THE OFFICIAL MEMBER NEWSLETTER OF THE AMERICAN ASSOCIATION OF MANAGED CARE NURSES
NURSES’ NOTES
Volume Sixteen, Number Three
President’s
Message
Managed Care Nurse Leader of the Year
Nominations Due October 1st!
by LaNita Knoke, RN, BS, CMCN
We are on the
threshold of the
largest Managed
Care Fall Forum to
date. It seems
amazing but we
will have almost
800 managed care
professionals in
one place to collaborate and network! If you have
not registered,
think about the
magnitude of over 390 managed care nurses
along side of other managed care professionals and the largest exhibit hall ever with over
80 exhibitors all in the fabulous Bellagio, Las
Vegas!
by Patti Hulcher
Alright members, I know that you all have a coworker, supervisor or friend that you look to
for support and leadership OR maybe YOU are
the one that people come to for advice, guidance and direction. Either way, it’s time to
speak up and recognize such outstanding
leadership! Don’t miss your opportunity to
acknowledge someone that you feel exudes
exemplary leadership characteristics! We
know that all of you work very hard everyday
and deserve recognition for all that you do…so
don’t miss the chance to let someone know
how much you look up to them – nominate
them for the 5th Annual Managed Care Nurse
Leader of the Year Award!
What impact can your presence bring? Get
registered today! While you are registering,
look at the nursing preconference – great topics, which will lead to great discussions with
over 70 other nurses. Can you afford to miss
this? Do not let this opportunity pass you by.
In case you missed the announcements, we
are currently in the process of voting for placements of the two open board of directors positions. Please take the time to review the 8
awesome candidates and cast your vote today to assure we continue to have a full and
active board of directors for AAMCN. If you did
not receive an email directing you to vote contact Patti, Katie or I and we will get you set
up.
I mentioned this in the last newsletter but if
you still have not had the opportunity to check
out the newly redesigned and upgraded
AAMCN website, please do so today! See what
it can do for you and what information is available for you. If you need assistance or tutoring, just give Patti a call or send her an email
and she will help you navigate through it. Explore the different discussion groups and
networking opportunities with other managed
...continued on page 2
To submit a nomination, please contact Patti
Hulcher TODAY at phulcher@aamcn.org with
examples and reasons of why your candidate
should be the Managed Care Nurse Leader of
the Year. Nominations will close on October 1.
NOMINATION CRITERIA
Examples/Descriptions of leadership in the
following areas:
• Leadership Impact on Managed Care
• Mentoring Achievement with examples
• Leadership & Managed Care Nursing Achievements
• Contributions made to strengthen managed
nursing and the Nursing profession
• Noted personal leadership qualities
Personal Characteristics Exuded
• Charisma - Instills faith, respect, and trust.
Has a special gift of seeing what others need to
consider. Conveys a strong sense of mission.
• Individual consideration - Coaches, advises,
and teaches people who need it. Actively listens and gives indications of listening. Gives
newcomers a lot of help.
• Intellectual stimulation - Gets others to use
reasoning and evidence, rather than unsupported opinion. Enables others to think about
old problems in new ways. Communicates in
a way that forces others to rethink ideas that
they had never questioned before.
• Courage - Willing to stand up for ideas even
if they are unpopular. Does not give in to pressure or to others' opinions in order to avoid
confrontation. Will do what's right for the company and for employees even if it causes personal hardship.
• Dependability - Follows through and keeps
commitments. Takes responsibility for actions
and accepts responsibility for mistakes.
Works well independently of the boss.
• Flexibility - Functions effectively in changing environments. When a lot of issues hit at
once, handles more than one problem at a
time. Changes course when the situation
warrants it.
• Integrity - Does what is morally and ethically
right. Does not abuse management privileges.
Is a consistent role model.
• Judgment - Reaches sound and objective
evaluations of alternative courses of action
through logic, analysis, and comparison. Puts
facts together rationally and realistically. Uses
past experience and information to bring perspective to present decisions.
• Respect for others - Honors and does not
belittle the opinions or work of other people,
regardless of their status or position.
Inside
pg 2.....
pg 2.....
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pg 3.....
pg 4.....
