Summary
Overview
Work History
Education
Skills
Additional Information
Licenses
Timeline
Volunteer

Treva Bowman

Santa Maria,CA

Summary

Hands-on leader with exceptional organizational, critical thinking and prioritization skills. Possessing 15 years of related experience and passion for contributing to business success. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Overview

15
15
years of professional experience

Work History

Medical Management Consultant M&R and E&I (Telecommute)

United HealthCare
08.2018 - Current
  • Consultant between health plan and delegates, using information from statistical analysis, and other sources to affect increased efficiency and effectiveness in clinical delegation activities as defined by applicable delegation agreement for both Medicare and Commercial HMO line of business
  • Systemically or at member level, support delegate activities designed to improve clinical outcomes in efficient and effective manner
  • Consult in development and monitoring of targeted programs and strategies designed to achieve appropriate utilization and quality goals across care continuum
  • Effectively understands use of data to effect positive change in utilization patterns
  • Superior analytical skills: networks outside and inside organization and builds positive relationships with key individuals and groups
  • Monitors monthly and quarterly UM performance and quarterly performance of assigned delegates
  • Analyzes data and interprets results to assess performance of delegate to ensure alignment with utilization and quality goals of business
  • Contributes to Quality Team strategies to improve HEDIS, STARs, and other quality metrics
  • Identifies internal and delegate strategies for improvement including identification of specific outcomes and metrics to monitor progress to goal
  • Provides feedback and makes recommendations about process improvement, in coordination with Chief Medical Officer, to clinical delegates; presents to delegate workgroups, delegates, and leadership.
  • Broadened improvement initiatives, troubleshooting problems for corrective action.
  • Compiled research data and gave professional presentations highlighting finds and recommended optimizations.
  • Evaluated current processes to develop improvement plans.
  • Produced detailed and relevant reports for use in making business decisions.
  • Gathered, documented, and modeled data to assess business trends.
  • Reviewed internal systems and organized training plans to address areas in need of improvement.
  • Skilled at working independently and collaboratively in team environment.
  • Self-motivated, with strong sense of personal responsibility.
  • Managed time efficiently in order to complete all tasks within deadlines.

Nurse Specialist Dedicated to AON Active Health Exchange (Telecommute)

Cigna Healthcare
03.2017 - 06.2018
  • Actively engages with health care professionals (HCP) and their staff or directs internal staff or matrix partners to work collaboratively and share actionable information on active customers to achieve results
  • Deliver coordination of care actions associated with triple AIM, to include: Transition of care for post-acute and post ER careNetwork redirection, ER reduction and clinically appropriate alternatives, Benefit optimization (pharmacy), Complex case consultation, Population Mgmt. activities associated with risk reduction, Large claims- review all YTD large claims and share notes and details on how it's managed to optimize outcomes with focused opportunity for improvement, Out-of-Network Utilization, Care coordination across multiple providers, Coordinates referrals for unattached customers in locality to physicians participating in designated service area, Identification of and referral to Cigna programs and products in collaboration with treating HCP, Delivers clear communication among health care team and Cigna through facilitating live conversation and documentation in Cigna HCP systems, Works effectively with Cigna Clinical staff to coordinate care coordination with HCP as needed, Establishes strong relationship with in-network delivery systems, ensuring readiness and availability to accept appropriate customer transfers.

Delegation Oversight Nurse (M&R, E&I, & C&S) (Telecommute)

Cigna Healthcare
04.2012 - 03.2017
  • Proficient in coordinating and performing all pre-delegation, annual, and re-review audits; monitoring delegated activities to ensure compliance with NCQA, State, Federal, Joint Commission and URAC requirements if applicable
  • Audit delegates' structure, utilization management programs, operational design, and denial decisions to assure insured members receive appropriate, high-quality, cost-effective services according to State, Federal guidelines, and Healthcare Policies
  • Review internal policies and procedures, update as necessary along with standard operating procedures
  • Maintain documentation to support compliance and accreditation evidence of delegated entities, using centralized tools and resources
  • Monitor Care Access and outpatient/inpatient referral denials for delegated entities
  • Function as central point of contact for delegated entities; liaison to address issues as occur and ensure resolution through communication with internal partners
  • Participate in Joint Operation Meetings (JOM) with assigned delegated groups.

