Adele Ball, M.S.N., R.N.

(C) 760-402-8990

msadele@yahoo.com

Accomplished masters prepared nurse, experienced in acute and

ambulatory care, managed care, telework, quality, accreditation,
and health plan environments, seeks a leadership position within
an innovative organization that will afford professional growth.
CORE COMPETENCIES

Quality Management
Change Management
Remote Workforce Management
Operations
Program Development and
Implementation

Disease and Case Management

Accreditation and Compliance
Medical Data Analysis
Strategic Planning
Coaching/Mentoring

PROFESSIONAL EXPERIENCE
HEALTHNET, WOODLAND HILLS, CA
July 2014 to Dec 2014 -High Risk Case Manager
AMERISOURCE BERGEN, LASH GROUP, Frisco, Texas
October, 2013 to Feb, 2014- TeleHealth Educator
Completed and credentialed for Genzyme Lemtrada team
HEALTHWAYS, Nashville, Tennessee
2002-2011
Senior Director, Care Management Operations, High Risk
Provide daily operational direction to a community of 200+
nurses, psychologist, social workers and nurse practitioners
working remotely from home to provide telephonic disease and
case management services to patient / member populations for
clients nationwide. Function as the subject expert for High Risk
Care Management division within the enterprise. Coordinate work
and maintain quality and efficiency of the High Risk division
within four business units across the country to assure NCQA
standards are met. Identify data needs and facilitate the
collection and analysis of the data to demonstrate outcomes and
productivity.

Functioned as a program manager to ensure successful and

timely implementation of multiple new contracts.

Achieved elevated ratings on the annual quality audit

performed by key client, achieving greater than 95% in all
areas
Facilitated successful achievement of NCQA accreditation
for targeted contracts.
Led efforts to achieve URAC accreditation for High Risk
Unit.
Coordinated with IT to ensure a seamless transfer of
division operations onto new software platform.
Facilitated cross training that allowed high risk care
management staff working from home to support disease
management call campaigns for call centers nationwide.

RADYS CHILDRENS HOSPITAL AND HEALTH CENTER,

San Diego, California

2000-2002

Team Leader, Quality and Case Management

Held responsibility for the oversight of the Case Management and
Utilization Management departments. Formulated and communicated
case management plans that efficiently utilized health care
services towards optimum outcomes in the safest, most cost
effective manner. Developed, implemented and coordinated acute
and ambulatory quality improvement programs.
Collaborated with
medical leadership to provide quality monitoring of medical
staff practices to assure quality and accreditation standards
were met. Interfaced with outside agencies and provided dispute
resolution through written communications.

Led business process re-engineering, including the development

of
revised
process
flows,
procedure
documentation
and
functionality. Developed content integration as it relates to
the implementation of new clinical applications
Assessed organizational needs in the area of clinical
informatics and proposed strategies to meet those needs
Demonstrated expertise in examining errors and identifying
root cause

SCRIPPSHEALTH, San Diego, California

1998-2000

Director, Systemwide accreditation, Licensure and Risk

Management
Internal consultant for matters relating to both state and
federal healthcare regulation and Joint Commission standards.

Provided leadership and coordination of performance improvement

and risk management functions for healthcare system.

Orchestrated and developed processes for ongoing education of

licensure and accreditation standards for improved employee
performance
Collaborated with Vice President of Outcomes Management to
develop system wide performance improvement plan
Educated, coordinated and directed systemwide efforts for
successful '99 survey process which encompassed six acute care
hospitals, two skilled nursing facilities and a home health
agency
Prearranged
and
implemented
systemwide
work
team
to
successfully respond to HCFA validation survey
Planned,
ordered
and
coordinated
the
systemwide
Risk
Management program and acted as the Risk Management consultant
to system Biomedical Safety Committee
Coordinated systemwide risk management education programs in
collaboration with corporate legal department
Acted both as a resource and a coordinator to standardize the
risk control efforts throughout the system
Assessed compliance with applicable standards and developed
plan of action for identified areas of non-compliance, playing
a key role in JCAHO validation surveys

EDUCATION
M.S.N. Healthcare Systems Administration, University of San
Diego, San Diego, California
Bachelor of Science in Nursing, University of San Diego, San
Diego, California