R
Rick CCM

California Regional Director, ACO Clinical Transformation at UnitedHealthcare

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About

A result oriented Healthcare Quality Professional with diverse experience in many aspects of Patient care. Experiences include extensive work in Case Management, both in Hospital and Managed Care, Clinical Sales and Support managing cross functional teams, Nursing Informatics and Critical Care Nursing. Specialties: * Catastrophic and Trauma Case Management. Discharge Planning Utilization Review and Management. Capitation and Managed Care. Use of Milliman and Interqual criteria Ambulatory Case Management with focus on OneCare and SPD Population Management and Supervision of both Inpatient and SNF Case Managers. Providing resource information and guidance to on-site Case Managers. Clinical experience in a variety of acute care areas including Critical Care, Recovery Implementation of Meditech Client Server and EMR Order Operating System. Project Management coordinating software, medical device implementations and training Facilitator for a variety of stakeholders including Physicians, Nurses and Ancillary Staff.

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Work experience
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Sep 2019 - Present

UnitedHealthcare

California Regional Director, ACO Clinical Transformation

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Aug 2016 - Present

United Health Care

Medical Management Consultant

Collaborate with Hospitals and Medical Groups in order to provide in depth analysis of key performance indicators such as inpatient bed days, readmissions, outpatient surgery utilization and support services, both for commercial and Medicare members. Consult with Medical Groups and Hospitals in order to maintain and enhance HEDIS measures as well as STAR ratings. Provide assistance to Medical Groups and Hospitals in bringing case management solutions patients in need.

Jun 2014 - Present

Monarch HealthCare, an Optum company

Manager, inpatient case management services

- Initiation of Model of care for Cal-Optima members - Training and supervision of case managers and PCC's - Audit preparation - On-going evaluation of case management effectiveness of Cal-Optima members

Sep 2013 - Present

Yoh Healthcare Staffing, Monarch Healthcare

RN Case Manager

After hours case management as well as Concurrent and retrospective review of members hospitalized in the Orange County Area.

Jan 2014 - Jun 2014

Healthsmart MSO

RN Ambulatory Case Manager

Ambulatory Case Manager specializing in OneCare, SPD, and Senior Advantage. Duties include.. Care Coordination Complex Case Management Service Coordination

Mar 2012 - Sep 2013

Monarch HealthCare

Supervisor, Inpatient Case Management

My responsibilities include…

Sep 2010 - Aug 2012

Mission Hospital

Care Manager

Performed inpatient case management and discharge planning for a variety of patient populations including critical care, trauma, surgical, medical and cardiac service lines. Determined RAC review criteria and guided RAC review appeals.

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Mar 2010 - Jul 2011

ICU Medical

Clinical/Technical Support

Provided Clinical education and support for hospital products with a focus on critical care monitoring and critical care cardiac output device implementation and support

Jun 2009 - Feb 2011

Disneyland Resort, Guest Health Services

Registered Nurse

Provide first response assessment, triage, and first responder treatment in park. Provide customer Service based on Disney Resort's core values to internal and external customers. Provide BLS training to cast members.

Apr 2002 - Mar 2010

Abbott Laboratories/Hospira Worldwide

Account Manager

Provided Clinical education, product coordination and management for various service lines, including Critical Care, Infusion Devices, and Hospital products. Provided financial analysis and workflow improvement to customers implementing products. Increased sales in Infusion device, pain management, critical care product lines by 10%

Feb 2007 - Sep 2008

Disneyland Resort, Guest Health Services

Registered Nurse

Provide first response assessment, triage, and first responder treatment in park. Provide customer Service based on Disney Resort's core values to internal and external customers. Provide BLS training to cast members.

Oct 2005 - Feb 2007

Saddleback Memorial Home Care

Registered Nurse

Provided Home Health Care to patients recently discharged from hospital. Provided assessment, treatment of various conditions including Cardiovascular, Respiratory, Neurological, Orthopedic, Endocrine, Gastro-intestinal and renal. Provided treatment for wounds in various stages as well as communication to families and physicians.

May 1999 - Oct 2005

Medical Help

Critical Care Registered Nurse

Provided Critical Nursing care in a variety of settings including Cardiovascular, Surgical, medical, Neurological Intensive care units. Provided Emergent Nursing care in both Basic and Trauma settings.

May 2001 - Apr 2002

Mission Hospital Regional Medical Center

Critical Care Nurse

Provide Critical Care Nursing to Intensive care cardiovascular patients

Sep 1999 - May 2001

Monarch HealthCare

Case Management

Provided Case Management and Utilization Review for in-patient locations at Mission, Saddleback, and Mission, Laguna Beach Hospitals.

May 1999 - Oct 1999

Mission Hospital

Case manager

Provided Case Management and Utilization Review for Mission Hospital.

Jan 1995 - Jul 1999

St. Joseph Hospital

Registered Nurse

Critical care Nursing for Trauma, Cardiac, Surgical and medical service lines.

Education

2015 - 2017

Grand Canyon University

Masters of Science in Nursing, Health Informatics

1991 - 1994

California State University

Bachelor's of Science Degree, Healthcare Administration

1980 - 1985

Cypress Community College

Associates Degree, Nursing

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