Cathy Kauffman has over 30 years of experience in nursing and healthcare management. She has held several director level positions managing utilization review, quality improvement, and case management programs. Her experience includes managing Medicare, Medicaid, and commercial health plans. She is skilled in accreditation, regulatory compliance, and leading organizational change.
The document outlines key concepts in quality management systems for health care organizations. It discusses that quality goals should include excellent care, strong coordination, high consumer satisfaction and good health outcomes. It also summarizes the components of quality management systems which include adopting medical standards, establishing a quality committee, utilization review, and more. Additionally, it discusses the various drivers that influence health care quality including federal/state regulations, contracts, accreditation standards, and health organization missions.
Natalya Csatari has over 15 years of experience as a registered nurse. She has worked as a care manager for Wellcare Health Plan and United Health Care, where she coordinated care for members, assessed needs, and developed and implemented care plans. She also served as Director of Nursing at Always Care Adult Medical Day Care Center, overseeing nursing services and education. Csatari aims to obtain a position that allows her to utilize her clinical expertise and experience in care coordination and management.
Jennifer Fighera has over 20 years of experience in healthcare operations leadership. She currently serves as the Transfer Center and Telemedicine Director for HCA, where she directs all aspects of the transfer center service line. Previously, she held nursing management and operations roles at several hospitals, where she improved processes like the patient transfer process. She has experience in areas like strategic planning, service line development, staff management, and quality improvement.
Stephen L. Martin has over 24 years of clinical and administrative nursing experience, including managing post-discharge follow up calls and improving quality, compliance, and patient satisfaction metrics as a nurse manager. He has a track record of analyzing data to identify issues, developing solutions through collaboration, implementing policy changes, and tracking results to achieve performance goals in demanding hospital environments. Martin is seeking a leadership role where he can apply his strategic and problem-solving skills.
Children's Hospital Los Angeles faced financial challenges under new DRG-based reimbursement and embarked on an organization-wide transformation. Key initiatives included improving clinical operations through initiatives like standardized patient placement, interdisciplinary care coordination, and reducing clinical variation. Governance was strengthened with a defined leadership structure and patient flow meetings. Enabling technologies such as an optimized bed board and case management system were implemented to improve operations. Tracking progress showed benefits like reduced length of stay, increased capacity to serve patients, continued decreasing mortality trends, and improved financial and patient satisfaction outcomes. Lessons learned emphasized focus on quality, leadership engagement, communications, and strategic technology investments.
Sunday Kerobo has over 10 years of experience as a Registered Nurse in various clinical and administrative roles. She currently serves as the Director of Operations for three assisted living facilities, where she oversees daily operations, budgets, staffing, regulatory compliance, and resident care coordination. Previously, she held roles such as Director of Nursing, House Supervisor, Charge Nurse, and Case Manager for several healthcare organizations, where her responsibilities included developing policies, supervising staff, managing patient care, and ensuring quality standards.
Sharon Kulesz is an accomplished healthcare professional with over 20 years of experience in healthcare education, management, and professional development. She has held leadership roles at organizations such as the American College of Radiology, Alliance for Continuing Education in the Health Professions, and American Academy of Physician Assistants, where she developed and managed educational programs, oversaw operations and budgets, and strengthened relationships with partners. Kulesz has expertise in areas like curriculum development, program management, and facilitating continuing education in various settings. She is passionate about developing educational opportunities to advance healthcare professionals.
Case management involves eight key activities: assessment, planning, implementation, coordination, monitoring, evaluation, outcomes measurement, and general activities. It is a collaborative process that helps ensure a client's needs are met in a quality, cost-effective manner. Case managers at Medina Hospital focus on discharge planning, utilization review, and tracking avoidable days to facilitate positive patient outcomes and reduce financial risk for the facility.
The document outlines key concepts in quality management systems for health care organizations. It discusses that quality goals should include excellent care, strong coordination, high consumer satisfaction and good health outcomes. It also summarizes the components of quality management systems which include adopting medical standards, establishing a quality committee, utilization review, and more. Additionally, it discusses the various drivers that influence health care quality including federal/state regulations, contracts, accreditation standards, and health organization missions.
Natalya Csatari has over 15 years of experience as a registered nurse. She has worked as a care manager for Wellcare Health Plan and United Health Care, where she coordinated care for members, assessed needs, and developed and implemented care plans. She also served as Director of Nursing at Always Care Adult Medical Day Care Center, overseeing nursing services and education. Csatari aims to obtain a position that allows her to utilize her clinical expertise and experience in care coordination and management.
Jennifer Fighera has over 20 years of experience in healthcare operations leadership. She currently serves as the Transfer Center and Telemedicine Director for HCA, where she directs all aspects of the transfer center service line. Previously, she held nursing management and operations roles at several hospitals, where she improved processes like the patient transfer process. She has experience in areas like strategic planning, service line development, staff management, and quality improvement.
Stephen L. Martin has over 24 years of clinical and administrative nursing experience, including managing post-discharge follow up calls and improving quality, compliance, and patient satisfaction metrics as a nurse manager. He has a track record of analyzing data to identify issues, developing solutions through collaboration, implementing policy changes, and tracking results to achieve performance goals in demanding hospital environments. Martin is seeking a leadership role where he can apply his strategic and problem-solving skills.
