Summary
Overview
Work History
Education
Skills
Certification
Affiliations
Timeline
Generic

Tracy J Whitworth

Camp Verde

Summary

I am presently seeking employment with an employer that works to continually educate their staff with the latest in technology while offering progressive steps towards career advancement. I believe it is important to work within a multidisciplinary team environment where we all can bring ideas to the current situation based on present and past experiences.

Experienced with comprehensive care management and strategic planning. Utilizes leadership skills to enhance patient care and operational efficiency. Strong understanding of regulatory compliance and team collaboration, ensuring optimal care standards and continuous improvement.

Overview

21
21
years of professional experience
1
1
Certification

Work History

Director of Care Coordination

Tuba City Regional Healthcare Corp
  • Responsibilities include guidance and direction on strategic plans to enhance patient care. Such as streamlining processes that are inefficient and working with internal partners and external partners on innovative technologies that may assist with cumbersome hardware software systems.
  • Care coordination - Overseeing the day-to-day operations of the care coordination team comprised of social workers, nurses and administration staff.
  • Purchased referred Care – is a program of payor of last resort for those Native Americans that meet the 5 criteria set forth by the IHS guidelines. This program is intended to help those unfunded and underfunded people to achieve quality healthcare if services are needed outside the current healthcare system.
  • Utilization Review - working towards elevating our utilization review department from the current hybrid model of all case managers assigned duties include this in addition to acute case management discharge planning and assisting with outpatient clinic referrals for needs.
  • Durable Medical Equipment – In the planning stages of expanding this department to include warehousing oxygen concentrator start – to help decrease the amount of admissions experienced due to lack of delivery options by external providers for this need in a rural community.

Travel Case Management/Utilization Review

Tuba City Regional Healthcare Corp
12.2023 - 04.2025
  • Presently traveling through Host Healthcare 13+ week assignments noted below:
  • Utilization Review for upwards of 20 patient caseloads: 13-week contract with end date of April 24, 2025. Responsibilities, including, but not limited to:
  • Utilization review of all patients admitted to the acute setting via InterQual criteria
  • Case Management Assessments, assisting with social determinants of health concerns and medical educational and resource needs.
  • Clear and concise written and/or verbal communication with providers and medical directors regarding case review findings and recommendations.

Kern Medical Center
07.2024 - 01.2025
  • Utilization Review for upwards of 50 patient caseloads: 26-week contract with end date of January 24, 2025, with this being my second extension at this facility. Responsibilities, include, but not limited to:
  • Utilization review of all patients admitted to the acute setting via InterQual criteria
  • Clear and concise written and/or verbal communication with providers and medical directors regarding case review findings and recommendations.
  • Collaborating with payors and community resources as needed to assist in transition to the next appropriate level of care once medically cleared.

Case Manager

Marin HealthCare Medical Center
03.2024 - 06.2024
  • Case Manager with upwards of 24 patient caseloads: 13-week contract with end date of June 22, 2024. Responsibilities include, but not limited to, sole ownership of care coordination and/or discharge planning of the patients admitted to the acute setting and floated to cardiac, ICU, Med/Surg and PMC (step down unit) as needed. The following are some areas of knowledge gained and/or expertise within the following software platforms:
  • Epic
  • Parachute (Durable Medical Equipment) order system
  • Allscripts (transition to HLOC, next level of care) referral system
  • Electronic PASSR, for transfer to skilled nursing facility (SNF)

Case Manager/Utilization Review

Medical Center Hospital
12.2023 - 03.2024
  • Case Manager/Utilization Review for 22 bed Observation Unit: 13-week contract with end date of March 16, 2024. Responsibilities include, but not limited to, sole ownership of the utilization review and care coordination and/or discharge planning of the patients admitted to the observation unit and floated to other floors as needed. The following are some areas of knowledge gained and/or expertise had:
  • 22 bed observation unit
  • Script care (pharmacy management system/houses claim information)
  • Cortext; Xsolis (utilization review AI software platform)
  • OneNote – houses local resources
  • Outlook for email communication
  • Engagement with community navigators as needed.
  • In-depth familiarity with home health and hospice/palliative care requirements
  • Identified medication assistance opportunities to guide patient’s and/or family towards to help with decreasing the risk for a return to acute admission (RTA)

