senior clinical transformation manager sr senior clinical transformation manager resume example with 20+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - - -

Ambitious Registered Nurse with solid history of success in care coordination, case management, value-based care, and clinical operations. Motivated to drive productivity, profit, and efficiency goals through proactive and hands-on leadership. My objective is a position that delivers next-generation solutions to improving workplace productivity by leveraging multidisciplinary partnerships, providing quality healthcare, enhancing organizational culture, improving patient experience, and cultivating positive staff experience. My focus is to establish an empathetic and caring interdisciplinary team that increases health care outcomes to achieve value-based care and Quadruple Aim Goals of Healthcare.

  • Project Planning
  • Documentation and Reporting
  • Goal Setting
  • Teamwork and Collaboration
  • Hiring and Training
  • Problem Resolution
  • Verbal and Written Communication
  • Performance Tracking and Evaluation
  • Staff Training
  • Technical Proficiency
  • Team Building
  • Cost Control
  • Performance Evaluations
  • Onboarding and Orientation
  • Scheduling and Coordinating
  • Patient Care Planning
  • Patient Examination
  • Patient Care Assessment
  • Nursing Consultation
  • Accurate Documentation
  • Subject Matter Expert (SME) Case Management
  • SME Clinical care, quality, and utilization
  • Analyzing Data
  • Coordinated Language of Caring Project to drive Net Promoter Score (NPS)
  • SME for team and culture development
  • Demonstrated knowledge of NCQA, CMS, and HEDIS requirements to achieve better Quadruple Aim Health Care goals
  • Training and Development
  • Administration and Reporting
  • Work Planning and Prioritization
  • Recruitment and Hiring
  • Employee Coaching and Motivation
  • Complex Problem Solving
  • Time Management
  • Supervision & Leadership
  • Organizational Skills
  • Relationship Building
  • Data Management
  • Microsoft Office
  • Critical Thinking
  • Training & Development
  • Team Management
  • Planning & Organizing
09/2019 to Current
Senior Clinical Transformation Manager (Sr, Senior Clinical Transformation Manager Cvs Health Macon, GA,
  • As a Senior Clinical Transformation Manager (Sr. CTM) I am responsible for the ongoing clinical management of physician practices participating in Accountable Care Organizations (ACO), Value Based Programs, Patient Centered Medical Homes (PCMH), and Population Health Management programs.
  • I lead multidisciplinary practice transformation and performance improvement initiatives to achieve key performance indicators (KPIs).
  • Work to guide practices in achieving targeted goals that include improved quality, efficiency, and utilization based on industry benchmarks such as HEDIS, NCQA, and CMS.
  • As a Sr. CTM I am accountable for driving progress toward desired transformational change and performance improvement to achieve value-based care.
  • I ensure health care teams are working towards achieving savings goals set for the practice, HEDIS quality goals, CMS benchmarks, NCQA requirements, and Quadruple Aim Healthcare Goals.
  • Responsible for coaching and partnering with multidisciplinary healthcare teams to improve population health management for achieving KPIs and value-based care.
  • Build and effectively maintain relationships with the practice leadership and key clinical influencers involved in practice transformation.
  • Regularly facilitate efficient, effective practice improvement meetings with multidisciplinary healthcare teams to monitor, present, and discuss progress on the transformation action plan and achievement in KPIs.
  • Monitor and review the progress of the practice in milestone achievement and ensure the practice is accountable for successful completion.
  • Use data to analyze key cost, utilization and quality data and interpret results to assess the performance of the practice.
  • Use data to analyze trends and work with stakeholders to agree on and implement proactive strategies to address issues, and measure impact using a PDSA rapid cycle improvement approach.
  • Consult and guide the practice on developing innovative solutions, including bringing best practice experience and connecting practices with other high performing practices to spur innovation.
  • Responsible for the clinical partnership for ACO to improve clinical quality, utilization, cost efficiency, and patient/provider satisfaction.
11/2013 to 10/2019
Clinical Manager Case Management/Care Coordination Healthcare Resolution Services, Inc. (Hcrs) Toppenish, WA,
  • Led a team of approximately 20 clinical staff and provided coaching/mentorship.