Children's Hospital Los Angeles faced financial challenges under new DRG-based reimbursement and embarked on an organization-wide transformation. Key initiatives included improving clinical operations through initiatives like standardized patient placement, interdisciplinary care coordination, and reducing clinical variation. Governance was strengthened with a defined leadership structure and patient flow meetings. Enabling technologies such as an optimized bed board and case management system were implemented to improve operations. Tracking progress showed benefits like reduced length of stay, increased capacity to serve patients, continued decreasing mortality trends, and improved financial and patient satisfaction outcomes. Lessons learned emphasized focus on quality, leadership engagement, communications, and strategic technology investments.
Linda M. Shepherd has over 30 years of nursing experience including roles as Chief Nursing Officer, Director of Intensive Care Units, and Director of Surgical Services. She holds an MBA and BSN and is licensed to practice nursing in Virginia. She has worked at HCA Healthcare since 2006 where she currently serves as CNO, leading quality initiatives that have earned her facility numerous recognitions. Prior to that, she held various director and nursing roles with increasing responsibilities at Carilion Clinic from 1995-2006.
This document is a resume for Chelsee Bavas summarizing her 25 years of experience in healthcare management and quality improvement. It lists her areas of expertise including organizational leadership, process improvement, data analytics, and operations management. It then details two of her most recent roles, as a Senior Specialist in Performance Improvement from July to October 2016 where she led quality improvement teams, and previously as a Clinical Director from April to October 2014 where she provided analysis and training to increase access to care. The resume concludes with her education and security clearance.
Robert W. Brenner is a physician executive who has transformed large healthcare organizations. As Chief Medical Officer of Summit Medical Group, one of the largest physician-owned practices in New Jersey, he oversees clinical strategy and operations, population health programs, and the growth of new services. Under his leadership, Summit Medical Group has expanded to over 300 providers, grown annual revenue to over $300 million, and achieved high quality outcomes. Brenner has over 25 years of experience in healthcare administration, quality improvement, and clinical leadership.
Alison Hurst has over 30 years of experience in healthcare including nursing, case management, emergency services, and leadership roles. She holds a Bachelor's in Nursing and multiple certifications. Her objective is to obtain a challenging position that allows her to utilize her clinical expertise, leadership, and collaborative skills. She has a history of successfully managing teams, implementing improvements, and reducing costs.
The internship abstract describes organizing and aligning staff job descriptions at the Monmouth County Regional Health Commission to meet the standards for national accreditation from the Public Health Accreditation Board. The intern provided an orientation on the accreditation process and worked with documents like personnel policies, competency skills packets, and sample job descriptions to reformat job descriptions for public health nurses, administrative staff, and environmental specialists. The reorganized job descriptions are under review by the Health Officer and will then be submitted to the Public Health Accreditation Board for approval. Having competent staff and job descriptions aligned with accreditation standards will improve performance management and communication within the health department.
Olga Plesko has over 20 years of experience in nursing and healthcare management. She currently works as the Medical Services Manager for Centres for Pain Management, where she is responsible for nursing standards, infection control policies, and the electronic medical record system. Previously, she held several management roles including Client Services Manager at Mississauga Halton Community Care Access Centre, where she managed teams, implemented new programs, and collaborated with community partners. She also has experience as an Occupational Health Nurse developing return to work programs. Plesko has an MBA and certificates in nursing leadership, healthcare management, and occupational health.
Christy Boutross-Wright has over eight years of experience in clinical services administration, quality assurance, and program management for home health agencies. She has held roles such as Manager, Program Manager for Clinical Excellence, Administrator, and Director of Clinical Services. In these roles, she developed policies and procedures, managed budgets, oversaw quality improvement, and ensured regulatory compliance. She is skilled in areas such as strategic planning, staff supervision, and clinical program development.
Lane Hickey has over 25 years of experience in healthcare administration, finance, and operations. He holds a Master of Public Health degree and has held leadership roles at Kaiser Permanente, Dermpath Specialists, and Portland State University. Currently, he owns and operates Dermpath Specialists, a medical billing and pathology lab services company serving dermatologists and other providers.
Ruth E. Thomas's resume summarizes her experience and qualifications for health and business administration roles. She has over 25 years of experience in managed care, case management, quality management, compliance, nursing and human resources. Her resume highlights her education, certifications and professional skills in areas such as leadership, management, analytics, and Microsoft Office proficiency.
Martha J. Hott has over 15 years of experience as an administrative assistant and executive assistant. She has excellent computer skills and experience with MS Office applications. Her background includes roles providing administrative support to CEOs, executives, managers, and professionals in various industries such as education, healthcare, advertising, and accounting. She is proficient at tasks like calendar management, correspondence, record keeping, and client services.
Jeanette Ray has over 13 years of experience as a Business Analyst on GE Power's Supplier Master Data. She has strong project management, analytical thinking, and problem solving skills. Most recently, she worked with Alstom to migrate GE Power suppliers to their new Master Data Management system. She has a proven track record of driving accuracy and efficiency through process improvements.
Robert "Conor" E Smith has over 30 years of experience in various roles in the pharmacy industry including managed care, PBMs, retail pharmacy, and pharmaceutical sales. He is currently seeking a position as a medical science liaison or in specialty pharmacy, health economics, or outcomes research. His most recent role was as Director of Pharmacy at Magnolia Health Plan where he oversaw pharmacy programs and specialty, behavioral health, and retail pharmacy spend of $150M annually.