President’s Message Cont.
Not all Nurses are Equal
Corporate Corner
Introducing BrightSky
Board of Director’s Nomination
Summaries
pg 4..... New CMCNs!
pg 5..... New Members
pg 6..... Board of Director’s Nomination
Summaries Cont.
President’s Message cont.
...continued from page 1
care nurses and professionals.
As we are all aware, 2012 will mark the next
presidential election. As we move towards this
election, are you interested in becoming involved? If so, you may want to involve yourself
in our Legislative Committee. Drop Shelly,
Patti or I an email with your interest and we
will help you find involvement.
Do you have a great idea for a webinar or other
presentation? Do you like to teach others and
present? If so, contact Patti, Katie or I and we
will set you up with the Leadership committee
or another appropriate project. We are always
looking for fresh ideas and presenters.
You may also be interested in the updated
Managed Care textbook and certification program. Encourage those you network in to become certified or become certified yourself in
your specialty. If you have questions on either, please contact Patti, Katie, myself or
another board member. We are here to make
sure you get what you need.
So meet us in Vegas, get involved and active.
Let us make sure our voices are heard.
Fall Managed Care Forum
November 10-11, 2011
Bellagio Hotel
Las Vegas, NV
Not All Nurses Are Equal
by Richard Yadon, CPC, CERS
In every health care organization there are
many different types of nurses. I don’t mean
nurses differentiated by a clinical specialty.
While that is important, it is not as important
as most nurses might think. When we are
working with health care companies to find or
upgrade their nursing talent, they tell us that
all nurses are not equal!
There are the nurses that stand out from the
rest due to superior performance, loyalty, responsibility and a consistent positive attitude. There are also nurses that don’t exceed
expectations, but they meet them. Often they
are responsible, loyal and get their work accomplished on a timely basis. The last category is defined by the nurses who are noticeable for their inadequacies.
These individuals are known for all of the
wrong reasons. Often they have poor attendance, problems with tardiness, and inneroffice problems with co-workers or superiors.
They usually are negative and condescending. The first of these categories are the
nurses that are valued most by organizations.
These professionals can be referred to as highvalued employees. High-valued employees
share common characteristics.
When determining if you are a high-valued
nurse and employee, you should look at the
following:
- Provide leadership – formal or informal
- Contribute practical and new ideas
- Create excellent and consistent results
Don’t miss the chance for the
highest quality continuing education, networking with a diverse
group of executive managed care
professionals and learn about the
latest available products and
services to utilize in your patient
population!
There will be an AAMCN Nurses
Pre-Conference focused on the
latest in managed care nursing on
Wednesday, November 9. Email
Patti Hulcher at
phulcher@aamcn.org or visit
www.aamcn.org for more
information.
- Require little supervision
- Facilitate the work of others
- Have unique skills and knowledge
- Without you, the company or your team would
suffer
- If you left for a top competitor, the company
could lose valuable information
- Dependable and reliable – attendance is excellent
If you want to attain the status of highly-valued employee, you need to set the pace, keep
your attitude positive and bring ideas to your
company that improve their bottom line or efficiency.
Richard Yadon, CPC, CERS is founder and CEO
of Health Career Professionals, LLC, a man2
aged care search, selection, and employee
retention firm, and frequent contributor and
speaker about health care employment issues. Find more career insights at
www.MyHealthCareerProfessionals.com
Corporate Corner
THANK YOU to our newest Corporate
Partner:
**SeniorBridge**
Actief Case Management, Inc.
www.actief-cm.com
CareSource
www.caresource-ohio.com/en/default.htm
CaridianBCT
www.caridianbct.com
Dexcom, Inc.
www.dexcom.com
Gilead Sciences, Inc.
www.gilead.com
Great Lakes Medical Supply
www.glmsupply.com
Health Career Professionals, LLC
www.HealthCareerProfessionals.com
Hill-Rom
www.hill-rom.com
Humana
www.humana.com
iScience Interventional
www.iscienceinterventional.com
iScreen Vision
www.iscreenvision.com
Landacorp, a SHPS Company
www.landacorp.com
Medtronic Xomed
www.xomed.com
Pritchett and Hull Associates, Inc
www.p-h.com
ResMed
www.resmed.com
Scrub Shopper
www.scrubshopper.com
SeniorBridge
www.seniorbridge.com
Sterling Medical Services
www.sterlingmedical.com
Tandem Diabetes Care
www.tandemdiabetes.com
The Scooter Store
www.thescooterstore.com/managedcare
Watermark Medical, Inc.
www.watermarkmedical.com
Yoh Healthcare
www.yoh.com
Don’t forget to check out our corporate
partners and their products and services!
