Patricia Horvath

About Patricia Horvath

Varied experience in Utilization Mgmt, Case Mgmt, Medical Mgmt Team Lead, Sr. Clinical Trainer Specialist, Manager of Case Management and Clinical Program Consultant-Medicaid Business. Resourceful, organized, detail oriented and a hands on team player able to provide individual case mgmt services to our members and group accounts base on their needs/expectations. Can manage diverse projects simultaneously and with excellent communication skills. Effective at building relationships with group accounts, employees and managers at all levels within an organization to support the business strategy, core values, resolve communications issues and motivate individuals to optimal performance. Conscientious and resourceful advisor with a reputation for sound judgment and achieving positive results.Specialties:> Thirty plus years of diversified:* Managed Care / WellPoint* Management and Director positions in Home Health Care* Interim Director of New York State Medicaid Managed Long Term Care (MLTC)* Quality Evaluator,Clinical Quality Assurance *Community Liaison*Medical Consultant *Nursing expertise -Medical/Surg, Nursing Home / Long Term Care, OR, ER,Oncology,HHC,Hospice,Peds, ICU, Community Liaison, & CCU*Developed strategic plans and developing/delivering on operational and quantitative data.*Contract negotiations and cost containment*Preceptor/Trainer*Statistical analysis and QM/QI reporting.

Experience

1. Quality Evaluator

   Anthem, Inc

   May 2013 — Present · US

   Responsible for participating in Clinical Quality Management activities that ensure programs meet accreditation and regulatory standards. Primary duties include team audits, prepare corrective action plans in response to oversight request, conduct audits of QM processes and files, writes Policies & Procedures, and assist with Provider Manuals, Audit Tools and guidelines. Responsible for specific QM processes, functions (i.e. Compliance, Grievances/Appeals or HEDIS and/or QI Projects). Develop and improve departmental processes and operations. Monitor goals, performances, and processes. Assist with issues of non-compliance. Mentor and coach staff. Train new associates and re-train current associate. Serve as a resource and SME.

Education

• Certifications

  Certified Case Manager, CMSA Case Management

• DANVILLE MEMORIAL SCHOOL OF NURSING

  RN Diploma, Nursing

  1977 — 1978

• JOHN TYLER COLLEGE

  RN ASN, Nursing

  1986 — 1988

• DANVILLE COMMUNITY COLLEGE

  Liscened Practical Nurse(LPN), Nursing

• OLD DOMINION UNIVERSITY

  Graduate Certificate, Health -Care Management / Administration

• ROCKINGHAM COMMUNITY COLLEGE

  EMT, EMS

Skills

• Long Term Care
• Organizational Excellence
• Quality of Care
• Continuous Improvement
• Home Care
• Medicaid
• Healthcare Management
• Case Managment
• Visio
• Medicaid Managed Care
• Inpatient
• Foot
• Disease Management
• Operating Room
• Nursing
• Associate Performance Evaluations
• Health Insurance
• Managed Care
• Healthcare
• Medical/Surgical
• Hospice
• Hipaa
• Mentoring
• Managing Others
• Utilization Management
• Clinical Expertise
• Medical Management
• Management
• Durable Medical Equipment
• Certified Case Manager
• Care Management
• Nursing Administration
• Clinical Research
• Medicare
• Provider Relations
• Nursing Homes
• Time Management
• Associate Coaching Skills
• Operational Excellence
• National Accounts