Shannon Stone Tucker
Huger
Summary
Accomplished Quality Assurance Professional with a proven track record at Humana, enhancing health outcomes through meticulous internal audits and fostering strong relationships. Expert in regulatory compliance and team leadership, demonstrated by leading audit tool development and achieving high-quality scores. Recognized for excellence with three Humana Star Awards.
Overview
18
18
years of professional experience
Work History
Quality Assurance Professional 2
Humana
08.2021 - Current
- Evaluate Associates who directly support our members to help them maximize positive health outcomes
- Audited for ECOM and SNP Programs
- Assisted in Development of Comprehensive Audit tool
- Involved in Post Discharge Focused Group and in creation of resource guides for CMs
- Teach New Hires by presenting an overview of Quality
- Taught new Hires and had CMs shadow for further understanding of Auditing Process
- Involved in CMSA audits
- Nurse Ambassador
- Involved in NRG
HCM-RN
Humana
09.2015 - 08.2021
- Worked as a CM for HAH as well as Transition Program
- Worked in SNP CM Overtime Project
- SME for team regarding CICO Process
- Involved Member of Humana's Leadership and Development Committee
- Three time recipient of Humana's Star Award
- High Quality Audit Scores
- Exceeding expectation in all areas on Associate Score Card
- Participated in ongoing professional development opportunities to stay current with industry trends and best practices within the field of telephonic case management.
- Provided education on disease processes, medications, and self-care techniques for patients and their families, empowering them to take charge of their health.
- Conducted ongoing evaluations of patients'' medical conditions and needs, advocating for appropriate resources when required.
Telephonic Case Manager
AmeriHealth Caritas
02.2015 - 09.2015
- Exceeded performance metrics consistently by managing caseloads effectively while prioritizing high-risk cases that required immediate attention.
- Participated in ongoing professional development opportunities to stay current with industry trends and best practices within the field of telephonic case management.
- Provided education on disease processes, medications, and self-care techniques for patients and their families, empowering them to take charge of their health.
- Conducted ongoing evaluations of patients'' medical conditions and needs, advocating for appropriate resources when required.
- Managed Case load of 110 Members
Care Transitions Coordinator
Amedisys
06.2011 - 02.2015
- Promoted a culture of collaboration by fostering open communication among all stakeholders involved in the care transitions process.
- Streamlined communication between healthcare providers, ensuring accurate and timely information exchange for improved patient care.
- Reduced readmission rates by identifying high-risk patients and providing targeted interventions.
- Coordinated post discharge home health and hospice services
Registered Nurse Case Manager
Medical University Of South Carolina
08.2006 - 06.2011
- Evaluated patient progress and adjusted care plans accordingly, ensuring continuity of care across all healthcare settings.
- Collaborated with physicians and other healthcare providers to ensure appropriate resource utilization for complex cases.
- Provided education and support to patients and families, empowering them to make informed decisions regarding their healthcare needs.
- Created orientation for new Case Manager hires.
- Involved in interviewing process for new hires.
- Assisted in Joint Commission on Accreditation of Healthcare Stroke Certification
Education
Master of Science - Nursing Administration
Medical University of South Carolina
Charleston, SC06.2005
Bachelor of Science - Nursing
Auburn University
Auburn, AL06.2000
Associate of Science - Nursing
Southern Union State Community College
Wadley, AL06.1998
Skills
- Internal Audits
- Detail Oriented
- Relationship Building
- Decision-Making
- Team Leadership
- Team Collaboration
- Problem-solving skills
- Collaboration and communication
- Documentation And Reporting
- Data Analysis
- Quality improvements
- Quality Assurance
- Regulatory Compliance
Timeline
Quality Assurance Professional 2
Humana
08.2021 - Current
HCM-RN
Humana
09.2015 - 08.2021
Telephonic Case Manager
AmeriHealth Caritas
02.2015 - 09.2015
Care Transitions Coordinator
Amedisys
06.2011 - 02.2015
Registered Nurse Case Manager
Medical University Of South Carolina
08.2006 - 06.2011
Master of Science - Nursing Administration
Medical University of South Carolina
Bachelor of Science - Nursing
Auburn University
Associate of Science - Nursing
Southern Union State Community College
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