Introducing BrightSky…A New Name to a Company You Already Know
by By Sean Mahone, President, Great Lakes Medical Supply, now part of BrightSky
Great Lakes Medical Supply will be changing duced every month; you can continue to visit
our name to BrightSky in November. Since BrightSky.com for fresh content. Upcoming
we started in 1995, Great Lakes Medical Sup- enhancements will allow users to wirelessly
ply has been a trusted name in diabetes man- upload their blood glucose values, and input
agement for managed care plans, but we are values such as medications, exercise, sleep
constantly faced with the incorrect assump- and mood. These values could then also be
tion that we can only provide services in the shared with the user’s friends and family,
Great Lakes region. BrightSky allows us to health care professionals, diabetes care team
take Great Lakes Medical Supply’s model and and even their health plan.
introduce it on a national scale. BrightSky is
committed to changing the game in the fight As a case management tool, the portal will
against the growing, costly epidemic of diabe- allow a whole new level of member health
tes. Our vision is to provide comprehensive, management. You can view member perforintegrated and patient-centered solutions that mance as an aggregate or you can drill-down
strip waste, cost and frustration from diabe- to focus on a particular member or
comorbidity. Your CFO or Medical Director
tes care.
may want to view and pull member data and
In Greek mythology, “dia” means “bright sky” costs differently than you as a case manager.
so it’s the perfect name to describe the inspi- With our portal, that’s allowed; it can be cusration, hope and positive outcomes that are tomized to the individual using it, not just the
the driving forces behind our company. While entire plan. And it’s not just the view that’ll
our name is changing, one thing isn’t – that’s set the portal apart for our health plans; partwho we are. Our customers, providers and ners also have access to our Clinical Reports
partnering health plans can continue to rely Library and proprietary analytics. Plans can
on our friendly staff, reliable shipment deliv- further utilize the portal to interface with their
eries and exceptional service – yesterday, to- providers, who have access to reports such as
gaps in care and pre-visit care plan.
day and in the future.
We are excited to launch our new online portal, BrightSky.com. It features free videos,
wellness tools, informative articles, recipes,
fitness tips and much more. And that’s just
the beginning. New features will be intro-
We are also excited to announce that we are
now a National Strategic Partner of the American Diabetes Association and a founding sponsor of their Living with Type 2 Diabetes program. This free, 12-month program offers
people living with diabetes the information and
support they need to start their journey with
diabetes and manage it throughout their lifetime. Enrollees receive information, healthy
recipes, tools and resources at timely intervals throughout the year and will also have
opportunities to find personal support in their
local communities or online. For more information on the Living with Type 2 Diabetes program, please visit diabetes.org/brightsky. To
learn more about Great Lakes Medical Supply, now part of BrightSky’s other educational
programs conducted by certified diabetes educators in the community or in provider’s offices, check out BrightSky.com. These
classes have been successful in helping to
promote further education at an ADA Recognized Education Program (hospital-based)
education program – 71% of attendees either
request to attend in-depth education or have
already attended.
It’s always been our goal to provide our health
plan partners the tools they need to better
manage their members with diabetes and control its costs. Whether it’s through new technology solutions, education or because we
simply provide great service to plans, providers and members, we want BrightSky to be
your total solutions diabetes provider. We’re
working to improve diabetes health, together.
Board of Directors Nomination Summaries
By Patti Hulcher
We have quite a selection of qualified candidates for the two available Board of Director
positions, available January 1, 2012, serving
a term until December 31, 2014! Below are
the summaries of each candidate’s qualifications and background information. The Board
of Directors are a direct representation of the
AAMCN membership – as a member, your responsibility is to ensure that all sectors within
managed care nursing are represented for a
well-rounded and diverse group to speak on
behalf of the membership. Please select the
two candidate(s) that you feel would best
serve AAMCN as a member of the Board of
https://
Directors
by
visiting:
www.surveymonkey.com/s/NDHNRFQ
www.surveymonkey.com/s/NDHNRFQ.