Kathleen Archibald is seeking an administrative, logistics, customer service, or distribution position. She was previously a logistics manager and customer service representative for several companies. She has over 15 years of experience in logistics management, order processing, shipping, collections, and customer service. Currently, she is only able to work in Philadelphia or Center City due to not having a car after a recent accident.
Annabella Roig has over 20 years of experience in health and social services administration, program development and evaluation. She has managed budgets up to $3.2 million and staffs of up to 9 people. Currently she is seeking opportunities to coordinate health services that address health disparities. She has extensive experience developing and managing public health programs and initiatives across multiple organizations.
Annabella Roig H Planning Resume 12 2011annabella721
Annabella Roig has 15 years of experience in health planning, community development, and non-profit management. She currently serves as Vice President of National Programs at Esperanza, Inc., where she oversees $3.25 million in funding and programs across six states. Previously she has held roles with the City of Philadelphia managing social services initiatives and the Philadelphia Housing Authority. Roig brings experience facilitating collaboration across sectors to develop and implement strategies and programs serving underserved communities. She holds an MPH in Health Administration and is a Certified Associate Project Manager.
This document contains the resume of Veronica McDowell, an RN with over 26 years of nursing experience in Florida, including hospital, skilled nursing facility, and home health roles. Her experience includes clinical nursing, nursing management, case management, director of nursing, and independent contractor work. She has an Associate's Degree in Nursing and is working toward her BSN. She also has numerous certifications in areas such as risk management, ICD-10, HEDIS/STARS quality audits, and nursing home administration.
Jack Mulcahy is an experienced professional resume writer who owns his own resume writing business and has worked as a resume coach for Pennsylvania CareerLink, helping over 1,700 job seekers improve their resumes and increase their interview rates. He has over 40 years of experience in writing, editing, marketing, and communications roles across various industries. The document provides details on his resume writing experience and qualifications, as well as his educational and employment backgrounds.
Stacy Estes has over 15 years of experience in healthcare reporting and analytics. She has extensive experience working with SQL, EPIC, and other data systems to develop reports on trends, quality metrics, financial performance, and patient satisfaction for various healthcare organizations. Her background includes roles analyzing clinical and financial data, developing dashboards and reports, and presenting findings to management. She is proficient in Microsoft Office, SQL Server, and other software.
Malek Harb is a 31-year-old Financial Manager from Amman, Jordan currently working at Copart - AGA Company. He has over 9 years of experience in accounting and financial management roles. Harb holds a Bachelor's degree in Financial and Banking Science from Philadelphia University. He is seeking a new position as an Account Manager or Financial Manager, preferably in the GCC countries or Jordan. Harb has expertise in accounting programs like QuickBooks, auditing, budgeting, and financial reporting.
I am a customer focused technical resource who is seeking full time employment in the greater Atlanta area. I am a problem solver with a proven record for success.
Veronica McDowell is a registered nurse with over 27 years of experience in skilled nursing facilities, hospitals, and home health in Florida. She has extensive experience in nursing management, clinical oversight, and regulatory compliance. She is seeking a position as a clinical manager or in regional nursing oversight. McDowell has various nursing certifications and a background in quality improvement, case management, and electronic medical records. She provides contact information and a detailed resume of her professional experience and training.
Kellie Rivera has over 15 years of experience in client advocacy and healthcare coordination. She has excelled in roles managing large caseloads and ensuring compliance with regulations. Most recently, she has worked on annual HEDIS projects for UnitedHealthcare abstracting medical records and creating reports to measure health plan performance.
Jennifer M. Vogel is a senior business leader with over 25 years of experience in healthcare, data analytics, and corporate reporting. She has extensive leadership experience developing and managing teams, implementing new processes and products, and collaborating across departments. Currently she is the Senior Director of Product Implementation at Geneia LLC where she oversees product development, quality assurance testing, and client implementations.
Tonya Snyr is a registered nurse seeking full-time employment. She has over 20 years of nursing experience in various clinical settings including home health, mental health, case management, and clinical communications. Her experience includes performing assessments, medication management, care coordination, and utilizing various computer programs for documentation and patient care. She is licensed in Michigan and Ohio and maintains all necessary certifications.
Shirley Nelson has over 30 years of experience in healthcare quality management and utilization management. She has held several director level positions where she oversaw quality improvement, utilization review, credentialing, and case management operations. Her experience includes working for large health plans and medical groups, managing teams, and ensuring regulatory compliance.
Charles Rowland has over 25 years of experience in healthcare management, with a focus on food service operations and long-term care administration. He currently serves as the Regional Manager for Healthcare Service Group, where he oversees food service accounts in New England and New York. Prior to this role, he held positions as a Nursing Home Administrator and Food Service Manager at several healthcare facilities in Connecticut. Rowland has a graduate certificate in long-term healthcare management and degrees in business administration and culinary arts.
Wendy Hug has over 20 years of experience in healthcare executive roles including operating multiple assisted living and memory care facilities. She specializes in operations, strategic planning, quality improvement, financial management, marketing and regulatory compliance. Her experience includes executive director roles where she successfully managed daily operations, maintained high occupancy rates, implemented cost savings initiatives, and ensured compliance with regulations. She has a MBA in healthcare management and nursing home administration certification.