Supervisor of Case Management

Optum Care of Arizona (formerly Optum Medical Network)
10.2021 - 12.2023
  • Responsible for the oversight and guidance of the nursing case manager department. Which includes but is not limited to; programs such as, CSNP Transitional Case Management, CSNP Complex and Disease Management Case Management, driving towards development and implementation of these regulatory programs to meet the criteria required for their model of care needs. Innovative ideas to help streamline current processes through more efficient and cost saving measures. Primary responsibilities are as follows:
  • Supervise a team of 10+ nurse case managers and social workers that service a current population of greater than 105k members/beneficiaries.
  • Act as hiring manager for open positions within the team.
  • Create internal policies and procedures, aligning within the guideline of regulatory program needs, job aids, teaching tools and orientation guidelines.
  • Provides clinical guidance and support to assigned CMs and other staff.
  • Assists in the hiring, orientation, training, and retention of CMs and other staff.
  • Performs oversight of CM caseloads and adjustments are made as needed for effective case management.
  • Assists in process improvement efforts for OptumCare AZ.
  • Regularly audits or oversees the audits of the CM team’s documentation on patient assessments.
  • Accountable for defined outcomes and metrics associated with the case management processes.
  • Serves as the clinical liaison and collaborates with OptumCare AZ vendors and community partners.
  • Maintains audit tools of CM programs.
  • Facilitate the use of community resources to mitigate return to acute of our members / beneficiaries.
  • Facilitate monthly and weekly team meetings.
  • Manage the patient survey response process and contact members as requested.
  • Coordinating Interdisciplinary team rounds and other projects.
  • Prepare productivity and performance reports for department and leadership meetings.
  • Ensures standardized execution of workflow processes, policy and procedure, auditing, etc.
  • Manages case managers’ assigned case load
  • Act as a resource for direct reports to include inquiries and assistance as needed
  • Advocating and facilitating members / beneficiaries with coordination of care issues, as needed

Pre-Service Coordination for the National IRF/LTACH account (Utilization Review)

Naviehealth
12.2020 - 10.2021
  • Responsible for prior authorizations for Acute Inpatient Rehab (IRF) and Long-Term Acute Care Hospital (LTACH) requests. Primary responsibilities are as follows:
  • Developing relationships with internal and external providers regarding authorization requests.
  • Review clinical received, compiling information, requesting addition information if needed.
  • Running Interqual and/or MCG, sending results to the Medical Director with recommendations as appropriate.
  • Notifying all parties involved of the final determination and next steps regarding the medical director’s decision.

Transitional Care Coordinator/Skilled Inpatient Care Coordinator

NavieHealth
05.2019 - 12.2020
  • Responsibilities include, but not limited; completion of weekly functional assessments and engagement of the Acute/PAC inter-disciplinary care team, while providing them with the nH Outcome tool to align expectations for discharge planning. This position had a high level of patient/family and provider contact, assisting with serving as a link between the patients and appropriate health care personnel to achieve a mutually beneficial outcome.
  • Weekly review of targets for length of Stay (LOS), outcomes and discharge plans with providers and families.
  • Complete all SNF concurrent reviews, updating authorizations on a timely basis
  • Assess and monitor patients’ continued appropriateness for current care setting according to InterQual criteria or nH Outcome.
  • Participation in weekly SNF rounds and providing accurate information to the naviHealth Sr. Manager and/or Medical Director.
  • Enter documentation in a timely, accurate manner in nH coordinate tool
  • Daily review of census and identification of barriers to manage independent workload and ability to assist others.
  • Perform other duties and responsibilities as required, assigned or requested
  • Asked to assist in the Tenet Roll-out in the Arizona Market until permanent member could be hired and trained for the BPCIA position. Assisted with training of that new employee and remain available to assist when needed. Coverage lasted for 5 months, while simultaneously still crossing over to manage the Health Plan members.
  • Participated in the Disease Management Education to be launched in the future related to cancer diagnosis.