Rosalind Handy, RN, BSN, MS, CMCN
Ms. Handy brings 20 years of nursing experience to the table, with a wealth of knowledge
in adult, pediatric, geriatric and long-term care
services. Currently, Ms. Handy serves as the
Director of Healthcare Management Services
at the Houston branch of Amerigroup, where
she has worked for nearly seven years. Ms.
Handy has been instrumental serving on several long-term care adhoc committees, has
created and implemented operational guide-
lines and developed process improvement
strategies within the organization. An AAMCN
member for nearly four years, she secured
her CMCN in 2007 and in 2010, served on the
updating committee for the home study program study guide. Outside of her professional
accomplishments, Ms. Handy serves on the
Board of Directors at her local church, is the
President and Founder of “Tea for Soul,” an
outreach ministry for troubled women, and is
the President of the Culture Club, a community outreach organization that promotes culture and education through reading, planned
field trips and social functions for people of
all sexes and ages.
Trudy Peters, RN, MBA, CCRN-R, CCM, LHCA
With over 30 years working in the healthcare
industry, Ms. Peters has many years of experience in nursing and managed care, to include hands on and management experience
in Worker’s Compensation, Home Health,
Long-Term Care, Behavioral Health, Private
Duty, Hospice and Provider Services. Starting her career as an LPN, Ms. Peters completed her RN while working as a ‘float nurse’
and raising two children, and has since obtained a BS in Organizational Management,
and an MBA in both Health Care Management
and Organizational Management: Healthcare
Administration. Ms. Peters knew she wanted
to be a change agent, starting her entrepreneurial career by knocking on the doors of
large insurance agencies in OK, asking for
traumatic injuries, workers’ comp cases, etc,
that might need the specialized attention of a
Case Manager. In 1995, she started her own
business, which has grown over the past 17
years and is now Peters Agency Care Management, a faith-based for profit agency with
over 300 employees. The agency has received
the “Top 500 Elite” national status in 2009
and 2010, as rated by CMS, and Ms. Peters
was named “Business Woman of the Year” in
2010 by the National Association of Professional Women (NAPW).
Gloria Hayman, BA, RN, CMCN
Currently a Care Management Nurse Manager at Mercy Care Plan, Ms. Hayman has
more than thirty years of nursing experience,
with the last twenty years in managed care.
She has a diverse background in frontline
hospital clinical experience, utilization management, case management and leadership
roles. Her managed care career has spanned
from starting in a group module HMO to working in disease management programs, on-site
...continued on page 6
Congratulations New CMCNs!
Julie Augustine, RN, CMCN
Occupational Health & Safety Manager
Grinnell Mutual Reinsurance
Maisha Duty, LVN, CMCN
Care Manager
IEHP
Rebecca Markley, RN, BSN, CMCN
Inpatient Review Nurse Case Manager
IEHP
Tamia Banks, LPN, CMCN
Humana
Virginia Gallardo, LVN, CMCN
UM Nurse
IEHP
Cynthia Payne, RN, CMCN
XLHealth
Terry Benware, RN, CMCN
Anthem
Laurie Berg, RN, BS, CCM, CMCN
Humana
Susan Boss, RN, CCM, CMCN
HealthNet
Rebecca Fernald Carbone, RNm CMCN
Medical Management Senior
Anthem BCBS
Melanie Gould, RN, CMCN
Kathryn Gray, RN, CMCN
Director of Utilization Management
IEHP
Kimberly Harris, RN, BSN, CMCN
Sr Medical Management Nurse
Anthem
Marcia Hogue, RN, CMCN
Humana
Bernice Peters, LPN, CMCN
Humana
Deborah Roberts, RN, CMCN
Humana
Linda Robison, RN, CMCN
PCC
CareSource
Johnis Saczynski, RN, CMCN
IEHP
Cathy Hufford, RN, CMCN
HealthNet
Cindy Sanders, RN, PAHM, ADS, CMCN
Enterpose Precepter and Auditor
Anthem
Kathie Coker, LPN, CMCN
Humana
Mary Ann Irby-Gamble, RN, BSN, CMCN
HealthNet
Kathleen Stribrny, RN, BSN, CMCN
Triwest Healthcare Alliance
Irma Cortez, RN, CMCN
IEHP
Desha Jones, RN, BSN, CMCN
Utilization Management Nurse
HealthNet Federal Services
Teresa Thomas, LPN, CMCN
Humana
Lauri Castaneda, RN, CMCN
RN Care Manager
IEHP
Jacqueline Degarmo, RN, CMCN
UM Nurse Reviewer
Anthem BCBS
Kendra Draksler, RN, BSN, CCM, CPC, CMCN
Humana
Anne Kaufman, RN, CMCN
Family Health Network
Carolina Magdaleno, LVN, CMCN
IEHP
4
Eloisa Verceles, RN, CMCN
Case Manager
IEHP
Welcome New Members!
