Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

Kim Tagg

Kansas City,Missouri

Summary

Dedicated Nurse Leader committed to meeting the members and patients where they are while improving health outcomes through affordable means. Lifelong learner, possessing a Master’s in Business Administration and a Master’s in Science of Nursing. Registered Nurse with 15 years of progressive and diverse experience in healthcare. Skilled in providing leadership to high functioning nursing teams including utilization management nurses, complex care managers, oncology nurse navigators, and high-cost claimant nurses with focus on case management, utilization review, non-clinical customer support team, cost containment, quality improvements, discharge planning, community health, leading through change, and emotional intelligence. Extensive knowledge of commercial insurance guidelines and regulations. Good understanding of Medicare and Medicaid guidelines and regulations. Patient care nursing focused on oncology, compassionate hospice care, palliative care, home health, and preventative-wellness care. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success. Dedicated Nurse professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.

Overview

15
15
years of professional experience

Work History

Director, Utilization Management

Blue Cross And Blue Shield Of Kansas City
02.2018 - Current
  • Oversight of staff of 60+ RN’s and 20+ non-clinical staff
  • Responsible for all lines of business (Commercial, FEP, JAA (Unions), Medicare Advantage, QHP IFP)
  • Established and implemented goals, metrics, and KPI’s
  • SME in effective use of MCG clinical guidelines and interpretation of guideline analytics
  • Implemented diagnosis specific programs from inception to production (oncology and NICU) that resulted in multi-million-dollar savings
  • Implementation of musculoskeletal pain management program and site of service affirmation
  • Thoughtful thinker while identifying needs of the business
  • Responsible for hiring of leaders, re-design of workflows, performance evaluations, disciplinary actions, and mentoring
  • Acted as a financial steward while figuring and maintaining budget for UM department
  • Ownership and oversight of multiple vendor partnerships
  • Worked directly with Medical Director SME’s as well as department SVP, and DVP
  • Ownership for NCQA utilization management re-accreditation, quality monitoring, gaps in care improvement, and ongoing audits Re-wrote and implemented improved policies and procedures
  • Responsible for origination of digital partner from inception through production
  • Advocate for continued education and unique learning opportunities for staff
  • Participate in product development activities such as assisting in evaluation of design and reviewing QA and leading UAT/deployment efforts
  • Ownership of multiple concurrent development projects over the full project lifecycle
  • Leading through change advocate
  • Appointed “Change Champion” for population health division 2020 and 2021
  • Lead population health team through implementation of new platform from inception to production utilizing change principles
  • Optimized UM workflows while providing ideas and support for automation
  • Utilized Lean Six Sigma Principles to identify inefficiencies, improve processes, and remove bottlenecks
  • Analyzed, researched, and implemented new staffing models that resulted in better member support, higher employee satisfaction, while acting as a financial steward
  • Intense collaboration with operations, provider relations, sales and customer experience to optimize business outcomes, mission, and values

Registered Nurse

University Of Kansas Health System
07.2009 - Current
  • Possessing vast experience in providing nursing care to patients and advocating patient’s rights
  • Ability to work with patients, taking his/her medical records and coordinating with physician on safe discharge plans
  • Utilization management and review utilizing Interqual
  • Excellent interpersonal skills, problem solving skills and maintaining good rapport with patients, family members, physicians, and referral sources

Registered Nurse

Kansas City Hospice, Care
06.2014 - 09.2017
  • Admissions and Case Management, Oncology, Act as patient advocate and implement total patient care initiation through a team nursing process
  • Post and pre chemo patient care, PICC/central line care, support for chemo side effects, wound management and dressing changes
  • Post operative and post chemotherapy assessment and interventions

Floor RN

The University of Kanas Health System
07.2009 - 05.2016
  • High risk obstetrics, medical-surgical, cystic fibrosis, and float

Education

Master of Business Administration - Health Care Administration

University of Phoenix
Kansas City, MO

Master of Science - Nursing

University of Phoenix
Kansas City, MO

Bachelor of Science - Nursing

Avila University
Kansas City, MO

Skills

  • Designs and implements quality and operational improvement strategies
  • Excellent attention to detail
  • Superior Collaboration skills utilizing open and effective communication
  • Strategic Planning
  • Operations Management
  • Organizational Development
  • Budget Management
  • Contract and Vendor Management

Additional Information

  • Licenses, Certifications, and Accomplishments ,
  • Registered Nurse (Multi State)
  • Healthcare: Lean Six Sigma Black Belt Certified – 2020
  • Rising Trendsetter nominee in STEMMy -2021
  • Change Champion Award 2020 and 2021

Timeline

Director, Utilization Management

Blue Cross And Blue Shield Of Kansas City
02.2018 - Current

Registered Nurse

Kansas City Hospice, Care
06.2014 - 09.2017

Registered Nurse

University Of Kansas Health System
07.2009 - Current

Floor RN

The University of Kanas Health System
07.2009 - 05.2016

Master of Business Administration - Health Care Administration

University of Phoenix

Master of Science - Nursing

University of Phoenix

Bachelor of Science - Nursing

Avila University
Kim Tagg