manager director case management in carlsbad ca resume adele ball

Adele Ball, M.S.N., R.N. (C) 760-402-8990 msadele@yahoo.com

Accomplished masters prepared nurse, experienced in acute and

ambulatory care, managed care, telework, quality, accreditation,

and health plan environments, seeks a leadership position within

an innovative organization that will afford professional growth.

CORE COMPETENCIES

Quality Management Disease and Case Management

Change Management Accreditation and Compliance

Remote Workforce Management Medical Data Analysis

Operations Strategic Planning

Program Development and Coaching/Mentoring

Implementation

PROFESSIONAL EXPERIENCE

HEALTHNET, WOODLAND HILLS, CA

July 2014 to Dec 2014 -High Risk Case Manager

AMERISOURCE BERGEN, LASH GROUP, Frisco, Texas

October, 2013 to Feb, 2014- TeleHealth Educator

Completed and credentialed for Genzyme Lemtrada team

HEALTHWAYS, Nashville, Tennessee

2002-2011

Senior Director, Care Management Operations, High Risk

Provide daily operational direction to a community of 200+

nurses, psychologist, social workers and nurse practitioners

working remotely from home to provide telephonic disease and

case management services to patient / member populations for

clients nationwide. Function as the subject expert for High Risk

Care Management division within the enterprise. Coordinate work

and maintain quality and efficiency of the High Risk division

within four business units across the country to assure NCQA

standards are met. Identify data needs and facilitate the

collection and analysis of the data to demonstrate outcomes and

productivity.

Functioned as a program manager to ensure successful and

timely implementation of multiple new contracts.

Achieved elevated ratings on the annual quality audit

performed by key client, achieving greater than 95% in all

areas

Facilitated successful achievement of NCQA accreditation

for targeted contracts.

Led efforts to achieve URAC accreditation for High Risk

Unit.

Coordinated with IT to ensure a seamless transfer of

division operations onto new software platform.

Facilitated cross training that allowed high risk care

management staff working from home to support disease

management call campaigns for call centers nationwide.

RADY’S CHILDREN’S HOSPITAL AND HEALTH CENTER,

San Diego, California 2000-2002

Team Leader, Quality and Case Management

Held responsibility for the oversight of the Case Management and

Utilization Management departments. Formulated and communicated

case management plans that efficiently utilized health care

services towards optimum outcomes in the safest, most cost

effective manner. Developed, implemented and coordinated acute

and ambulatory quality improvement programs. Collaborated with

medical leadership to provide quality monitoring of medical

staff practices to assure quality and accreditation standards

were met. Interfaced with outside agencies and provided dispute

resolution through written communications.

Led business process re-engineering, including the development

of revised process flows, procedure documentation and

functionality. Developed content integration as it relates to

the implementation of new clinical applications

Assessed organizational needs in the area of clinical

informatics and proposed strategies to meet those needs

Demonstrated expertise in examining errors and identifying

root cause

SCRIPPSHEALTH, San Diego, California 1998-2000

Director, Systemwide accreditation, Licensure and Risk

Management

Internal consultant for matters relating to both state and

federal healthcare regulation and Joint Commission standards.

Provided leadership and coordination of performance improvement

and risk management functions for healthcare system.

Orchestrated and developed processes for ongoing education of

licensure and accreditation standards for improved employee

performance

Collaborated with Vice President of Outcomes Management to

develop system wide performance improvement plan

Educated, coordinated and directed systemwide efforts for

successful '99 survey process which encompassed six acute care

hospitals, two skilled nursing facilities and a home health

agency

Prearranged and implemented systemwide work team to

successfully respond to HCFA validation survey

Planned, ordered and coordinated the systemwide Risk

Management program and acted as the Risk Management consultant

to system Biomedical Safety Committee

Coordinated systemwide risk management education programs in

collaboration with corporate legal department

Acted both as a resource and a coordinator to standardize the

risk control efforts throughout the system

Assessed compliance with applicable standards and developed

plan of action for identified areas of non-compliance, playing

a key role in JCAHO validation surveys

EDUCATION

M.S.N. Healthcare Systems Administration, University of San

Diego, San Diego, California

Bachelor of Science in Nursing, University of San Diego, San

Diego, California