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Wilbert ACHE

Director, Healthcare Services/Utilization Management

Director, Healthcare Services/Medical Management - Clinical Review at Premera Blue Cross

Greater Seattle Area

Section title

Wilbert ACHE's Email Addresses & Phone Numbers

Wilbert ACHE's Work Experience

Molina Healthcare

Director, Healthcare Services/Utilization Management

October 2013 to Present

Gentiva Health Services

Branch Director

April 2012 to October 2013

Bellevue, WA

Swedish Medical Center

Manager, Patient Access and Referral/Business Development

January 2011 to April 2012

Wilbert ACHE's Education

Seattle Pacific University

Master's of Science in Nursing Administration

2008 to 2010

University of San Carlos

Nursing Bachelor's of Science in Nursing

1989 to 1994

About Wilbert ACHE's Current Company

Molina Healthcare

About Wilbert ACHE

📖 Summary

Professional Achievements: • Creator of Community Health Plan of Washington’s Durable Medical Equipment Procedural Manual and Formulary (1998) • Co-developer of the Charge Nurse Leadership Program for Group Health in Seattle (2010) • Co-creator of the staffing model at Group Health Cooperative Extended Observation Stay Unit in Seattle (2010) • 2012 Gentiva Recipient of Shared Vision Award - Improved EBITDA/BottomlineDirector, Healthcare Services/Utilization Management @ From October 2013 to Present (2 years 3 months) Branch Director @ From April 2012 to October 2013 (1 year 7 months) Bellevue, WAManager, Patient Access and Referral/Business Development @ •Daily management and organization related to client services, admission, and referral operations from the point of identification of a prospective patient through the referral process. This is to include timely outsourcing, scheduling, and communication of assignments •Ensure productivity according to best practice and department standards are met by partnering with clinical managers and supervisors, client service representatives, schedulers, referral staff, and other staff as appropriate. •Business development by marketing the agency to referral sources (i.e. hospitals, SNFs, AFH, ALF, etc.) •Involved in creating strategies as we transitioned business to a more profitable outcome •Developed departmental process/workflow in admission and referral operational efficiency •Work closely with quality department to ensure best practice and guidelines are met •Led in the re-structure and position elimination for workflow/process improvement. •Departmental fiscal budget oversight. Has shown excellent monthly savings of up to 18% •Process improvement oversight within the department showing immediate excellent results in workflow within a short period of time. •Process improvement showing immediate decrease of overtime usage of up to 83% in a short period of time. •Intradepartmental partnership for improvement and success of the agency •Coached and worked with staff on simplified process for workflow improvement •Oversight of 30 staff on a daily basis to include process monitoring and disciplinary action •Oversight of the Synagis program. Recognizing it’s financial disadvantage from previous year, presented business report and successfully closed program •Staff mentoring for skills development and improvement •Utilized McKesson, EPIC, Allscripts Systems From January 2011 to April 2012 (1 year 4 months) RN Care Manager @ • Provide expert clinical case management, patient care management, utilization/clinical review, retrospective review, cost containment/savings, utilization of M&R and Interqual criteria, and d/c planning. • Expert analyst of patient's clinical information and making recommendations for appropriateness of care. • Expert in complex clinical case management, organizer and facilitator of patient care. • Highly skilled in organization, problem solving, and planning of complex medical and d/c planning cases in a unit with a more challenging under-served population. • Preceptor to new care manager staff. • Lead daily patient care rounding primarily in cardiac/telemetry and stroke units with the mid level practitioners, charge RN, social workers, pharmacist, chaplain, staff RN in order to provide directions/strategic nursing care plan thereby promoting the movement of the patient through the system appropriately until discharge. • Assure financial integrity of the organization by decreasing waste, providing insurance updates and concurrent appeals and by monitoring