RN Adjunct Instructor

University of Antelope Valley
12.2013 - 12.2016
  • RN to BSN undergraduate- instructed all courses per 8-week term
  • Developed lesson plans to meet academic, intellectual, and social needs of students
  • Challenged and motivated students through in-depth lectures and discussions
  • Lectured and communicated effectively with students from diverse backgrounds
  • Initiated thought-provoking classroom discussions to help students develop their critical thinking abilities.
  • Engaged students with insightful and compelling classroom discussion of topics relevant to coursework to boost student learning and retention
  • Created and implemented course agendas, lesson plans and activities to successfully meet course objectives
  • Improved student understanding by efficiently managing teaching materials and answering students' discussion inquiries
  • Integrated current events and cultural themes into course materials to contextualize subject matter and facilitate lifelong learning
  • Used technological equipment to enhance process of students' learning
  • Collaborated with department head to create dynamic, ongoing curriculum development, and instruction improvement program
  • Worked cooperatively with other members of faculty and staff to contribute to overall institutional effectiveness
  • Graded quizzes, tests, homework, and projects to provide students with timely academic progress information and feedback
  • Met with students to dispense study and career advice and provide guidance and potential opportunities within chosen field

ER Case Manager

Kaiser Permanente
06.2014 - 08.2015
  • Developed and implemented comprehensive case management plans to address client needs and goals
  • Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients
  • Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources
  • Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems
  • Collaborated with interdisciplinary team to determine timely delivery of services
  • Developed comprehensive discharge plans to transition clients to appropriate service providers in community
  • Liaised with social worker to expedite financial assistance not covered by insurance

Registered Nurse

Sansum Clinic- Urgent Care (Adults & Peds)
06.2011 - 04.2012
  • Evaluated patient care needs, prioritized treatment, and maintained patient flow in rapid paced environment.
  • Administered medications via oral, IV, and intramuscular injections and monitored responses
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions
  • Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Audited charts and reviewed clinical documents to verify accuracy
  • Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches

Registered Nurse (Charge Nurse Pediatrics)

Santa Barbara Cottage Children's Hospital
04.2009 - 02.2012
  • Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options
  • Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols
  • Organized and managed care of patients undergoing various therapies and procedures
  • Collected blood, tissue, and other laboratory specimens and prepared for lab testing
  • Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches
  • Educated family members and caregivers on patient care instructions
  • Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches
  • Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care

Education

MBA - Leadership and Management

Capella University
Minneapolis, MN

Master of Science - Nursing with Emphasis in Healthcare Informatics

Grand Canyon University
Phoenix, AZ

Bachelor of Science - Nursing

California State University
Carson, CA

Associate of Science - Nursing

Allan Hancock College
Santa Maria, CA

Associate of Science - Vocational Nursing

Santa Barbara City College
Santa Barbara, CA

Skills

  • Adobe Systems Adobe Acrobat
  • Business Administration
  • Project Management
  • Business Planning
  • HEDIS
  • CMS
  • Health care data management
  • Foundations and Concepts of Healthcare Informatics
  • Microsoft SharePoint
  • Microsoft Windows
  • Microsoft Access
  • Microsoft SQL Server Reporting Services
  • Microsoft Office
  • Microsoft Excel
  • Microsoft Visio
  • Google Docs
  • Epic Systems
  • Google Analytics
  • Data Gathering
  • Trend Forecasting
  • Staff Management
  • Medical Condition Coding Software
  • Data Analysis
  • Quality Standards
  • MySQL
  • Tableau
  • McAfee
  • Consulting

Additional Information

References Available Upon Request

Licenses

  • Registered Nurse in the State of CA, 748025
  • Registered Nurse in the State of AZ, 193810
  • Public Health Nurse in the State of CA

Timeline

Medical Management Consultant M&R and E&I (Telecommute)

United HealthCare
08.2018 - Current

Nurse Specialist Dedicated to AON Active Health Exchange (Telecommute)

Cigna Healthcare
03.2017 - 06.2018

ER Case Manager

Kaiser Permanente
06.2014 - 08.2015

RN Adjunct Instructor

University of Antelope Valley
12.2013 - 12.2016

Delegation Oversight Nurse (M&R, E&I, & C&S) (Telecommute)

Cigna Healthcare
04.2012 - 03.2017

Registered Nurse

Sansum Clinic- Urgent Care (Adults & Peds)
06.2011 - 04.2012

Registered Nurse (Charge Nurse Pediatrics)

Santa Barbara Cottage Children's Hospital
04.2009 - 02.2012

MBA - Leadership and Management

Capella University

Master of Science - Nursing with Emphasis in Healthcare Informatics

Grand Canyon University

Bachelor of Science - Nursing

California State University

Associate of Science - Nursing

Allan Hancock College

Associate of Science - Vocational Nursing

Santa Barbara City College

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Treva Bowman