Aleta R. Harris is applying for a position as a Nurse Consultant with the Food and Drug Administration. She has over 18 years of experience as a Registered Nurse and 15 years of experience as a Nurse Consultant in case management and education roles. Her experience includes work as a case manager, utilization manager, and team leader with various healthcare organizations. She believes her qualifications in areas like Medicare regulations, case management, and quality improvement would make her well-suited for the Nurse Consultant position.
Ellen M. Wells is a senior healthcare leader with over 20 years of experience in C-level roles managing all aspects of group medical practices, home health, hospice, and acute care facilities. She holds degrees in nursing, business administration, and education. Throughout her career, she has consistently grown organizations through strategic planning and achieved revenue growth through leadership in areas such as marketing, business development, and human resources.
Julie Holtz-Kallas has extensive experience managing healthcare organizations and programs. She has held executive roles overseeing operations, quality improvement, and Medicaid programs. Her skills include strategic planning, process improvement, relationship building, and leading cross-functional teams. She currently works as a volunteer proposal writer developing grant initiatives to fund behavioral health programs for youth.
The document provides a summary of Dawn Marie Rady's skills and experience. It includes 3 paragraphs:
1) Her objective is to lead a large patient-centered service group and provide high quality care. She has skills in management, training, care management, and quality improvement.
2) She has a Bachelor's in Nursing and is licensed in Wisconsin. Her education includes a nursing degree from Marian College.
3) Her experience includes over 15 years in quality improvement and management roles for health insurance and hospital organizations, where she improved processes, oversight programs, and patient outcomes.
Jennifer Leach is a registered nurse and certified director of nursing seeking a challenging position. She has over 24 years of experience in long term care and short term rehabilitation facilities, including serving as director of nursing at two facilities. Her experience includes managing nursing staff, implementing quality programs, and ensuring regulatory compliance. She is proficient in computer systems used in long term care facilities and is currently pursuing her BSN degree.
Richard Cockerton has over 30 years of experience in health and social care, including as a registered mental nurse and in management roles. He has specialized in continuing healthcare assessments and has extensive experience completing assessments, reviews, and case management. He is skilled in developing processes, leading projects, and improving customer experience and organizational performance. Currently he works as an independent nurse assessor, completing assessments and case management for multiple clinical commissioning groups.
Joy Moss has over 22 years of experience in healthcare executive roles including clinical sales, innovation, consultations, program development and implementation, education, and account management. She has a track record of surpassing sales targets and optimizing business opportunities through client relationships and problem solving. Her expertise includes client prospecting, sales/account management, clinical analysis, documentation, budgeting, applications, software support, and customer service. She has held several roles such as Account Executive, Healthcare Consultant, Clinical Informatics Educator, RN Consultant, and Regional Clinical Consultant.
Mila Frazier has a Master's in Health Administration and over 10 years of experience in healthcare administration and operations. She is skilled in project management, data analysis, and ensuring compliance with regulations. Currently she volunteers as a health promoter for her church, where she plans educational programs and assists congregants in making healthcare decisions.
Lisa Marie Simon has over 15 years of experience in leadership roles in the long-term care field, including as Director of Adult Day Healthcare Programs at several facilities on Long Island. She has a proven track record of increasing and maintaining high occupancy rates. Her skills include developing strategic initiatives, managing daily operations, ensuring regulatory compliance, and training staff. She holds a Master's degree in social work and is dually licensed as a nursing home administrator and clinical social worker in New York and Missouri.
The document is a resume for Anthony C. Rahn that outlines his objective of obtaining a position with a stable firm where he can contribute positively. It then details his qualifications and over 2 years of experience in healthcare IT implementation along with various technical skills. Finally, it provides his professional history working in roles such as a Grand Central Analyst and various patient access and registration supervisory roles.
The document provides a summary of a perfusionist's professional objective, education, and extensive employment experience spanning over 20 years working in director and clinical roles for various healthcare organizations throughout the United States. Key experiences include currently serving as Director of Extracorporeal Technologies & Perfusion Services at Ochsner Health System where responsibilities include managing the perfusion program and leading initiatives in standards, efficiencies, and new service lines. Previous roles include clinical perfusionist, director of business development, and regional director positions with responsibilities such as account management, business expansion, and clinical standards.
Tiffany Curtis has over 15 years of experience in healthcare leadership, quality improvement, and project management. She currently works as a Quality Improvement Consultant, assisting healthcare providers in meeting requirements for electronic health records and quality reporting. Previously she has held roles as a nurse manager and clinical supervisor. She has expertise in healthcare policy, process improvement, data analysis, and ensuring regulatory compliance. Curtis holds an MBA in Healthcare Management and multiple nursing certifications.
Richard Scott Rahm has over 15 years of experience in clinical administration and program management. He currently works as the Practice Administrator for Polley Clinic of Dermatology, where his responsibilities include human resources management, supply procurement, financial oversight, and community outreach. Previously he held roles in clinical administration, medical education, and retail management. He has a MBA and BS in Management/Marketing from East Carolina University.
