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Lori Williams

Lori Williams

Registered Nurse (RN, CCM) Audit & Training Manager for Healthcare Services at Molina Healthcare Texas

location_on Dallas/Fort Worth Area

Registered Nurse (RN, CCM) Healthcare Services Audit Manager at Molina Healthcare

Registered Nurse (RN, CCM) Healthcare Services Quality Audits and Training Manager at Molina Healthcare

Awards Earned:

3

3

1

1

1

Level: LEVEL 02 (12mo pts: 402 pts)

Rating: 4.67/5 stars (109 ratings)

Lifetime points: 2620 pts View details

Thought Leadership:

% performance based on average of all engagements

Selected: % of applied

63%

Recognized: Contributions valued by peers

38%

Peer Support: Percentile of active participants

29%

Profile

Summary

"It is my belief that wellness is a holistic venture and lifestyle. I love to engage people in improving their overall understanding of wellness, getting them excited about the impact they can have on their own personal health, and increasing self-confidence and participation through self-care, prevention, access, education, and community connection."
Registered Nurse with proven leadership experience, competent clinical skills and wide base of knowledge and experience in healthcare services administration, and long term care services and support. Demonstrated expertise in case management, Gerontology, project management, process refinement with strategic mind set. Capacity to incorporate initiative and sound judgment, set clear expectations, manage and refine workflows and balance priorities. Able to successfully interact with all levels of leadership, strong communication skills, organizational and problem-solving abilities, and competence with handling sensitive and confidential information.

Experience

Registered Nurse (RN, CCM) Healthcare Services Audit Manager

Molina Healthcare

October 2015 - Present

Built Audit dept. from ground up for the Texas health plan. Developed Quality Review initiatives workplan, hired staff to provide transparent feedback to senior leadership and corporate executives for ongoing oversight. Plans, develops, implements and monitors progress of all lines of business within Healthcare Services program. Focused on Quality Improvement, controlling medical costs, and ensuring compliance with state and federal regulations, NCQA standards and contractual obligations. Compliance coordination and collaboration for all Longterm Support Services teams including, but not limited to Case Management, Complex Case Management, Transitions of Care, Behavioral Health, Nursing Facilities, and Utilization Management teams. Interdepartmental work groups, new employee orientation training, planning with corporate executives, mid-management, leadership and staff levels of Healthcare Services team to ensure programs are standardized and provide optimal outcomes for Molina Healthcare members. Provides clinical subject matter and operational expertise and guidance to Healthcare Services teams. Completes complex tasks, supports multiple projects and programs to include tracking, project coordination, data analytics and document management. Develops and edits policies, Standard Operating Procedures, and resource tools in coordination with program management. Conducts audits across MCO health plan for continuous quality monitoring and improvement. Facilitates health plan through NCQA accreditation, Texas Dept. of Insurance (TDI) audits, HSAG/Performance Measure Validation (PMV), CMS, HHSC surveys.
Related skills: Training and adult learning, Performance Improvement, EMR, EMAR, QNXT, Clinical Care Advance, Interqual, Milliman (MCG), knowledge of CMS, HHSC, NCQA, HEDIS, WebEx, Excel, Powerpoint, Kronos, Clinical Care Advance, Concur, Data Analytics, Project Management.

Registered Nurse (RN, CCM) Healthcare Services Quality Audits and Training Manager

Molina Healthcare

August 2015 - Present

Skills

Healthcare 7
Nursing 2
Leadership 1
Negative Pressure Wound Therapy
Wound Care
Diabetes Management
Heart Failure
Medication Therapy Management
Geriatrics
Dementia
Pediatrics
Pain Management
Medicare
IV
ICU
Case Managment
Clinical Research
Medicaid
Medical/Surgical
Case Management
Home Care
Acute Care
JCAHO
Critical Care
Hospitals
Healthcare Management
Medical-Surgical
Managed Care
Healthcare Information Technology
Disease Management
Team Building
Physician Relations
Electronic Medical Record (EMR)
Working with Physicians
U.S. Health Insurance Portability and Accountability Act (HIPAA)
Utilization Management
Patient Safety

Industries

Activities