Manager Director Case Management In Carlsbad CA Resume Adele Ball

Adele Ball, M.S.N., R.N. (C) 760-402-8990

[email protected]

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 Change Management Remote Workforce Management Operations Program Development and Implementation

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Disease and Case Management Accreditation and Compliance Medical Data Analysis Strategic Planning Coaching/Mentoring

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.

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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. 

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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.   

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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