Elizabeth Barnett, BSN
Staff Vice President, Clinical Compliance
WellPoint
Fran Kelly, RN
Care Manager
HealthNet Federal Services
Naomi Blake, RN
Care Advocate/Utilization Manager
OptumHealth New Mexico
Derwin Kendall, RN, CNN
Kaiser Permanente
Amy Bolas, RN, BSN
Utilization Review, UMI
HealthNet Federal Services
Trisha Brisendine, RN, BSN, CCM
WellPoint
Christina Brown
Supervisor HCS
HealthNet Federal Services
Barbara Bucher, BSN, RN, PHN
High Risk Infant Coordinator
Kaiser Permanante of S CA Medical Group
Pamela D. Cessna, LPN
Capital BlueCross
Amy M. Cleveland, RN
Manager, Medical Management Operations
Centene Corporation
Sharon Cojocaru, RN
Utilization Management RNI
HealthNet Federal Services
Julie Kilfoyle
Care Manager II HealthNet Federal Services
Shirley Shumaker, RN
UM Manager
XI Health
Danielle Lagana
Carol Loftin, RN
HealthNet Federal Services
Betty Starr, BSN
Nurse Manager
Gateway Health Alliance
Lynnetta Loveland, RN, BSN
WellPoint
Jade Stone, LVN
Exceptional Home Health
Donna H. Mann, ADN, RN
Director of Operations
Dobson and Associates
Deborah Stubbs, RN, MS, CCM
Director, Managed Care Services
Summit Reinsurance Services, Inc.
Leisa Mattson, RN
Director UM/CM
SelectHealth
Nicole Y. Thomas, BSN
Utilization Management Nurse
XL Health
Barbara Mayo
Deborah Thomas, RN
HealthNet Federal Services
Edith J. McCall, RN
ADON
Golden Living
Paul K. Tooke, AAS, RN
UM/CM Specialist
Dobson and Associates
Catherine McElroy, RN
Robin DiNuova, RN
HealthNet Federal Services
Nina Shrestha, RN, BSN
Carefirst Bluecross Blueshield
Sandra J. Soper, BSN
Utilization Management Supervisor
MHS Indiana
Donna King, RN
VA
Angela Crafton, RN, OCN
Winifred Davis-Green, LVN
HealthSpring
Anita Seamster, LVN
Monarch Healthcare
ImeeJean McGrath, RN
Maury Meredith, RN
Patricia Turner
HCMS Manager
Amerigroup
Patricia A. Uldrich, RN
Sr. VP CNO
Saint James Mercy Hospital
Sheryl Dobson-Wainwright, RN, BSN
Owner
Dobson and Associates
LaTricia Norris, RN
Associate Vice President, Healthcare Mgmt.
Svcs.