Medical Nurse Case Manager

Corvel
10.2018 - 04.2019
  • Responsibilities include, but not limited to, management and coordination of care of the injured worker in workers compensation cases. This is performed within the guidance of ODG guidelines and at the direction of the adjuster.
  • Claimant caseload is 25 – 30 cases, with an average of 22 cases per medical nurse case manager.
  • Strong communication skills required as the medical nurse case manager is often working with multiple disciplines, to include but not limited to; adjusters, internal/external providers and attorneys.
  • Medical Nurse Case Manager’s expectations included:
  • General knowledge of Microsoft office suite required.
  • Attendance of medical nurse case managers at physician follow-up appointments.
  • Travel throughout Arizona as needed.

Acute Care Case Manager

Banner Estrella Medical Center
12.2017 - 09.2018
  • Responsibilities include but not limited to; management of acute care needs of patients that are admitted to the ED and Observation units and utilization review for status of patients utilizing MCG.
  • Patient caseload of 30 – 45 patients, with an average turn-over of less than 24 hours.
  • Strong communication skills utilized interdepartmentally and establishing relationships with outside providers
  • Continuously reviewing case management processes and working with leadership regarding more efficient ways to meet the goals of the company while balancing patient needs, for a win-win outcome.
  • Banner Core initiative
  • LOS roll-out
  • Strong case management skill set for complex cases.

Supervisor of Care Management

Optum Care of Arizona (formerly Optum Medical Network)
12.2015 - 12.2017
  • Responsible for the oversight and guidance of the nursing care manager department, to include but not limited to; seeking NCQA accreditation and driving towards development and implementation of innovative ideas to help streamline current processes through more efficient and cost saving measures.
  • Supervise a team of 10 nurse case managers and social workers that service a current population of greater than 105k members/beneficiaries.
  • Act as hiring manager for open positions within the team
  • Create internal policies and procedures, job aids, teaching tools and orientation guidelines
  • Facilitate monthly team meetings and trainings for staff
  • Facilitate regular interdisciplinary meetings to ensure collaboration and coordination among the teams
  • Assist in NCQA accreditation project to bring Case Management accreditation to our business segment and various other internal committees
  • Assisted in the recommendation for EMS (Enterprise Management System) internal accreditation for our business segment.
  • 1:1 Field visits with staff monthly to assess quality of services being provided by staff and assess any process improvement needs.

Manager of Care Management

Cancer Treatment Centers of America @ WRMC
03.2014 - 12.2015
  • In this role, I ensure that the care management program results in the clinical coordination of care and services for all patients. I am responsible for overseeing and guidance of the department, to include, planning, developing and implementation of innovative ideas to help drive best practices, by assisting in the removal of barriers. I currently have 16 direct reports that I supervise and am accountable for.
  • Additional responsibilities also include contributing to the hiring and termination decisions, developing of job descriptions, competency and performance standards, ensuring compliance with budgetary guidelines and providing counseling and training to address disciplinary problems. Areas of contribution in this role have been as follows:
  • Contributed to the team developed to assist with Commission on Cancer (CoC) accreditation received with silver accommodation July 2015
  • Contributed to the team developed to assist with the Lung Centers of Excellence (Lung COE) accreditation received August 2015.
  • Was an active participant in the comprehensive care plan initiative role out March 2015
  • Was an active participant in the undiagnosed and sexual health pathways rolled out in 2014/2015.
  • Currently working with a team on a process to streamline the symptom assessment tool and how it is received by the patient empowered teams.
  • Participated in Lean Six Sigma processes
  • Currently working with the cancer registrar regarding the tracking of care plans for the new CoC standards on qualifying patients.
  • Guest Panelist at the Arizona Cancer Coalitions annual Survivorship Meeting held in May 2015

Survivorship Support Care Coordinator

Cancer Treatment Centers of America @ WRMC
08.2012 - 03.2014
  • This position entailed the continued development of support programs to assist patients with their Quality of Life needs as defined by them. To assist in facilitating patients in their transition back into life and reinforce the importance of communication of their needs with their healthcare team, both those in house and to outside providers. Projects I was involved with are as follows:
  • Co-Creation of Survivorship Care Plans housed electronically within EHR with our Medical Oncologists.
  • Creation, design, and implementation of the annual body image workshop
  • Assisted with the implementation of the Legacy Program
  • Guest speaker at the Leukemia & Lymphoma Society’s September 16th event regarding “Survivorship Care Plans: The Next Step”.
  • Poster accepted at the International Congress on Palliative Care 2014 regarding “Every Team Needs a Coach: Lessons learned from incorporation of life coaching into a palliative care delivery model.”

