Open to opportunities

Mary Sprague

@marysprague

Message

I’m an RN case manager and clinical consultant improving quality outcomes and reducing readmissions.

United States

Message

What I'm looking for

I’m looking for a care-management or clinical consulting role where I can coordinate complex patients, partner across interdisciplinary teams, and drive measurable improvements in quality, readmissions, and HEDIS outcomes—ideally in a value-based, audit-focused environment.

I’m an experienced RN case manager and clinical consultant with 10+ years in care management, utilization review, chronic disease management, and population health. I’m known for improving quality outcomes, reducing readmissions, strengthening member engagement, and advocating for patient-centered care through consultative communication and clinical judgment.

In my current role as a Remote RN Case Manager, I manage ~200 complex CKD/ESRD cases monthly—building care plans, conducting medication reconciliation and education, coordinating transitions with providers/pharmacists/social workers, and reviewing documentation and quality gaps to support value-based care goals. Previously, I maintained 100% audit compliance while driving a 15% reduction in inpatient readmissions, improved HEDIS compliance and satisfaction by 20%, mentored new nurses, and ensured Joint Commission readiness.

Experience

Work history, roles, and key accomplishments

Current

Remote RN Case Manager

Current

Strive Health

Jan 2025 - Present (1 year 5 months)

Managed approximately 200 complex CKD/ESRD cases monthly, delivering clinical assessments, care planning, medication reconciliation, and patient education to improve adherence and reduce avoidable utilization. Collaborated with providers, pharmacists, social workers, and interdisciplinary teams to support care transitions, address social determinants of health, and improve value-based quality outc

Clinical Case Management Chronic Kidney Disease (CKD)Care Transitions Medication Reconciliation Patient Education Population Health Utilization Management Clinical Documentation Review Interdisciplinary Collaboration

RN Nurse Medical Management II

Anthem Blue Cross Blue Shield

Jan 2021 - Jan 2025 (4 years)

Maintained 100% audit compliance while supporting a 15% reduction in inpatient readmissions through proactive care coordination and member engagement strategies. Developed individualized care plans to improve HEDIS compliance and increased satisfaction scores by 20%, while mentoring new nurses and ensuring 100% Joint Commission readiness.

Utilization Review Care Coordination Audit & Compliance Joint Commission Quality Improvement Patient Engagement

RN Nurse Case Manager

Blue Cross Blue Shield of Tennessee

Jan 2017 - Jan 2021 (4 years)

Oversaw 75–90-member Medicaid/home health caseloads and reduced hospital admissions by 22% and emergency department use by 20% through proactive outreach. Closed 85% of care gaps while maintaining 100% audit compliance, and integrated social determinants of health assessments to improve access to community resources.

Medicaid Care Management Emergency Department Utilization Reduction Care Gaps Audit & Compliance Social Determinants Of Health (SDOH)Population Health Chronic Disease Management

RN 3 Supervisor, TB Program

State of Tennessee Department of Health

Jan 2016 - Jan 2017 (1 year)

Directed a tuberculosis (TB) program across 10 counties, championing 100% DOT completion. Coordinated outbreak control with correctional facilities and hospitals, and improved reporting rates by 20% through training and grant compliance.

Public Health Program Management Tuberculosis (TB) Control DoT Outbreak Response Compliance Audits Training Delivery Grant Compliance Stakeholder Management

RN Med-Surg & OB Charge Nurse

Starr Regional Medical Center

Jan 2012 - Jan 2017 (5 years)

Provided med-surg and mother/baby care as a charge nurse, supporting postpartum education that improved patient satisfaction by 15%. Led team transitions and emergency responses with zero critical incidents.

Mother Baby Care Postpartum Education Charge Nurse Leadership Emergency Response Patient Safety Clinical Oversight

RN Occupational Health Case Mgr

Skyridge Medical Center

Jan 2015 - Jan 2016 (1 year)

Managed injury cases for 1.2K employees, achieving a 95% return-to-work rate and reducing ED transfers by 40% and reportable incidents by 20%. Provided ergonomic education and supported wellness program engagement, increasing participation by 25%.

Return To Work Support Ergonomic Education Wellness Programs ED Transfer Reduction Safety Focused Nursing Employee Advocacy

RN Emergency Department

Skyridge Medical Center

Jan 2014 - Jan 2015 (1 year)

Provided care in a Level III trauma center, triaging up to 30+ patients per shift and leading rapid responses in critical situations. Precepted new nurses and ensured full compliance with safety protocols while meeting emergency care targets.

Emergency Nursing Triage Rapid Response Patient Safety Clinical Target Attainment