over and under utilization. • Coordinates with physicians and mid-level practitioners to assure appropriate clinical documentation supporting the assigned DRG. • Involved in several committees more specifically on patient flow/throughput as flow through the acute care setting is important. Total throughput of patients should be maintained or increased as patients are able to be placed more appropriately, moved more quickly, and discharged in a timely fashion. • Individually partnered with the Adult Hospitalist Team for daily patient care rounding to determine treatment and disposition plans of patients thereby promoting the movement of the patient through the system. • Directly involved in the re-organization of case management department. • As an ongoing process, assess patients daily to insure the right care is delivered at the right time by identifying delays and removing barriers. From May 2002 to February 2011 (8 years 10 months) RN Burns Unit: ICU - Pediatric/Adult @ • Supervised of up to 30 – 40 staff on a daily basis. • Expert in complex treatment of Mild to Severe Burns patients in medical and critical care units serving both Adults and Pediatrics. • Organized unit staffing schedule From December 1998 to May 2004 (5 years 6 months) RN Case Manager @ • Case Management for products: BHP, Health Options, PEBB, ChiP under Dennis Braddock management (DSHS secretary) • Garnered productivity savings of $1.5 to 2 million dollars per year totaling $5-6 million dollars prior to getting laid off. • Created the Durable Medical Equipment procedural manual for the company. • Case Management/Pre-authorization for medical/surgical procedures • Performs review, screenings and claims/pharmacy data analysis for Medicare patients from various sources such as phone interviews, HRA screening review, medical/pharmacy record reviews; outreach to primary care and specialty care providers, review of inpatient admission notes. • Triages patients to level 1 2 or 3 case management following Care Management policies and procedures. • Completes assessments and development of a comprehensive treatment/care plan (in conjunction with a Case Manager if in level 3 case management.). • Integrates and coordinates the services provided in the primary care and specialty care arenas Integrates current best practice guidelines related to acute and chronic disease management. Insurance case management for Basic Health Plan, Healthy Options, PEBB, and CHiP. Liaison to hospitals. From December 1998 to April 2002 (3 years 5 months) Research RN @ • Research Nurse - involved in an investigative research regarding Chronic Fatigue Syndrome on Human Twins. From April 1996 to December 1998 (2 years 9 months) Nurse Manager/Supervisor/Staff Development Coordinator/CNA Class intructor @ From September 1992 to December 1998 (6 years 4 months) Master's of Science in Nursing, Administration @ Seattle Pacific University From 2008 to 2010 Nursing, Bachelor's of Science in Nursing @ University of San Carlos From 1989 to 1994 Wilbert ACHE is skilled in: Case Management, Utilization Management, Strategic Planning, Healthcare, Clinical, Home Care, Acute Care, Insurance, Access, Nursing, Health, Hospitals, Critical Care, Healthcare IT, Healthcare Management


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Frequently Asked Questions about Wilbert ACHE

What company does Wilbert ACHE work for?

Wilbert ACHE works for Molina Healthcare


What is Wilbert ACHE's role at Molina Healthcare?

Wilbert ACHE is Director, Healthcare Services/Utilization Management


What is Wilbert ACHE's personal email address?

Wilbert ACHE's personal email addresses are not available


What is Wilbert ACHE's business email address?

Wilbert ACHE's business email address is w****[email protected]


What is Wilbert ACHE's Phone Number?

Wilbert ACHE's phone (**) *** *** 332


What industry does Wilbert ACHE work in?

Wilbert ACHE works in the Insurance industry.


Who are Wilbert ACHE's colleagues?

Wilbert ACHE's colleagues are Tim McMichael, John TDD, Derek Dietrich-Muller, Pallavi Sathe, Max Brumfiel, Max Lungu, Skyler Mahjoubian, Taushka Donovan, LeAnne Harrington, and Ron Ruiz


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In a nutshell

Wilbert ACHE's Personality Type

Extraversion (E), Intuition (N), Feeling (F), Judging (J)

Average Tenure

4 year(s), 0 month(s)

Wilbert ACHE's Willingness to Change Jobs

Unlikely

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