This resume is for Kylee Deterding, an experienced nurse seeking a position in healthcare leadership. She has a Master's degree in Nursing Health Leadership and minors in Nursing and Healthcare Administration and Organizational Dynamics. As an ICU nurse, she led process improvement projects that reduced infections and improved patient outcomes. As a graduate student, she consulted on a project to reduce chemotherapy wait times using Lean tools. She is skilled in data analysis, process improvement, and developing strategic business plans to improve operations and patient care.
Nancy Pike is a senior level healthcare executive with over 30 years of experience leading operations and clinical services across various healthcare organizations. She has extensive experience in strategic planning, business development, physician relations, and turning around underperforming departments. Pike currently works as the CEO of a mediation and negotiation services firm, and has held interim executive roles at hospitals and healthcare systems focusing on improvements and turnarounds.
Jennifer Thomas has over 20 years of experience in healthcare administration and providing services to marginalized populations. She has held several roles coordinating programs that support independent living for seniors and people with disabilities. Her experience includes facilitating training programs, conducting intake and assessments, developing community partnerships, and engaging members to take an active role in managing their healthcare.
This document provides an executive summary and resume for Chris Bracale, an experienced operations professional with many years of experience managing clinical programs and teams within the healthcare industry. Bracale has a proven track record of leading teams to improve quality of care while reducing costs. Currently, Bracale works as the Senior Manager of Medication Therapy Management at Express Scripts, where he oversees daily operations and a team of pharmacists and other staff.
1. Cathy L. Kauffman
BSN, RN, CCM, LNC
108 Pacolet Street, Summerville, SC 29485
Email; psunsg1975@gmail.com
Cell: 814-935-2884
Summary of Professional Skills
Professional and progressive management preceded by diverse clinical experience
including med-surg, emergency, long term care, behavioral health, and addictions
care; case and disease management in managed care/insurance, dual eligible
population health, and worker’s compensation. Start-up of Medicare-Medical Dual
Eligible of integrated Medical Management Demonstration in SC and independent
consulting business.
Extensive experience with multiple successful Accreditation, State and CMS reviews
in utilization and case management. Successful accreditation and quality
improvement experience specific to HEDIS, NCQA, URAC, and JCAHO. Independent
Medical legal consultation, HIPAA Readiness Consultation, Case Management.
Certifications have included Medical-Surgical, Legal Nurse Consultant, Managed Care,
and Case Management.
Other professional character attributes:
• Self-Starter
• Succession Planner
• Persistent
• Change Agent
• Objective Situational Leader
• Best Practice Vision
• Proactive Succession Planner
• Supportive and Successful
Mentor
Summary of Experience
Progressive Management – Director Amerihealth Caritas First Choice VIP
Medicare-Medicaid Integrated Medical Management SC Demonstration start up,
BCNEPA Sr. Director Clinical Operations (leadership of a staff of 100 working in
medical management and quality management); Nursing Director Drug/Alcohol and
Behavioral Healthcare Facility; Highmark Director Utilization and Case Management,
and Director of Quality Improvement; Regional Manager Care/Case Management
Capital BC; Crawford Regional Manager Worker’s Compensation. Other management
experience includes: Unit Supervisor Long Term Care; and Unit Nursing Coordinator
Medical/Surgical VA Hospital; Compliance Director Landacorp (National Managed
Care Software).
Healthcare Quality and Compliance – JCAHO, URAC and NCQA accreditation,
HEDIS, DOH, HCFA/CMS. Director of Regulatory Compliance with for national
managed care Software Company; JCAHO and DOH compliance for Behavioral
Health; Consultant - Healthcare and HIPAA Compliance. Recent introductory skill
development with STARS.
• Educator – Presenter at national level on diverse healthcare subjects
pertinent to utilization nurses, case managers, other healthcare professionals,
Confidential Resume of Cathy Kauffman 1
2. and attorneys relating to medical/surgical, long term care, case management,
risk management, legal issues, and quality improvement issues. Prior
instructor for Accredited LPN Program. Published. History of proven successful
staff development. Recent (February 2016) presentation to Clinical Research
audience on the topic of “Role of Case Management in Clinical Research.”
• Owner/Consultant - Integrist Healthcare Consulting, LLC privately
owned consultation providing Legal Nurse Consulting – Medical-Surgical and
Long Term Care Legal Consultation; Case Management Services; Healthcare
Compliance Consultation, HIPAA Privacy Consultation, Training and Education;
Case Management Program Development; National Level Healthcare
Educator/Presenter.
• Sales and Marketing – Quadrupled the client base for regional PA Worker’s
Compensation site to insurers/self payers and employers; sales of
independent medical/quality/legal services
• Diverse Clinical Experience – Includes but not limited to Emergency, ICU,
medical/surgical, home health, hospice, long term care, behavioral health,
and drug and alcohol addictions care.
• Medical Management and Case Management – Diverse care coordination
experience including: Employer based and Independent Case Management
Services, Disease/Condition Care Management; Utilization Management,
Disease Management; Worker’s Compensation; Managed Care Case
Management Services for Commercial, Medicare and Medicaid products.