  • Managed all human resource issues including yearly appraisal and merit increases.
  • Responsible for team productivity, coached to increase individual goals, collaborated with team members to achieve business and client goals.
  • Developed policies and procedures to improve workflows/processes.
  • Mentored nurses to help achieve career goals.
  • Project management lead for depression process, performance metrics, Language of Caring, engagement inbound call team, and RN Licensure.
  • Collaborated with non-clinical team to develop workflows and process for supporting clinical care/case management.
  • Collaborated with multidisciplinary team to establish record of comprehensive patient care plans.
  • Streamlined discharge planning to create efficient, patient-oriented care strategies.
  • Leveraged years of expertise to create effective, pragmatic training materials for new or current staff members.
  • Resolved problems and delivered solutions by collaborating with multidisciplinary teams.
  • Partnered with healthcare organizations to meet greater needs, preventing duplication and optimizing resource utilization.
  • Planned and directed nursing services in high-specialized patient care areas in accordance with NCQA, HEDIS, and CMS.
  • Collaborated with team members to identify and accomplish improved clinical outcomes, reduce cost, increase patient satisfaction, and improved staff partnership/morale.
  • Create diverse, equitable, and inclusive work environment.
  • Identified and hired talented individuals bringing valuable skills and great experience to team.
  • Enabled each member of staff to receive development opportunities by implementing workshops, seminars and regular training.
  • Evaluated quality index scores and key performance indicators to identify opportunities for improvement.
  • Implemented highly effective onboarding and coaching program for new and existing staff members and promoted cross-training in other areas.
  • Created onboarding program for new staff members, training in customer service and care coordination/case management procedures.
11/2010 to 11/2013
Population Health Solutions Case Manager Team Lead OptumHealth City, STATE,
  • Subject matter expert for a team of Case Management RNs and provided coaching, mentorship, and leadership in collaboration with Clinical Manager
  • Assisted with managing the team schedule, urgent patient issues, maintaining goals, and monitoring of applications/systems
  • Collaborated with peers and leadership to set daily goals to meet performance goals/metrics
  • Assist Clinical Manager with managerial responsibilities
  • Manage escalated cases
  • Resource and subject matter expert to clinical staff
  • Care Coordination duties
  • Approve PTO
  • Coordination of clinical schedule with manager
  • Prioritizes daily dialer job to provide nurses with new patient enrollments
  • Help team achieve performance guarantees and EBMs
11/2005 to 11/2010
Case Manager RN OptumHealth City, STATE,
  • Provided telephonic case management for complex medical needs for achieving better health care outcomes and quality care coordination
  • Educate patients on health care issues, provide benefit information, and refer to health care programs
  • Collaborated with physicians on patient medications, medical needs and performance.
  • Developed patient care plans, overall patient health assessments and evaluations.
  • Actively participated in family and patient planning processes.
  • Assessed and reviewed patients for discharge and planning and integrated services for patients requiring home care, home infusion and durable medical equipment (DME).
  • Collaborated in consults, patient care plans development, patient monitoring and evaluations.
  • Incorporated appropriate nursing methods to create individualized care plans.
  • Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions met patients' treatment goals.
  • Helped patients navigate healthcare system and care options by educating on relevant subject areas and answering questions throughout treatment process.
  • Collaborated with physicians during medical rounds, updated treatment plans and provided plan of care to patients and families.
  • Complex case management of multiple physical and mental healthcare needs
  • Prioritize cases and ensuring standard operating procedures are achieved
  • Train new employees
  • Train Case Management Nurses in Manila Philippines
04/2001 to 11/2005
Public Health Nurse Saint Louis County Department Of Health City, STATE,
  • Planned, organized, and delivered health care to clients and their families by assessing health/home environmental status
  • Provide health education and clinical assessment to pregnant and parenting mothers
  • Oversee ancillary personnel in the performance of their duties
