ANDREA BAKER
Westport
Summary
Results-driven Clinical Nurse Director with 22 years of clinical, administrative, and patient care experience. Gifted in building and implementing approaches to increase quality and streamline processes. Significant leadership background in Care Management directing multidisciplinary healthcare teams to achieve care objectives and outperform business targets.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Senior Clinical Manager
Strive Health/Humana Market (KY/IN)
01.2022 - 01.2023
- Promoted high morale and staff retention through dynamic communication, prompt problem resolution, proactive supervisory practices and facilitation of positive work environment.
- Facilitated interdisciplinary rounds, market team meetings, as well as external payor meetings
- Monitored clinical quality metrics and patient care delivery daily
- Generated/analyzed reports to identify trends/anomalies and areas of concern
- Collaborated with other departments to coordinate seamless patient care workflows
- Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.
- Regularly evaluated employee performance and provided feedback.
- Implemented onboarding for new employees, which enabled each to effectively learn tasks and job duties.
- Initiated pilot projects within the market to enhance patient experience and achieve market metrics
Lead RN Care Manager
Strive Health/Humana Market (KY/IN)
07.2020 - 01.2022
- Supervised a team of RN’s and Care Coordinators while acting as the clinical subject matter expert and resource for patients/families
- Managed patient caseloads effectively, ensuring timely interventions and thorough follow-ups to mitigate potential complications.
- Developed strong relationships with patients and their families, providing education on diagnosis, treatment options, disease process and management, as well as emotional support.
- Focused education on diseases such as CHF, CAD, Diabetes, CKD, and ESRD, including Renal Replacement options.
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
- Generated/analyzed reports as needed for management, identifying trends/anomalies and areas of concern
- Provided networking opportunities with Kidney Transplant Centers in Kentucky, Indiana, and Tennessee.
- Trained new staff (nurses, care coordinators) in proper documentation (NCQA), care standards, operational procedures, and safety protocols.
- Providing auditing support for RN and Care Coordinator to ensure quality of care
Clinical Operations Manager, Care Management
Evolent Health/Passport Health Plan, Louisville, KY
05.2019 - 07.2020
- Oversaw daily operations of an RN care management team, including staff scheduling, caseload management, and team productivity metrics of a large Medicaid MCA (300,000+ members)
- Recruited trained, and mentored new employees, fostering their professional development within the organization.
- Submitted weekly/monthly reports to leadership demonstrating compliance with contracted service line agreements within the state and health plan cost-savings reports.
- Ensured regulatory compliance with timely audits, thorough documentation, and prompt corrective actions.
- Assisted with chart preparation for NCQA Care Management and Population Health accreditation.
- Conducted performance evaluations for staff members, identifying strengths as well as areas for growth and improvement opportunities.
RN Care Advisor/Embedded Case Manager
Evolent Health/Passport Health Plan, Louisville, KY
10.2015 - 05.2019
- Worked with pediatric special needs patients as well as foster care children to ensure access to healthcare services
- Collaborated telephonically and face to face with providers to ensure that their high-risk Medicaid patients had access to health care
- Addressed patient barriers to healthcare such as social determinants of health
- Provided education to patients/families via phone and in office visits regarding their diseases/conditions, dietary needs, and medications
- Assisted both providers and patients with navigating in-network options for tests, treatments, and submitting prior authorizations
- Collaborated across multiple departments throughout the Medicaid health plan to assist patients/providers including pharmacy, customer service, utilization management, claims, and provider network
- Assisted with training new hires and served as a resource/expert to fellow coworkers.
Renal Nurse Clinician/Living Donor Coordinator
Norton Children’s Hospital, Louisville, KY
01.2011 - 10.2015
- Developed, reviewed, and implemented living donor policies/procedures to ensure compliance with Medicare, CMS, and UNOS guidelines
- Provided education/support to floor staff and patients/families regarding both peritoneal and hemodialysis, renal conditions, transplant, and treatment plans
- Provided case management for pediatric dialysis/transplant patients
- Attended all kidney transplant surgeries, assisted in the OR to ensure compliance with UNOS protocols.
Registered Nurse
Norton Children’s Hospital, Louisville, KY
07.2002 - 12.2010
- Worked as a pediatric critical care resource nurse within the PICU, NICU, ER, Oncology, and Medical/Surgical units
- Responsibilities included providing complete care for 1 to 5 patients, administering medications, managing ventilated patients, dialysis, and ECMO, patient/family education, and collaborating with providers throughout multiple departments
- Completed peer review chart audits and provided orientation for new hires and student nurses.
Registered Nurse/Travel Nurse
Various Travel Agencies
05.2004 - 05.2007
- Worked as a travel nurse in California, Utah, Ohio, and Indiana
- Completed 8-13 week contracts in various settings including NICU, PICU, ER, Rehab, High Risk Antepartum/Post-Partum, Neuroscience/Oncology, Cardiology, and Trauma
- Displayed the ability to work efficiently within high volume/short staffed facilities.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
Education
Bachelor of Science in Nursing -
Bellarmine University, Louisville, KY
01.2002
Skills
- Clinical Leadership
- Training and mentoring
- Excellent Communication
- Clinical Quality Improvement
- Case Management
- Team Management
- Clinical Documentation
- Adaptability and Flexibility
- Problem-Solving
Certification
- Certified Case Manager
- Pediatric Nurse—Board Certified
- Basic Life Support/CPR Certified
Timeline
Senior Clinical Manager
Strive Health/Humana Market (KY/IN)
01.2022 - 01.2023
Lead RN Care Manager
Strive Health/Humana Market (KY/IN)
07.2020 - 01.2022
Clinical Operations Manager, Care Management
Evolent Health/Passport Health Plan, Louisville, KY
05.2019 - 07.2020
RN Care Advisor/Embedded Case Manager
Evolent Health/Passport Health Plan, Louisville, KY
10.2015 - 05.2019
Renal Nurse Clinician/Living Donor Coordinator
Norton Children’s Hospital, Louisville, KY
01.2011 - 10.2015
Registered Nurse/Travel Nurse
Various Travel Agencies
05.2004 - 05.2007
Registered Nurse
Norton Children’s Hospital, Louisville, KY
07.2002 - 12.2010
Bachelor of Science in Nursing -
Bellarmine University, Louisville, KY
- Certified Case Manager
- Pediatric Nurse—Board Certified
- Basic Life Support/CPR Certified
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