Professional Employment Experience
Evolent Health – (Through the Jacobson Group)
DSNP Case Management 10/26/2016 to Present
Care Manager/Advisor –Remote
• Transition of Care - Care Manager
o MSSP – Medicare Shared Savings Program
o Care coordination from initial assessment, through short term care
planning through at least 4 weeks post discharge
o Education of member/care givers, reassessments throughout changes
to level of care, implementation of action items in accordance with
established and prioritized goals, and evaluation of outcomes
• Complex Care - Care Manager
o In accordance with the standards for case management during long
term complex care management of members with multiple chronic
conditions
AmeriHealth Caritas – First Choice VIP Care Plus
Medicare-Medicaid Demonstration – South Carolina 03/16/2015 – 09/14/2016
Director of Integrated Medical Management
Reason for Leaving: Business Reorganization and Leadership Realignment
• Management of all aspects of the case and chronic disease management
program
Confidential Resume of Cathy Kauffman 2
3. • Implementation of person centric model of care consistent with Three Way
Contract Standards and Elements
• Development of effective care coordination and transition of care processes
• Staff development, evaluation, and education
• Strategic process enhancement to reduce readmissions, reduce avoidable
admissions, and optimize implementation of home and community based
services to enable members to remain safely in their homes
• Adherence to mandated assessment, care plan, reassessment and
multidisciplinary team meeting regulations
• Integration of medical and behavioral health services through proactive
individualized care planning
• Evaluated in collaboration with multidisciplinary team the identification of
Members eligible for long term support services
• Written Program Protocol, Program review and annual revision, Policy
development and work flow development
• Developed strategic proposals related to transition of care processes
• Audit validation of care coordination compliance with the Three-Way Contract
with SCDHHS and CMS
• Incorporation of HEDIS measures in all aspects of care coordination as
appropriate
• Contributor of authentic data to SC and CMS reports
BCNEPA – Blue Cross North East Pennsylvania 11/11/2011 – 03/14/2015
Sr. Director Clinical Operations
• Quality and Utilization Management Program development, implementation
and improvement
• Coordinated NCQA strategy for achievement of HMO NCQA reaccreditation;
First PPO NCQA accreditation – Successful Accreditation
• Oversight of QM and NCQA accreditation to achieve the plan’s first score of
100
• Evaluated and implemented departmental improvements such as creation
and/or reassignment of the right people to the right job
• Developed a Transition of Care program to close gaps in care between acute
care discharge and home; Webinar presentations to provider groups and
Federal Accounts (FEP)
• Implemented the first Leadership and Bench Training in collaboration with HR
o Included over 20 sessions over 1 ½ years; 11-22-13 graduation of first
class to create proactive and effective succession plan
o Developed Bench training program to strengthen succession plan
• Coordinated and oversaw aggressive HEDIS improvement plan
• Collaborated with Provider Contracting Department to for development and
measurement of quality and utilization metrics as related to facility incentives
• Implemented proposal submitted and approved by CEO for inclusion of clinical
and quality oversight of PCMH
• Exceeded projected annual cost savings targets my first year; achieved
greater savings in 2013; and continued to exceed savings in 2014.
• Created value add positions within UM and Quality departments from existing
positions including a Delegation Manager and Project Manager
• Reorganized and established aggressive departmental goals to optimize
quality, accreditation and care cost savings outcomes
• Developed a proactive leadership succession plan and training
Confidential Resume of Cathy Kauffman 3
4. • Rewrote and/or developed job descriptions across entire reporting
departments
• Developed and obtained approval for departmental career ladder to create
growth opportunities for stellar staff
• Collaborated with multiple organizational teams for implementation of
Affordable Care Act implementation
• Identified, tracked and trended utilization trends monthly identifying
opportunities and/or needs for expeditious corrective action
• Implemented new nationally established criteria sets within UM to optimize
healthcare specific reviews and justifiable savings
• Promoted a departmental vision of best practice achievement through process
improvement, stretch goals, staff development, and achievement of
appropriate certifications.
• Oversaw development and implementation of aggressive UM and QM strategic
work-plans ensuring timely milestone/outcome achievement and optimal
measurable outcomes of multiple initiatives
• Celebrated success!