Amerigroup Corporation
Cynthia Faubel, RN
Utilization Management Supervisor
HealthNet Federal Services
Toni Olin, RN, CCM
Manager, Healthcare Services
ODS Health
Laura Giglio, RN
UMRN1
HealthNet Federal Services
Renée Panec, RN
HealthNet Federal Services
Donna Weaver, RN, MS
Maryanne Parale, RN
Utilization Review Nurse
HealthNet Federal Services
Susan Werth, BSN, MS
Team Lead, Case Management
Amerigroup Community Care
Annelie Ginn
Manager, Care Management
HealthNet Federal Services
Pauline K. Peterson, RN
RN Consultant
Kimberly Hale, RN, BSN
PeaceHealth
Tiffany Philpot, BS, CCM, LHCA
Peters Agency Care Management
Connie Wiletzky, RN
Oncology/Genetics Service Line Director
Group Health Coorperative
Elizabeth Hix
Utilization Management
Anthem
Rasmia Rogong, RN, ADN
Healthcare Partners Medical Group
Elizabeth Gilmartin-Blake
Sheila Hooper, LNV
Universal American
Joyce Saigeon, RN
Utilization Management RN
HealthNet Federal Services
5
Sharon Vejvoda, RN, BSN
Mercy Hospital
Lee Ann Vitas, RN
Regional Vice President, Care Mgmt.
WellPoint
Carol Yates, BSN, RN
UM/CM Specialist
Dobson and Associates
Board of Director Nomination Summaries Cont.
...continued from page 4
and telephonic concurrent review, and post
discharge care coordination to reduce readmissions of Medicare Advantage members.
She has served members from commercial,
Medicaid, Medicare and other government
programs. An AAMCN member for seven years,
Ms. Hayman completed her CMCN certification in 2010 and is currently in a graduate
program for a Dual Masters in Nursing and
Business/Health Care Management, with an
expected completion in Fall of 2012. With
particular passion in healthcare finance legislation and the evolution of ACOs and Patient Centered Medical Homes, Ms. Hayman
feels that she can bring leadership,
mentorship, active participation in governance
and a diverse industry network to the AAMCN
Board of Directors. She see’s this as a role as
one of empowering nurses to use their voices
and expertise in improving the state of health of
this nation and promote the nursing profession.
Edith Boyer, MHCA, BSN, RN, CMCN
With over thirty-six years of nursing experience and more than eighteen years of those
in managed care, Ms. Boyer’s diverse background includes case management nursing
at managed care, hospital and community
settings, with roles that have spanned community health, federal regulation compliance,
administration, entrepreneurialship and nursing education. Her experience as a nurse
educator has ranged from being an adjunct
professor teaching Allied Health and Health
Services Administration courses, to a Certified Nurses Aide Train the Trainer and from a
Certified Third Degree Reiki Master in the Usui
System Reiki Natural Healing to a Licensed
Medical Missionary in the State of Michigan.
Additionally, Ms. Boyer has been a member of
AAMCN for 18 years, completing her CMCN
certification in 2000. Building upon her clinical and education background, Ms. Boyer
currently has her own consulting company,
E. Boyer Consulting, Inc, where she speaks at
medical education seminars in such areas
as stress reduction, visualization training,
case management and patient advocacy and
provides consulting in a variety of areas, including hospital and home care settings and
regulations.
Jean Bryan, RN, BSN, MBA
Ms. Bryan has over twenty-five years of nursing experience, including more than 15 years
of clinical and over 5 years within the managed care sector. Currently, Ms. Bryan is the
Quality Improvement Coordinator at
HealthCare USA, a Medicaid Managed Care
health plan, working with Disease and Care
Management staff to improve patient outcomes and access to care. Ms. Bryan performs NCQA and State-required health data
reports, chart reviews and audits, and is on a
policy and procedure committee, ensuring that
policies are accurate and up-to-date, meeting
the needs of individual departments, NCQA
guidelines and other requirements per state
contracts. Her role also includes working with
all departments to help staff understand how
activities and programs by managed care
plans and managed care nurses greatly and
positively impact their members. An AAMCN
member since 2005, Ms. Bryan is an active
participant on the COMI/Research Institute
within AAMCN and also a member of the
Lifestyle Institute Advisory Board, which is a
collaborative effort between AAMCN and
NAMCP to promote wellness, behavior and
lifestyle changes. With particular interest in
patient motivation, patient centered medical
home initiatives and nurse education on
healthcare reform and current trends, Ms.
