This document provides a summary of Carolyn Isaacson's background and experience. She has over 23 years of experience in healthcare, including leadership roles as Director of Nursing and Manager of Clinical Services. Currently, she is the Director of Quality and Compliance Management at Altus ACE, where she is building the infrastructure for quality and compliance. Previously she held national roles at UnitedHealthcare managing clinical adherence programs. She has extensive experience in quality monitoring, ensuring regulatory compliance, and training and developing staff.

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CAROLYN M. ISAACSON
4227 N. Webber Dr.
Pearland, TX 77584
713-385-4828
carolynisaacson@gmail.com
SUMMARY Registered Nurse seeks a challenging position in a quality-focused environment and offers
background of clinical and technical skills, with the following highlights:
 Leadership record as Director of Nursing and Manager of Clinical Services for multiple
healthcare organizations.
 Over 23 years in supervisory and staff positions in the healthcare arena, with a record of
performing effectively under time and budget constraints.
 Track record of successful coordination of projects and schedules with Managers and co-
workers at all levels of an organization.
 In-depth involvement in administering QA initiatives related to patient care and
JCAHO/Medicare/Medicaid surveys.
 Experienced in adult learning techniques and the authorship of materials used to assist
with change management and process standardization at all levels of hospital organization.
 Multiple Microsoft Certifications (MCSE, Novell CNA 5.0, A+) certifications; hands-on
experience with managing and testing application environments used for training delivery.
EDUCATION Aug 1989 – Aug 1991
Bachelor of Science in Nursing, University of Texas Health Science Center, Houston, TX
Licensed Registered Nurse, State of Texas
May 2000 – Nov 2000
Advanced Computer Education Center, School of Engineering and Applied Sciences,
Southern Methodist University, Houston, TX
 6/2000 – A+ Certificate
 11/2000 – Microsoft Certified Professional

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EXPERIENCE
01/16-Present Altus ACE – Accountable Care Entity (startup branch of the Altus Health System)
Director of Quality and Compliance Management
I am creating the infrastructure for both Quality and Compliance which will serve as oversight for all of
Altus ACE departments
 Quality and Compliance Infrastructure build are based on Medicare and Medicaid contract
requirements, federal and state regulations within the:
o Policies and Procedures
o Standard Operating Procedures
o Work Flows
o Committees
o Charters
o Bylaws
 Reports/metrics are created also based on Medicare/Medicaid, federal and state requirements and
HEDIS
 Audit tools created for all departments (Clinical Operations, IT, Network, Claims/Billing, Utilization
Review/Utilization Management)
 Quality Lead – for Altruista Implementation (Electronic Health System), creating and guiding the
Altruista team in creating HEDIS/STAR reports within the electronic system.
 Review vendor contract to ensure compliance with Medicare/Medicaid requirements, federal and
state regulations.
07/15-01/16 UnitedHealthcare - United Clinical Services/Business Standardization and Advancement
National Clinical Adherence Consultant (title change due to re-organization)
Manages State Adherence Programs for:
o Arizona
o Kansas
o NY
o Texas
 Ensures clinical processes, policies and procedures meet regulatory standards and are consistent
with Medicare/Medicaid State and Federal guidelines and national policies.
 Administers clinical quality monitoring and oversight of clinical programs/staff to meet defined
goals and contract requirements.
o As the subject matter expert (SME), collaborated with IT-Business Intelligence to
create and/or revise adherence reports generated from various databases and CareOne
(electronic documentation system) for the external and internal scorecard metrics to
measure health plan performance and compliance.
o Required improvement action plan from stakeholders if scorecard metric results are
below set goals (quantitative audit) and opportunities cited during a qualitative audit
(member charts – end to end process audit).
 Scorecard Reports and Metrics
 Clinical Assessment Completion Timelines
 Notice of Action Letters– Denial of Services
 Fair Hearing
 Appeal & Grievance
 Staff Competencies
 Staff Capacity
 Instrumental in ensuring health plan compliance as evidenced by the
improvement of the monthly scorecard metric results and corrections of
opportunities cited in the end-to-end process audit.
 This was accomplished by guiding and instructing nursing management in
improving standard operating procedures (identify process gaps),
workflows and assist management in creating staff clinical audit tools.
 Collaborates with cross-functional teams, IT-Business Intelligence, and health plan management
to provide contractual oversight of health services departments with the objective of ensuring

