Nurse Case Manager, Utilization Manager, Quality Manager, Directoror manager of Quality, Director or Manager of Case Man...
Martine Molett, RN, BSN, CCM 6244 Greenbudd Drive Goshen, OH 45122 (513) 509-0471 mobile
[email protected] AREAS OF EXPERIENCE * Registered Nurse (inpatient and outpatient care) * Certified Case Manager * Case Management * Disease Management * Utilization Management * Process Improvement * Software Inside/Outside Sales * Software Marketing * RFP Response Writing * Subject Matter Expertise * Current On-Line Graduate Student (MHA/Informatics) * Account Manager/Customer Relations * Work Comp/Disability Case Management * Quality Management * Project Management * Pediatric ER Nursing * Medical File/Bill Review * Appeals/Grievances
AREAS OF PROFESSIONAL EXPERTISE Quality Management, RN Coordinator Amerigroup Ohio, Inc.
October 2009 - June 2010 Cincinnati, OH
* Project management for the State of Ohio's Pay-for-Performance (P4P) initiativ es within the organization. * Responsible for Process Improvement Plan's (PIPs) and Quality Improvement Proj ects (QIPs). * Provide organizational education about quality care for members and P4P initia tives. * Support NCQA standards and processes within the health plan. * Participate within and attend state and community collaboratives. * Responsible for completion and presentation of the quality department's descri ption, work plan and evaluation. * Engage with senior level management to analyze resources necessary to promote desired clinical and operational outcomes. * Responsible for completion and submission of contractual documents and reports related to Quality Management and P4P initiatives within the health plan.
Subject Matter Expert - Case Management CH Mack, Inc. Cincinnati, OH
December 2007 - July 2009
* Provided business process and subject matter expertise to the following funct ions: QA, engineering, sales, marketing, and project management. * Supported customer engaged staff in their efforts to sell and deliver specific
implementations of our solutions. * Directly contributed to industry-specific content; assessments, workflows, req uests for proposals, reporting * Acted as an "in-house customer" for discussion and review of features and impl ementation * Assisted in the coordination and presentation of the user advisory group, incl uding being responsible for communications, collection of information, relaying of feedback both to and from the development team and management. * Supported team in analysis of customer business processes, both industry and c ustomer-specific requirements gathering capacity and in workflow creation and pr ocess improvement role as appropriate at various stages of development and deplo yment.
Health Care Sales Manager CH Mack, Inc.
March 2005 - November 2007 Cincinnati, OH
* Responsible for over 4.5 Million Dollars in Sales Revenue * Reported directly to Vice President, Sales and Marketing Strategy * Presented integrated care management software solutions to target markets - Ho spitals, Managed Care Organizations, Insurance Companies, Departments of Social Service and Area Agencies on Aging * Worked closely with Marketing Manager to develop targeted marketing materials for the health care industry. * Assisted in development of responses to RFP's from potential clients * Sales Forecasting * Served as a cross-functional member of the sales team to effectively create an d execute targeted sales campaigns.
Telephonic Case Manager/Utilization Review Nurse - March 2005 Genex Services, Inc.
September 2001 Cincinnati, OH
* Responsible for assessment, planning, implementation, coordination, monitoring and evaluation of assigned patients. * Identified potentially unnecessary services and care delivery settings, and re commend alternatives, if appropriate, by analyzing clinical protocols, standards and guidelines (Milliman, InterQual and Official Disability Guidelines). * Provided patient education to assist with self management * Interacted and negotiated with Medical Directors, Adjusters, Attorneys, Therap ists, Hospital UR personnel and other members of the health care team on challen ging cases * Participated in Quality Reviews for state certification and URAC accreditation * Case Manager orientation and training Telephonic Case Manager/Utilization Review Nurse September 2001 Anthem Managed Comp - Integrated Comp ncinnati, OH Primary Pediatric Nurse August 1997 - June 1998 Baby's Milk Fund/Hopple Street Health Center Cincinnati, OH
June 1998 Ci
Emergency Room Nurse 1994 - August 1997 Cincinnati Children's Hospital Medical Center Cincinnati, OH Graduate Nurse, High Acuity Unit 1993 - 1994 Cincinnati Children's Hospital Medical Center Cincinnati, OH EDUCATION University of Phoenix In Progress (On-line program) Masters of Health Care Administration and Informatics 2009 Xavier University B.S. Nursing
Cincinnati, OH August 1995
Christ Hospital School of Nursing cinnati, OH Diploma - RN
Cin Au
gust 1993 LEADERSHIP Board of Directors 2008 - 2010 Southern Ohio Valley - Case Management Society of America Nursing Advisory Board 2008 - 201 0 Bohecker College of Nursing ti, OH
Cincinna
Trauma Prevention Resource Committee 1995 - 1997 Cincinnati Children's Hospital Medical Center ati, OH Faculty Liaison Leader Christ Hospital School of Nursing
Cincinn 1992 - 1993 Cincinnati, OH
Class President 1991 - 1993 Christ Hospital School of Nursing Cincinnati, OH PROFESSIONAL ORGANIZATIONS Case Management Society of America (National and Local Chapter) Member since 1995 LICENSE AND CERTIFICATION Ohio State # RN - 254622 Certified Case Manager (CCM) - #00076869
References available upon request