RN Care Manager for Oncology Patients

Cancer Treatment Centers of America @ WRMC
03.2009 - 08.2012
  • Responsible for the coordination of care and support of patients and families regarding; but not limited to, symptom management, quality of life, and disability needs. This was accomplished through a patient empowered care model with a comprehensive care team. Examples of areas of responsibility are as follows:
  • Collaboration with insurance company representatives to assist with utilization review needs.
  • Assisting with the prior authorization processes for treatment needs.
  • Arrangement of home health, Palliative Care, Hospice and durable medical equipment for patient discharge needs.
  • Verbal or written communication needs for employers regarding any FMLA and or disability paperwork.
  • Facilitation of patient, family and provider meetings regarding complex decision making.
  • Proactive weekly nadir calls to patients in active treatment and monthly contact to patients in surveillance to assist with greater patient satisfaction and symptom management.
  • Coordination of community resources as needed and proactive interaction with primary care physician offices as needed.

RNCM/Registered Nurse Case Manager

Hospice of the Valley
07.2004 - 03.2009
  • Responsible for the direct care of terminally ill patients and families. This included but is not limited to personal visits, interacting with Hospice Medical Directors as well as community physicians and working with the interdisciplinary team to coordinate community resources as needed.

Education

Masters in Health Care an Innovation -

Arizona State University
Phoenix, Arizona
05.2017

Bachelors of Science - Nursing

University of Phoenix
Phoenix, Arizona
05.2011

Associate in Applied Science - Nursing

Jackson Community College
Jackson, Michigan
05.2000

Skills

  • Quality improvement
  • Care plan development
  • Healthcare administration
  • Staff development
  • Program management
  • Interdisciplinary collaboration
  • Community coordination
  • Clinical leadership
  • Process improvements
  • Program management expertise
  • Problem-solving abilities
  • Reliability

Certification

  • Registered Nurse issued by the State of AZ
  • Issued: Nov 2000
  • Expires: Apr 2025
  • Registered Nurse issued by the State of CA
  • Issued: Dec 2023
  • Expires: Nov 2025
  • Case Management Certified (CCM)
  • Obtained 3/2012
  • Obtained March of 2017
  • Renewed March 2022

Affiliations

Member of CMSA – Case Management Society of America

Timeline

Kern Medical Center
07.2024 - 01.2025

Case Manager

Marin HealthCare Medical Center
03.2024 - 06.2024

Travel Case Management/Utilization Review

Tuba City Regional Healthcare Corp
12.2023 - 04.2025

Case Manager/Utilization Review

Medical Center Hospital
12.2023 - 03.2024

Supervisor of Case Management

Optum Care of Arizona (formerly Optum Medical Network)
10.2021 - 12.2023

Pre-Service Coordination for the National IRF/LTACH account (Utilization Review)

Naviehealth
12.2020 - 10.2021

Transitional Care Coordinator/Skilled Inpatient Care Coordinator

NavieHealth
05.2019 - 12.2020

Medical Nurse Case Manager

Corvel
10.2018 - 04.2019

Acute Care Case Manager

Banner Estrella Medical Center
12.2017 - 09.2018

Supervisor of Care Management

Optum Care of Arizona (formerly Optum Medical Network)
12.2015 - 12.2017

Manager of Care Management

Cancer Treatment Centers of America @ WRMC
03.2014 - 12.2015

Survivorship Support Care Coordinator

Cancer Treatment Centers of America @ WRMC
08.2012 - 03.2014

RN Care Manager for Oncology Patients

Cancer Treatment Centers of America @ WRMC
03.2009 - 08.2012

RNCM/Registered Nurse Case Manager

Hospice of the Valley
07.2004 - 03.2009

Director of Care Coordination

Tuba City Regional Healthcare Corp

Bachelors of Science - Nursing

University of Phoenix

Associate in Applied Science - Nursing

Jackson Community College

Masters in Health Care an Innovation -

Arizona State University

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Tracy J Whitworth