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contractual obligations and policies are met for members in a range of products, i.e., Medicaid,
SSI/ABD, long term care, and dually eligible categories (Medicare/Medicaid), improving cost
efficiencies, and developing an environment of operational excellence.
 Communicate and guide Clinical/Medical and Business Executive leadership best practices,
barriers and potential solutions when operational processes or clinical programs are not
delivering results.
 Miscellaneous Experience:
o SharePoint
 Created a Project Site
 Created an Intake Site
 Created a Change Control and Approval Site
o Intermediate to advance proficiency with Microsoft Office Suite (Excel, Word,
PowerPoint, Visio)
10/12-07/15 UnitedHealthcare - Innovative Clinical Solutions
National Manager of Clinical Adherence
 Supervises team of Clinical Adherence consultants in execution and delivery of Clinical
Adherence Program for various health plans located in several states.
o Kansas
o Texas
o Delaware
o Massachusetts
o New York
o Arizona
 Ensures clinical processes, policies and procedures meet regulatory standards and are consistent
with Medicare/Medicaid State and Federal guidelines and national policies.
 Administers clinical quality monitoring and oversight of clinical programs/staff to meet defined
goals and contract requirements.
o As the subject matter expert (SME), collaborated with IT-Business Intelligence to
create and/or revise adherence reports generated from various databases and CareOne
(electronic documentation system) for the external and internal scorecard metrics to
measure health plan performance and compliance.
o Required improvement action plan from stakeholders if scorecard metric results are
below set goals (quantitative audit) and opportunities cited during a qualitative audit
(member charts – end to end process audit).
 Scorecard Reports and Metrics
 Clinical Assessments Timelines
 Notice of Action Letters– Denial of Services
 Fair Hearing
 Appeal & Grievance
 Staff Competencies
 Staff Capacity
 Instrumental in ensuring health plan compliance as evidenced by the
improvement of the monthly scorecard metric results and corrections of
opportunities cited in the end-to-end process audit.
 This was accomplished by guiding and instructing nursing management in
improving standard operating procedures (identify process gaps),
workflows and assist management in creating staff clinical audit tools.
 Collaborates with cross-functional teams, IT-Business Intelligence, and health plan management
to provide contractual oversight of health services departments with the objective of ensuring
contractual obligations and policies are met for members in a range of products, i.e., Medicaid,
SSI/ABD, long term care, and dually eligible categories (Medicare/Medicaid), improving cost
efficiencies, and developing an environment of operational excellence.
 Communicate and guide Clinical/Medical and Business Executive leadership best practices,
barriers and potential solutions when operational processes or clinical programs are not
delivering results.
 Miscellaneous Experience:

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o SharePoint
 Created a Project Site
 Created an Intake Site
 Created a Change Control and Approval Site
o Managed staff hiring and training
o Provided employee yearly evaluations and 1:1 weekly meetings to provide feedback of
performance.
o Intermediate to advance proficiency with Microsoft Office Suite (Excel, Word,
PowerPoint, Visio)
5/10-10/12 UnitedHealthcare Community and State (Texas)
Manager of Clinical Training (STAR+PLUS Program)
 Management and facilitation of the training program for health services staff resulting in
improved staff knowledge and proficiency and indirectly impacting the achievement of positive
customer outcome.
o Successfully authored, revised standard operating procedures (SOP), workflows (WF),
job aids (JA) and conducted training that was recognized by the State of TX (HHSC)
during the 2011 and 2012 onsite audit.
o Training related to:
 CareOne
 Service Coordination
 Inpatient Care Management (ICM)
 Utilization Management (UM)
 Intake
 Fair Hearing and Appeals
 Policies and Procedures
 Collaborated with the compliance team to ensure adherence to external and internal metric
standards and develop, as needed, action plan and education to correct deficiencies.
 Coordinated and revised policies and procedures to satisfy the Texas RFP requirements.
 Partnered with Health Services Directors and Managers, Compliance, Operations, National
Training Team and IT in implementation / roll-out of new programs, projects and clinical
initiatives.
 Mentored and supervised the training team in designing/re-designing of training materials and
delivery.
o Survey results from staff and managers provided insight to learning challenges resulting
in the need to redesign training.
o With my experience and guidance in adult learning techniques and curriculum design,
my staff was able to author learning materials that are relevant to health services. In
turn, health services staff are better prepared to provide coordination of care to
members.
o National Complex Care Training for New Employees (corporate trainers) – majority of
their materials used originated from the STAR+PLUS training materials.
 Provided management and staff guidance on project initiatives
o Facet / CareOne implementation (Claims System)
o Disease Management Performance Improvement Project (PIP)
o Personal Attendant Services (PAS) Reduction and Secondary Review
 Developed objective criteria to measure staff performance with defined parameters to ensure
quality of work.
 Managed staff hiring and training
 Provided employee yearly evaluations and 1:1 weekly meetings to provide feedback of
performance
3/01-5/10 HARRIS COUNTY HOSPITAL DISTRICT (Harris Health), Houston, TX
IT Nurse Education Instructor II / Nurse MIS