Centene Corporation – Absolute Total Care 03/22/2010 – 11/01/2011
Managed Care Organization/Medicaid
80k – 100k Members
Manager of Case/Utilization Management
• Revision and reorganization of case management program
• Care coordination oversight and management of Case Management Team of
RN Case Managers, Social Services, Program Coordinators, and Member
Connections Representatives
• Program coordination of Connections Plus Program – Member outreach
services
• Quality and process improvement project coordinator
• NCQA Accreditation 2010
• HEDIS incorporation into case management
• SCDHHS state audit 2010 and case management review
• Program coordinator for special projects including but not limited to
Hemophilia, Sickle Cell, High Risk OB, and other high cost and complex
disease processes
• Annual policy and procedure review and revision
McKesson 05/05/2008 – 03/17/2010
Remote: Community Based Field Case Manager/Medicaid
• Disease management services and care coordination for Pennsylvania
Medicaid members
• Provider education and assistance with care coordination for patient members
• Analysis of care options, implementation of individualized education strategies
and fluid measurement of member outcomes
Cove Forge Behavioral Health – White Deer Run – Williamsburg, PA
11/01/2005 – 05-02-2008
Director of Nursing – 170 bed facility
♦ Nursing Director Adult Rehab/Detox and Residential Treatment Facility
Confidential Resume of Cathy Kauffman 4
5. ♦ Community Liaison
♦ Compliance - PA and Federal Behavioral Health Regulations; JCAHO
Accreditation and DOH surveys
♦ Departmental Quality Improvement and Protocol Development
♦ Coordination - Staff Development and Client Education
♦ Risk Management/Safety Committee/Project Management
Capital Blue Cross – Allentown Regional Office of Harrisburg, PA
Regional Manager of Care and Case Management
Reason for leaving: Terminally ill family member
02/2005 –
10/2005
♦ Care and Case Management of NE Region for commercial and Medicare
members
♦ Case management system program development
o Software Vendor - TriZetto – ClinicalCare Advance
♦ URAC – DOH – CMS – NCQA Accreditation
♦ Discharge Outreach Program
♦ Utilization and cost management
♦ Budget development and management
♦ Staff development and training
Greater Altoona Career and Technology Center – Altoona, PA
08/2004 – 02/2005
♦ Program Director/Instructor – New Choices/New Options
♦ Instructor – Medical Assistant Curriculum/HIPAA Privacy
Integrist Healthcare Consulting, LLC. – Pittsburgh/Duncansville, PA
Legal Nurse, Case Management, and Compliance Consulting Service
Independent Consultant
2000-2005
Legal Nurse Consultant (Occasional services continue)
♦ Review and Analysis of Medical Records – Comprehensive Reporting
♦ Medical Malpractice, Managed Care, Personal Injury, and Criminal
Litigation Assistance
♦ Nursing Home negligence specialization; DUI cases; General Adult
Malpractice
Case Management and Elder Care Management Services Consultant
♦ Case Management Services – Health and Workers Compensation Care
Coordination
♦ Care Coordination Services – Elder Care Coordination – Long Term Care
Coordination
Education
♦ HIPAA Privacy, Case Management, Medical/Legal
Practice Management Consultant
♦ Acting Director
Compliance Consultant
♦ HIPAA Privacy Services, URAC Case Management Services
♦ Physician NCQA Credentialing and HEDIS Services
Confidential Resume of Cathy Kauffman 5
6. Landacorp, Inc. - Atlanta, GA 2000-2001
Medical Management Software Company – (Laid off 1-4-2001)
Director of Regulatory Compliance
♦ Research, analyze and incorporate all pertinent regulatory and
accreditation standards into internal policies, procedures and training
manuals and client education programs
♦ Compliance expertise included URAC, HCFA, JCAHO, DOH, and HIPAA
regulations
Highmark Blue Cross and Blue Shield - Pittsburgh, PA 1995 - 2000
Managed Care Organization
Director of Quality/Compliance
♦ Accreditation/compliance management pertinent to utilization review and
case management processes for HCFA/QISMC, NCQA, URAC, and DOH
with 5 years of accreditation success.
Organizational Director of Care and Case Management – Pittsburgh, Pa
Promotion
♦ Developed and managed care/case management division, including:
Medicare +Choice, Behavioral Health, Commercial, National, and Quality
Improvement units, including 300 employees
♦ Case Management Program development - Landacorp
♦ Implemented Provider Education and Disease Management Programs
♦ Coordinated Staff Education/Case Management and UM Certification
Programs
♦ Achieved successful HCFA, NCQA, DOH and URAC accreditations
♦ Appointment to URAC Commission for the development of National Case
Management Standards
Regional Director of Care and Case Management – Johnstown, Pa
♦ As above on a regional level
Crawford HealthCare and Rehabilitation Management - Altoona, PA
1990 -1995
Worker’s compensation, healthcare, and disability case management organization
Consultant-in-Charge/Regional Manager
♦ Provided oversight and management of case and vocational consultants
♦ Case Management – worker’s compensation/health
♦ Sales and marketing to new and existing accounts
♦ Prepared cases for litigation and assisted in deposition preparation
Valley View Nursing Home – Altoona, PA 1990
Long-term care facility
Nursing and Facility Continuing Education Instructor
Education and Quality Improvement Coordinator
♦ Developed staff education program and facility policies, Assessed and measured
quality of care in accordance with DOH requirements
♦ Coordinated and instructed nursing aid certification and training
Veterans Administration Medical Center – Altoona, PA 1983 – 1989
