Interested in program development and AI useage
FRANCES Li
Registered Nurse
Ontario,CA
Summary
Proven track record demonstrates leadership and effective planning skills, always striving to reduce utilization costs by identifying cost-saving measures, while maintaining the best outcomes for the population served
Professional with robust background in directing and managing large-scale operations, consistently driving success through strategic planning and execution. Adept at implementing innovative solutions that enhance productivity and operational effectiveness. Known for fostering teamwork and adapting to evolving business needs, ensuring alignment with organizational goals.
Overview
16
16
years of professional experience
2
2
Certifications
3
3
Languages
Work History
Director of Utilization Management & Complex Case Management
AbsoluteCare
Columbus, OH
10.2022 - Current
Oversaw 100% of nursing services including staffing, training and quality assurance within the utilization and case management department
- Implemented evidence-based practices and protocols to improve patient outcomes and safety with 92% compliance
- Collaborated with interdisciplinary teams to develop comprehensive care plans for patients updates on best practices and performance expectations to create positive, cost-effective outcomes
- Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
Vice President of Special Projects/Clinical Services/UM/CM/Delegation Oversight Ten Years
Heritage Provider Network /Lakeside Medical
Northridge , California
12.2009 - 06.2025
- Director of Special Projects/Clinical Services/UM/CM/Delegation Oversight six years
- Demonstrated positive outcomes for 97% of audits for UM and Complex Case Management, Ambulatory Case Management, and Special Needs Program to meet the State and Federal guidelines for HMO business
- Lead all HPN Corporate UM/QM meetings for ten years and Lakeside for six years
- Participate in all aspects of Utilization Management Education for Nursing and Ancillary Staff with inter-rater reliability passing at 92%
- Interact directly with groups, health plans, and members to maintain good UM/QM partnerships
Education
Associate of Science - Science of Nursing
Compton College
Compton, CA06.2020
Associate of Science - Human Biology
National University
Ontario, CA09.2019
Skills
- Project management
- Communication
Operations management
Problem-solving
Team management
Project coordination
Case management
Resource utilization
Staff management
Recruitment
Healthcare regulations
Quality improvement
Certification
CM - Certified Manager Certification
Interests
Timeline
Director of Utilization Management & Complex Case Management
AbsoluteCare
10.2022 - Current
Vice President of Special Projects/Clinical Services/UM/CM/Delegation Oversight Ten Years
Heritage Provider Network /Lakeside Medical
12.2009 - 06.2025
Associate of Science - Science of Nursing
Compton College
Associate of Science - Human Biology
National University