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 Responsible for Application Orientation for all clinical staff including structure, content, and
logistics of curriculum delivery. Successfully transitioned Clinipac McKesson contents to Epic
Clinical Systems.
 Primary resource assigned to the Helpdesk in order to provide “Level II” support with “How
To” knowledge and clinical expertise in Epic Clinical and Business Systems.
 Mentor/Lead role in precepting clinical IT-Educators.
 Designated project manager and lead instructor for inpatient and outpatient modules, (to include
the Epic Medication Administration Record module) Specialty Clinic Epic COE and business
system implementations (Epic Admit/Discharge/Transfer system and PeopleSoft).
o Authored curriculum to provide additional details as required for initial and ongoing
instruction of new hires.
o Map clinical workflow.
o Coordinated/project managed workgroups assigned to each section of the project.
 Develop learning reflection (test) to measure staff knowledge and instituted corrective action
plan when metric requirements were not met.
o Epic Medication Administration Record test – 70% of clinical/nursing staff pass the test and
30% of nursing staff failed.
o Remediation plan:
 Escalated results to the Chief Nursing Officer (CNO)
 Recommended hands-on training within the Epic system with supervision of
staff in the clinical setting
 Re-take the EMAR class and test - resulting in a passing rate of 100 %
 Designated as IT Education’s liaison to the Epic Leadership Team and cross functional teams.
 Primary Contact for HealthQuest’s ADT, Clinipac, and Appointment Systems Training delivery.
 Designated lead for several District initiatives including:
o 3 years as participant in new hire orientation process; introducing new hires to IT resources.
o Member of the Nurse Research Committee in 2003. Compiled and presented the “Nurse
Quality Indicator Report” to assess the District’s current status with the Magnet program’s
accreditation standards.
o Participated in major revision of Learning Resource Center / IT Ed policies and procedures.
o Participated in script testing for major HealthQuest software upgrade in 2005.
1/99-3/01 TEXAS CHILDREN’S HOSPITAL, Houston, TX
STAFF NURSE
 As member of the after-hours triage team, assisted callers with implementing protocols, utilizing
the Centramax application to facilitate care for patients in home settings. Accessed application
on Windows workstation, determining level of patient care needs. Responsible for making
sound judgments, overriding established physician protocols when necessary and augmenting
call center knowledge base as required.
 After Call Center Nurse – triage all range of pediatric patient conditions/diseases
2/97-8/98 MARINER HEALTH HOME CARE, Houston, TX
DIRECTOR OF NURSING / SUPERVISOR OF-
CLINICAL SERVICES
 Managed up to 1200 home visits monthly and coordinated delivery of services for caseload of
40+ patients by team of 25 healthcare professionals; interviewed hired, evaluated and facilitated
staff. Co-launched Houston branch operations with Administrator.
 Marketed to physician’s clinics, nursing facilities and assisted living to increase patient census.
 Developed policies/procedures targeted to quality assurance for nursing skills related to home
health/patient care and caseload management.
 Served as mediator on all staff/client disputes and difficult patient situations.
 Responsibilities included managing patient admissions, pre-certifications, and compliance with
Medicare, Medicaid, and other managed care insurance providers.
 While serving as Acting Administrator, completed State survey without deficiencies; led
chart audit process that satisfied State compliance regulations.
 Contributed to improvement of census and visits by 55% in 12-month period.
 Played key role in the coordination and successful outcome of JCAHO audit.

6. Carolyn Isaacson Page 6 of 6
 Assisted with reducing per-visit costs by 40% through increased productivity of full-time staff
and appropriate utilization of per diem staff.
 Oversee recruiting, staffing, hiring, and training of clinical team.
7/95-2/97 SOUTHERN HOME CARE, Houston, TX
CASE MANAGER (9/96-2/97)
(Responsibilities similar to those listed under Medical Innovations)
MEDICAL INNOVATIONS / PHYSICIAN VISITING NURSING SERVICE, Houston, TX
CASE MANAGER (7/95-7/96)
 Scheduled and managed home healthcare services for 20-30 patients; coordinated with
physicians, nurses, therapists, and social workers; ensured execution of physician orders.
 Monitored and conducted random inspections to evaluate performance of HHAs and LVNs;
approved plans of care; re-certified patients; verified billing for patient services with Medicare.
 Concurrently served as Acting Team Leader, IV Preceptor, and field nurse.
 Managed patients with – wound care, diabetes, COPD, cancer, behavioral health and other
acute and chronic conditions and diagnosis.
5/95-7/95 SRI / THC, Houston, TX
CONTRACT NURSE
 Fulfilled nursing assignments at M.D. Anderson and an outlying healthcare facility; provided
nursing care for bone marrow transplant, cancer, cardiovascular and med/surg patients.
1989-5/95 TEXAS CHILDREN’S HOSPITAL, Houston, TX
CHARGE / STAFF NURSE
 Maintained accountability for manpower budget analysis and operational cost reductions in
scheduling and coordinating daily, weekly, and monthly assignments for staff that administered
nursing care to patients on cardiology floor; coordinated with multi-disciplinary team to ensure
optimum quality of care; simultaneously served as staff nurse.
 Patient Population Assignment
 Cardiac Staff Nurse/Charge Nurse – cared for cardiac pediatric patients with congenital
heart diseases and heart transplant