12.2022
Senior Manager of Case Management
Aetna
01.2022 - 11.2023
LTSS (Long Term Support Services) Manager
Aetna
10.2018 - 01.2022
Supervisor of Case Management
Buckeye Health Plan
10.2013 - 10.2018
Bachelor of Science - Nursing
Herzing University
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