Executive Director Medicare Group & Retiree @ United Healthcare Medicare Solutions
Clinical Program Manager @ Humana
Health & Public Service/ Medical Management Consultant @ Accenture Services
Bachelor's in Nursing Degree, Registered Nursing/Registered Nurse @
Senior health service executive with proven record of achievement in strategic planning, implementation and development of innovative healthcare programs. Extensive experience leading marketing, case management and quality improvement initiatives in the managed care enviroment. Utilize business acumen and clinical expertise to align medical goals with business objectives. Reputation for "thinking outside of the box" to create win-win
Senior health service executive with proven record of achievement in strategic planning, implementation and development of innovative healthcare programs. Extensive experience leading marketing, case management and quality improvement initiatives in the managed care enviroment. Utilize business acumen and clinical expertise to align medical goals with business objectives. Reputation for "thinking outside of the box" to create win-win solutions. A persuasive catalyst and change agent; highly skilled in building discussions around HCP needs opportunities. An accomplished public speaker with extensive experience educating physicians and other healthcare professionals, patients and family.
• Dedicated Case Management Maven with strong payer and provider experience including assessments, implementations, and models of care.
• Navigating complex healthcare organizations, building relationships, delivering effective, compliant solutions.
• Leading large, diverse teams in implementation of quality improvement, cost reduction and revenue enhancement projects.
• Managing complex activities that require collaboration between diverse internal and external resources.
• Aligning program solutions and infrastructure to meet healthcare delivery needs, client goals and organizational objectives.
• Care Management Modeling
• Transitions of Care
• Clinical Informatics, Stars Analytics
• Strategic Planning & Execution
• Supply Chain Optimization
Executive Director Medicare Group & Retiree @ Accountable for defining, leading and coordinating all local initiatives in assigned markets for improvements of CMS Star ratings, quality, coding accuracy and medical cost. From April 2015 to Present (8 months) Clinical Program Manager @ Clinical Quality Program Manager for MMP Duals in Illinois, Ohio, & Virginia
Resposible for oversight of Clinical Quality for all Humana At Home Duals Programs. Primary role includes oversight of quality withhold measures and reporting all ICT activities.
Accountable for the development and maintenance of key relationships to drive strategic outcomes and optimize business results for the Demos.
Facilitated Demo implementations, monitoring and evaluations to assure adherence to the model of care, contract requirements, and compliance to meet and exceed regulatory requirements From May 2014 to April 2015 (1 year) Health & Public Service/ Medical Management Consultant @ ACCENTURE, INC. – HEALTH MANAGEMENT CONSULTING
Consultant, Health Management Services
Design and implement high-level clinical models of care. Drive down costs while improving quality and margins by comparing patient outcomes and care delivery costs with evidence-based practice standards. Lead quality improvement, cost reduction and revenue enhancement project teams. Examples:
Performed health plan accreditation assessment, gap analysis and remediation for a Top 10 payer. Completed current state assessments; presented data to facilitate business decision between NCQA and URAC accreditation. Engaged Accreditation Steering Committee; socialized proposed quality governance with stakeholders to secure buy-in. Implemented HEDIS operating model. Developed/deployed solutions to close gaps with focus on creating a formal, functional quality management infrastructure.
Implemented transformation of Nurse Liaison to Transition Nurse/Care Manager role for a multi-state post-acute/LTC organization. Provided consulting services and subject matter expertise in project management, care management, technical integration analysis and training, and change management leadership. Reconfigured the role of Nurse Liaisons and redesigned a more global and client-focused workflow.
Maximized CMS Stars quality bonus for a Top 5 payer. Recommended changes to the Heath Guidance Organization; key contributor on team that developed organizational structure, staffing, governance and key capabilities required to maximize CMS Stars quality bonus payments, while keeping operations efficiently legal and fully accredited. Built Stars governance model. From May 2010 to March 2014 (3 years 11 months) Nurse Manager Cancer Care Services and Cardiac Telemetry @ Direct the activities of 104+ health care professional in operations of 4 departments providing inpatient cardiac services, outpatient cancer care, radiation therapy, and cancer registry services. Manager and allocate resources, oversee staffing, monitor quality and regulatory compliance, ensuring alignment of policies and performance to support organizational vision, mission, and core values. From February 2009 to March 2010 (1 year 2 months) Regional Operations Director @ Drove enrollment and directed Renal Patient Management Programs in Ohio, Virginia, and DC Markets, with focus on providing safe efficient, therapeutic and ethical patient care. Full accountability for all financial and quality measures including risk management, quality assurance, and regulatory compliance. Position involved extensive networking and provider relations management. From December 2007 to February 2009 (1 year 3 months) Manager of Disease Management @ WELLPOINT, INC.
Provided leadership for up to 70 healthcare professionals, managers and support staff. Recruited, interviewed and hired for clinical and non-clinical positions. Evaluated employee performance, identified strengths and opportunities. Set goals, coached and motivated associates to strive for continuous improvement. Cultivated an atmosphere of teamwork; encouraged individual initiative.
Headed collaborative effort to develop an advanced (“next generation”) case management model that significantly improved clinical, financial, and satisfaction outcomes. Devised intervention processes, data collection and outcome measurement tools. Delivered highest ROI of any program in the company with annual net savings of $4.1 MM to $19.2 MM.
Developed and piloted care management strategies for Anthem’s Care Counselor Program. Launched in 2005, this highly successful program became one of the company’s core medical management strategies.
Managed Precision Rx Specialty Disease Management Program, guided a team effort that made this the largest specialty pharmacy program in the U.S.
Collaborated in development of a comprehensive COPD Disease Management program; saved >$4 MM in 3 years.
Played a key role in building/launching a large-scale medical management system in a health plan for case management documentation from an Access database to Anthem’s Internal Medical Management System. Result: a comprehensive, synergistic system for the entire organization.
Developed and implemented training materials, including proactive Education Work Plans for individual team members and a Care Management Motivational Interviewing & Behavior Change Training Manual. From September 1997 to September 2007 (10 years 1 month)
Bachelor's in Nursing Degree, Registered Nursing/Registered Nurse @ Ohio University-Lancaster From 2010 to 2013 Bachelor of Science (BS) and Master of Science (MS), Health Services Administration, 4.0 @ Hamilton University From 2003 to 2005 Associate's degree in Nursing, Nursing @ Kettering College of Medical Arts From 1993 to 1996 Monroe High School Cristina Walter is skilled in: Disease Management, Program Development, Managed Care, Healthcare, Case Managment, Inpatient, Program Management, Healthcare Consulting, Utilization Management, Healthcare Management, Nursing, Hospitals, Medicare, Healthcare Information Technology, Clinical Research
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