Federal Veterans Administration Hospital
Utilization Review and Quality Improvement Coordinator 1987 – 1989
Confidential Resume of Cathy Kauffman 6
7. ♦ Utilization review, Quality Improvement and Staff Education
In-service Coordinator 1985 - 1987
♦ Staff education, annual review compliance, program development, career
advancement committee
♦ Surgical Unit Staff – Promoted to Head Nurse within 3 months 1983 – 1985
Additional Professional Experience
♦ Clinical - Emergency, Medical,
Surgical, Drug and Alcohol,
Psychiatric and LTC from 1975
through 2008
♦ Nursing Education/Instructor
♦ Hospice/Home Health Care
♦ Health Insurance/Sales
♦ Sales/Marketing
Education
♦ BSN – Nursing - Pennsylvania State University, State College, PA – 1975
♦ Masters in HealthCare Administration – Incomplete - California College for Health
Sciences, 222 W. 24th
St., National City, CA 91950 – Completed 15 Credits –
1999
Professional Certifications
♦ Certified Case Manager: 1993 – Present
♦ Certified Legal Nurse Consultant: 2001 – 2006
♦ Certified Managed Care Nurse: 1996 - 2006
Publications
♦ Appointed to editorial board of Case in Point – August 2013
♦ Case in Point – “Fortifying Powerlessness – Managing Unmanageable
Lives,” December 2007
♦ ADVANCE – “Case Management and HIPAA” – June 2001
♦ ADVANCE - “The Ying and Yang of Case Management – Balancing Cost and
Quality” – September 1999
♦ ADVANCE – “Case Management Opportunities in Managed Care” – January 2002
♦ ADVANCE – “Case Management Outcomes” – March 2002
♦ Journal of Care Management – “HIPAA – A New Protected Species” – July/August
2001
♦ Bimonthly Newsletter - Integrist Healthcare Consulting, LLC
♦ West Allegheny Magazine – Regional Pittsburgh Magazine – “How to Select a
Nursing Home” – July/August 2001
♦ HIPAA 101 – “Cool Tools” Web-Based Program – PRIME
♦ Author/Continuing Care – “Case Managers: Planning for Life through Life Care
Planning” – December 2002
♦ Inside Case Management – “Just Do It … HIPAA Privacy” – January 2003
♦ Discharge Planning – “Marketing with HIPAA” – Fall-Winter 2004
♦ Editor – Lippincott and Williams - 2003 to present
♦ Editor – PRIME - Continuing Education Courses – 2002 to present
Presentations
Confidential Resume of Cathy Kauffman 7
8. ♦ Speaker – Clinical Billing and Research – “Role of Case Management and Care
Coordination in Clinical Research.” – February 2016
♦ Speaker – Wyeth Pharmaceutical Conference – Case Management and Patients
with Depression – September 2008
♦ Speaker - CMSA June 2005 - The Role of TNF Modifying Agents in the treatment
of Rheumatoid Arthritis
♦ Speaker: MOSBY Case Management Conference – November 2003 –
Presentations: Case Management and HIPAA and Case Management Malpractice
and Litigation
♦ Speaker: General Topics include: Case Management Issues, HIPAA Privacy,
Clinical, and Medical-Legal Case Issues
♦ Speaker: NBI (National Business Institute) Nursing Law Update Seminar -
“Universal Healthcare Issues” and “Current Legal Issues in Nursing”
♦ Speaker: NBI (National Business Institute) Medical Record Review and Analysis
for Attorneys
♦ Speaker: DUPONT National Case Management Presenter (Deep Vein Thrombosis)
- 2000 thru 2001
♦ Speaker: NBI – (National Business Institute) - Nursing Home Negligence –
November 8, 2002
♦ Speaker: NBI (National Business Institute) Medical Record Review for Paralegals
♦ Speaker: Lorhman Institute - HIPAA Privacy for Healthcare Professionals
♦ Speaker: CMSA Annual Seminar and Nationally – “Legal Issues and Case
Management”
♦ Speaker: PRIME, INC. - Low Back Pain Case Management, Rheumatoid Arthritis
and DVT National Presenter
♦ PRIME, INC. – Program Development Editor and Speaker
♦ PSNA – Speakers Bureau 2001
♦ ASPE – American Society of Professional Education – HIPAA Privacy Compliance
♦ Educator: Community College of Allegheny County – Part Time Case Management
Certification Instructor
♦ Educator: HIPAA Privacy Workshops – Altoona Career and Technology Center
♦ Speaker: Centacor – “Managing Rheumatoid Arthritis”
♦ Auditor: Perigee Healthcare Consulting – NCQA Physician Office
Assessments/Health America Client
♦ Auditor: Outcomes, Inc. – NCQA Physician Office Assessments/Health America
Client
♦ Case Manager Subcontractor - Nation’s Care Link – Long Term Care Nurse
Assessment – Subcontracting Services
♦ Case Manager Subcontractor - Bunchcare and Associates, Inc. – Case
Management Services
Advisory Committees
♦ GENENTEC Advisory Committee – National Case Management Committee 1998 -
1999
♦ SANOFI Advisory Committee – National Case Management Committee 1999
♦ STADTLANDERS Advisory Committee – National Case Management Committee
1999
♦ CMSA – Pittsburgh Chapter – Member and Education Committee – 2001
♦ URAC Case Management National Advisory Committee - 1998
♦ URAC (National) Education Advisory Committee- 2000
Confidential Resume of Cathy Kauffman 8
9. ♦ CMSA (National) Nomination Committee - 2000
♦ CMSA Special Interest Group (Acute Care) Moderator – 200l
♦ CMSA Acute Care (SIG) Leader – 2001 – 2002
♦ Blair County Chamber of Commerce - Health and Safety Committee – 2002-03
Professional Organizations
♦ Case Management Society of America (CMSA)
♦ Association of Manager Care Nurses (AMCN)
References available upon request
Confidential Resume of Cathy Kauffman 9
10. ♦ CMSA (National) Nomination Committee - 2000
♦ CMSA Special Interest Group (Acute Care) Moderator – 200l
♦ CMSA Acute Care (SIG) Leader – 2001 – 2002
♦ Blair County Chamber of Commerce - Health and Safety Committee – 2002-03
Professional Organizations
♦ Case Management Society of America (CMSA)
♦ Association of Manager Care Nurses (AMCN)
References available upon request
Confidential Resume of Cathy Kauffman 9