Raynie Fike, RN, CCM
Litchfield Park
Summary
Driven regional manager offering in-depth understanding of healthcare market conditions and regional preferences. Strategic and proactive leader with skill implementing successful changes to business policies and procedures within hospital systems, insurance plans and ambulatory spaces. Ready to apply several years of experience and leadership abilities.
Overview
9
9
years of professional experience
3
3
years of post-secondary education
Work History
REGIONAL MANAGER
Evernorth Care Group
09.2024 - Current
- Lead clinical operations to align with quality, financial and patient experience goals.
- Enhanced clinical operations workflows which improved patient outreach timeliness during care transitions & ensured ongoing management of chronic conditions.
- Successfully built care plan module within Epic system, trained and supported case managers to enhance patient-centered care with PCMH-compliant care planning.
- Conducted peer review of complex clinical cases and treatment plans, ensuring adherence to best practices and improving patient outcomes.
- 18 Primary Care, Dermatology and Behavioral Health Practices
REGIONAL HEALTH SERVICES MANAGER
Optum Home & Community Care
02.2023 - 09.2024
- Virtual Care management paired with RN, Care Coordinator and MD/NP in home care.
- Directed MA, RN and MSW teams through two acquisitions, ensuring continuity of service and staff engagement.
- Improved team accountability by implementing case rounds with medical directors, coordinated remote team meetings, and promoted cross-disciplinary collaboration.
- Educated teams on NCQA, HEDIS, and quality metrics, driving performance improvement within documentation and clinical practice.
- Conducted peer review of safety protocols and compliance reporting ensuring adherence to industry regulations.
- Maintained staff productivity and exceeded patient satisfaction benchmarks by collaborating with analytics teams to increase reporting accuracy.
- Led comprehensive investigations into workplace incidents, patient grievances and near-misses, identifying root causes and implementing corrective actions that reduced safety occurrences.
- Urgent Care and Case Management Division for the top 5% of chronically ill patients
DIRECTOR OF NURSING
Continuum Pediatric Nursing Services
04.2022 - 02.2023
- Launched & Managed Arizona Nursing Division.
- Oversaw all healthcare operations for Arizona pediatric home health branch including clinical practice, operational procedures, intake, sales, marketing, and quality outcomes.
- Launched new branch in AZ, which included AZDHS, ALTCS applications and site reviews.
- Pediatric Home Health
CLINICAL OPERATIONS MANAGER
Center Well
Peoria
07.2021 - 04.2022
- Led quality assurance initiatives, with recent focus on reducing hospital readmissions, improving patient satisfaction scores, and increasing STAR ratings.
- Launched acquisition activities including marketing/sales initiatives to rebrand Kindred as Center Well.
- Collaborated with interdisciplinary team to optimize workflows and ensure efficient documentation and clinical decision making.
- Home Health & Primary Care Practice
ASSISTANT DIRECTOR OF NURSING
North Mountain Healthcare LLC
Phoenix
10.2020 - 07.2021
- Financial, clinical, quality oversight.
- Infection Prevention - led facility through 8 deficiency-free infection control surveys with AZDHS during the COVID pandemic.
- Quality Improvement - nursing practice improvements ensured a 5-star Annual Inspection Survey in May 2021.
- Financial Stewardship - Staffing & budget goals exceeded, significant reduction in the use of registry nurses.
- Long-term Care & Skilled Nursing Facility
SUPERVISOR, CASE MANAGEMENT
Phoenix Children's Hospital
10.2016 - 10.2020
- Responsible for team of RN Case Managers, Resource Coordinators, Utilization Review RN's & Nurse Auditor's.
- Redesigned all nursing, case management, utilization management, and nurse auditor workflows; incorporated the use of resource coordinators so licensed staff could work to the height of their licensure; implemented new training, onboarding and orientation.
- Created post-discharge follow-up system, reducing readmissions and improving care transitions.
- Piloted successful ED-diversion program, by engaging ED Case Managers to directly schedule specialist appointments and prevent admissions.
- Enhanced denial management and nurse auditing processes to reduce administrative waste and improve efficiency of operations between case management and risk management departments.
- Pediatric Hospital
Education
Dual MSN/MBA - Nursing Leadership in Healthcare Systems
Grand Canyon University
Phoenix, AZ 01.2025 - 02.2026
BSN -
Grand Canyon University
Phoenix, AZ 01.2013 - 12.2014
Skills
- Remote Team Leadership
- Quality Improvement
- Project Management
- Case Management Operations
- NCQA/PCMH/AZDHS Accreditation
- Training & Development
- Quality Audits
- Staff Coaching
- Performance Evaluations
- Denial Management
- Utilization Management
- Risk Mitigation
- Process Improvement
- Change Management
- Grievance/Complaint Investigation
- Population Health Management
- Staff Development
- Cross-functional Collaboration
- Proficient in Microsoft Office Suite
- Regulatory compliance
Certificates & Licensure
- Registered Nurse (RN) 190777, 2014
- CCM 4258931, 2022
Timeline
Dual MSN/MBA - Nursing Leadership in Healthcare Systems
Grand Canyon University
01.2025 - 02.2026
REGIONAL MANAGER
Evernorth Care Group
09.2024 - Current
REGIONAL HEALTH SERVICES MANAGER
Optum Home & Community Care
02.2023 - 09.2024
DIRECTOR OF NURSING
Continuum Pediatric Nursing Services
04.2022 - 02.2023
CLINICAL OPERATIONS MANAGER
Center Well
07.2021 - 04.2022
ASSISTANT DIRECTOR OF NURSING
North Mountain Healthcare LLC
10.2020 - 07.2021
SUPERVISOR, CASE MANAGEMENT
Phoenix Children's Hospital
10.2016 - 10.2020
BSN -
Grand Canyon University
01.2013 - 12.2014