Vicki White
Chicora,PA
Summary
Accomplished Community Health Program Administrator(RN) at ACMH, adept in chronic disease management and leadership. Spearheaded growth initiatives, enhancing community health through strategic collaborations and program leadership. Excelled in stakeholder engagement and analytical problem-solving, significantly improving health outcomes and access to care.
15 years of UR and Case management experience and being the Director of the department for 5 years. Experience working with complex case managers from insurance companies to facilitate safe discharge plans for complex patients.
Provided education on disease processes, symptom management, medication management, and assisted with social determinants of heath that were affecting the patients health.
Overview
35
35
years of professional experience
Work History
Community Health Program Administrator
ACMH
Kittanning, PA
03.2023 - 10.2024
- Managed the PA Rural Health program for ACMH Hospital
- Spearheaded program planning and staff development to promote growth
- Fostered community connections and networks, driving collaborations with local organizations
- Liaison between the hospital and the community in promoting population health, health equity, and improving access to quality care
- Chronic disease management and prevention of disease in the younger population by providing education on healthy living to employees and the community
- Managed a nurse navigator program to prevent readmissions, and potentially avoidable utilization
- Coordinated with program managers and other stakeholders to create detailed implementation plans, milestones and risk mitigation protocols.
Director of Case Management and Social Services
ACMH
Kittanning, PA
07.2018 - 03.2023
- Managed 18 employees responsible for patient care coordination and discharge planning.
- Collaborated with Managed Care Organizations to drive good patient outcomes, and support the financial well-being of the hospital.
- Evaluated the patient's medical records to ensure that appropriate care was provided according to the clinical, medical necessity guidelines, and organizational standards.
- Ensured compliance with all relevant regulations and standards, guided by CMS, and managed Medicare/Medicaid.
- Monitored all case management activities to ensure adherence to established guidelines
- Defined and applied utilization review methods to guarantee conformance with medical coverage plans.
- Identified, assessed, and managed high-risk cases in need of intensive care coordination
- Prioritized and organized tasks to efficiently accomplish service goals.
Clinical Appeals Specialist
ACMH
Kittanning, PA
05.2010 - 01.2019
- Appeal/Denial management
- Audit Management Team; Coding and clinical audits
- Liaison to the Case Management Staff
- Liaison to ancillary departments; Revenue Cycle, Billing, Registration and HIM
- Knowledge of Regulatory and Payer requirements
- Worked closely with the Physician advisor/Medical Director
RN UR/Case Manager
ACMH
Kittanning, PA
09.2000 - 05.2010
- Coordinated discharge planning to ensure continuity of care post-hospitalization.
- Evaluated patients, recognized and addressed complications and coordinated treatment with other members of critical care team.
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
- Collaborated with doctors to plan post-treatment home care and prevent return hospitalization.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
RN, ICU
ACMH Hospital
Kittanning, PA
06.1989 - 03.1993
Education
Diploma in Nursing RN -
Mercy Hospital School of Nursing
06-1986
High School -
Butler Area High School
06.1984
Skills
- Chronic Disease Management and prevention
- Leadership and Team Management
- Appeal Management
- Community Engagement
- Authorizations with insurance companies
- Patient Discharge Coordination
- Strong Communication Skills
- Analytical Problem Solving
- Driven Self-Starter
- Proficient Computer Skills
- Policy and procedure improvements
- Stakeholder engagement
- Program leadership
Key Qualifications
- Chronic Care Management
- Managed a Nurse Navigator Program
- Appeals and denials
- Community outreach for disease prevention
- Authorizations with insurance companies
- InterQual experience
- Discharge Planning
- Commercial, Medicaid and Medicare Insurance Experience
- Social Determinates of Health monitoring
- Microsoft Word, Outlook, Excel, PowerPoint, Lifesize and Teams
- Exceptional communication, critical thinking and problem-solving ability
- Self-motivated, independent worker
- Computer Experience
Timeline
Community Health Program Administrator
ACMH
03.2023 - 10.2024
Director of Case Management and Social Services
ACMH
07.2018 - 03.2023
Clinical Appeals Specialist
ACMH
05.2010 - 01.2019
RN UR/Case Manager
ACMH
09.2000 - 05.2010
RN, ICU
ACMH Hospital
06.1989 - 03.1993
Diploma in Nursing RN -
Mercy Hospital School of Nursing
High School -
Butler Area High School