  • Collaborate with other health care providers to assure delivery of required or needed services
  • Train student nurses for public health clinical
  • Preceptor for new employees
  • Organize trainings for Public Health Nursing Staff
  • Lead Case Manager for elevated lead levels in children for St
  • Louis County
  • Lead Educator for children with elevated lead leads
  • Provide trainings for local daycare providers
  • Promoted healthy habits and practices in outreach materials and presentations.
  • Collaborated with local health departments and other community partners.
  • Entered client records in centralized database for progress tracking.
  • Performed assessments for each individual case to determine best fit for materials and services.
  • Tested clients for common conditions and referred to other community resources based on specific needs.
  • Educated public regarding community health resources in correctional facilities, community centers and churches.
  • Initiated programs to address health needs of families with emphasis on women and children.
  • Maintained up-to-date and comprehensive electronic and paper filing systems.
  • Answered phone calls, emails, letters and faxes and efficiently provided accurate information and responses.
  • Provided patients with post-discharge follow-up and recommended available counseling programs.
  • Gathered, organized and disseminated information from various sources that included health plans, hospitals, providers and government entities to appropriate individuals.
  • Planned and coordinated patient and family teaching and health education.
05/1999 to 12/2002
Neonatal Intensive Care Unit Nurse St. Louis Children's Hospital City, STATE,
  • Planned, organized, and delivered critical care to newborn infants
  • Provide intensive clinical care to newborns with congenital health issues or newborns born prematurely
  • Teach and demonstrate newborn/infant childcare
  • Organize and delegate patient care to assistant
  • Interact with other health care professionals to provide family centered care
  • Refer families to programs for care after discharge
  • Managed day-to-day routines for newborn babies by administering medication and fluids and checking vital signs regularly.
  • Utilized valuable communication skills to deliver information to family members regarding patient treatment, care and medical options.
  • Delivered exceptional care to average of 1-3 neonatal ICU patients in Neonatal Intensive Care setting.
  • Assessed ICU patients each shift to ascertain vitals and key information.
  • Checked on patients regularly to track progress with treatments, changes in symptoms and need for emergency interventions.
  • Administered medications by diverse means and tracked responses.
  • Supervised cardiac monitors, mechanical ventilators and alarms and oxygen delivery devices.
  • Evaluated patient vital signs and laboratory data to assess needs and provide emergency interventions.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Identified abnormal and critical respiratory patterns through direct pulmonary assessments.
  • Stocked clinical workstations and procedure rooms with necessary supplies.
  • Demonstrated self-reliance by meeting and exceeding workflow needs.
Education and Training
Expected in 12/2020 to to
Master of Science: Nurse Leadership And Administration
Capella University - Minneapolis, MN
Expected in 12/2013 to to
Master of Science: Master of Health Administration
Webster University - St Louis, MO
Expected in 01/1999 to to
Bachelor of Science: Nursing
University of Missouri - St Louis Barnes College - St Louis, MO
  • Certified Case Manager, Commission for Case Manager Certification - 2009
  • HEDIS Measurement Year 2021 technical specifications - 2021
  • Frontline Leader Trained - 2012
  • Green belt Certified - 2012
  • Preceptor trainer - 2010
  • Balance Performance Scorecard metric Super User - 2016
  • Emerging Leader Program Certification -2018
  • Culture Ambassador - 2017
  • Lean Certification - 2018
  • M&R Certification level 1,2,3 - 2019
  • Accountable Care Level 1 certification - 2019
  • Press Ganey - 2022
  • Diversity, Equity, and Inclusion - 2022

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Resume Overview

School Attended

  • Capella University
  • Webster University
  • University of Missouri - St Louis Barnes College

Job Titles Held:

  • Senior Clinical Transformation Manager (Sr, Senior Clinical Transformation Manager
  • Clinical Manager Case Management/Care Coordination
  • Population Health Solutions Case Manager Team Lead
  • Case Manager RN
  • Public Health Nurse
  • Neonatal Intensive Care Unit Nurse


  • Master of Science
  • Master of Science
  • Bachelor of Science

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