Bryan’s interest in Board participation includes not only learning from others within
AAMCN, but also to be able to share her knowledge and experience.
Cheryl Slagle, RN, CMCN, CCM, CCP
Ms. Slagle has over twenty-five years of nursing and healthcare administration experience,
with thirteen years in managed care. Her background includes extensive training and experience in management, staff development,
and supervision and case management in
hospital, home care and managed care settings. Ms. Slagle has held several senior-level
management positions at managed care companies, serving Medicare, TriCare and Commercial members, and currently, Ms. Slagle
is the Vice President of Health Services at
CareSource, a non-for-profit public sector
HMO, serving members in Ohio and Michigan. Ms. Slagle has successfully developed
and implemented policies and processes in
accordance with Code of Federal Regulations,
URAC and state regulations and Administrative Code. Under her management, CareSource
Ohio achieved a 100% score in HSAG Medical
Management Audits, as well as a decreased
medical cost ratio (MCR). Ms. Slagle currently
serves on the Board of Directors for the 2011
year, replacing a Board Member who was unable to fulfill the remainder of her term, and
in 2009, she was named Managed Care Nurse
Leader of the Year by AAMCN. In addition, she
has been a champion for AAMCN, encouraging her organization to join corporately, implementing the CMCN into the career ladder and
having her entire staff become certified, and
currently chairs AAMCN’s Leadership Institute.
Stefany Almaden, RN, PhDc, MS, CCM, CPUM, CMCN
Working in the healthcare industry for over
twenty years, Ms. Almaden brings more than
15 years of Care Management experience in
a variety of settings, including managed care,
IPAs/Medical groups, hospitals/hospital sys6
tems and academia. Her diverse experience
has led to Ms. Almaden’s extensive knowledge
in a multitude of areas, such as: legislative
updates, regulatory and accreditation standards (NCQA, JCAHO, CMS, QIO, DMHC, DHHS,
DOI); Utilization/Medical Management (UM),
Care Management (CM), Quality Management
(QM), Appeals and Grievances and Medicare
severity reimbursements (CDI). After years of
successful senior management positions,
Ms. Almaden decided to further utilize her
expertise by starting her own consulting company in 2005, The Almaden Group, doing consulting and interim management contracts
for Care Management/Care Coordination, Discharge Planning & Social Work Operations,
as well as Documentation Improvement Initiatives & RAC Audits’Prep. She has been a
speaker at several nationally recognized conferences and a published author in several
Case Management Journals, as well as a contributing author to the Nurses’ Notes Newsletter. Ms. Almaden serves as an Adjunct faculty at the University of Phoenix and Cal State
LA, has guest lectured at several universities,
and is currently a Doctoral Candidate in Health
Services: Health Management and Policy Specialization. In addition to her career accomplishments, Ms. Almaden is also a past member of the AAMCN Board of Directors, Chair of
the Care and Outcomes Management Institute (COMI) and has been a CMCN since 2005.
Sheryl Riley, RN, OCN, CMCN
With more than twenty-five years of nursing
experience, twenty of those in managed care,
Ms. Riley has an extensive professional background which includes: operations, marketing and sales, EHR/EMR/Technology, Chronic
and Oncology care management program development, policies and procedures, business
and strategic market development as well as
implmentation and opening of new markets
and products. After years of senior-level management positions, Ms. Riley decided to use
her expertise in a consulting capacity and is
currently the Managing Partner of Clarion,
LLC. Ms. Riley has been an active AAMCN
member for 15 years, serving as the past President and previous Board member, Co-Chair of
the Research Institute, Co-Chair of the COMI,
member of the Lifestyle Institute Advisory
Board, a Mentor in the Mentoring program
and moderates sessions at the Spring and
Fall Managed Care Forums. She is a published
author in many publications, including the
Nurses’ Notes Newsletter, and has been a
speaker at several nationally recognization
conferences, which includes those held by
AAMCN and it’s affiliates. Outside of her
professional development, Ms. Riley works as
a member of the Parish Nurses, volunteers
for flu and blood pressure clinics, officiates
for three sports (hockey, basketball & lacrosse)
and works with the local animal rescue.