1. Beale, Tramecya Monique MSN, RN, CCM, COHN

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Not a day passes that I don't think about the tremendous career diversity that nursing has afforded me-from direct patient care to strictly administrative roles, and positions that amalgamate aspects of both. Sometimes we seek opportunities that are ideally suited for our proficiencies, lifestyle, and career objectives. Other times, a position that was not previously considered seeks us out, resonates with our nursing passion, and inspires us to ponder a trajectory not before contemplated. For me, this epiphany was Medicare Provider Outreach & Education (POE). Before becoming a POE manager, I began working for Medicare as a provider education consultant with one of several Medicare Administrative Contractors (MACs). This period of transition from direct patient care to the administrative capacity of education and outreach was nothing short of a personal renaissance. What my colleagues interpreted as excitement about my new role was actually confirmation that my professional journey was indeed aligned with the fiber of my being. My new position focused on the very ideologies that led me to pursue a nursing career: sharing knowledge and educating others, connecting with a purpose to serve the greater good, evidence-based practice, all while building longstanding community partnerships.


As a Senior Provider Education Consultant-a crucial bridge between Medicare and healthcare providers-I was an interpreter of Medicare guidelines as well as the billing and documentation expectations of the MAC. After approximately 2 years working in this capacity, providing one-on-one guidance, developing educational materials, and fostering a sound understanding of the foundational tenets of Medicare policy, an opportunity to work from home as a Medicare educator was offered. After much deliberation, I was sufficiently persuaded to accept the offer.


I no sooner became fully acclimated to this new role, when my manager called an impromptu conference to announce she was resigning in 2 weeks. I hadn't been with this new team 4 months, and the one person who lobbied on my behalf seemed to be abandoning me before I could benefit from her experience and sage tutelage! Suddenly, I didn't feel very secure or acclimated anymore. However, one day she called and said, "Monique, you are very well qualified and I think you would be suited for my role - I hope you'll at least consider applying for the job once it is posted." I politely thanked her for the kind words and the vote of confidence but I convinced myself that I wasn't interested in the added responsibility. Eventually though, I tossed my hat into the ring and was offered an interview for the job. I flew to our home office in Nashville, TN, and survived a day of intense vetting. I flew home that same evening, with no true gauge of the outcome. Months passed before I received a call from the person I had interviewed with in Nashville, and who I would directly report to. "Monique, we have made a decision regarding the POE Manager role, and I am calling to let you know that you were selected." The wait was over and I savored the success, not yet thinking of the trials awaiting me on the other side of triumph. The promotion from educator to manager meant shifting from peer to leader of the education team, no small feat in any setting; but certainly more challenging for a newcomer with a lot of "innovative" ideas to pitch, and buy-in to obtain from the disadvantaged location of my home office.


My workday usually begins with a mental scan of everything on my proverbial to-do list. Always more than could be tackled in a single 24-hour period, the goal is less of ticking off items, than categorizing tasks by priority level-immediate, urgent, important, and vital. The evidence that I am never far from my work literally or figuratively, is scattered about my home-sticky notes, random sheets torn from a legal pad, all covered with scrawling that will no doubt be vital at some point during the day.


From the instant I open my Outlook email, I realize my well-intentioned and carefully contemplated plan for the day is obsolete. This is par for the course in the business of Medicare administration. The organizational meetings and conferences begin early; in between there's scant time to touch base with, and provide direction to, the educators, or handle the required administrative duties. On an average day, it is not outside the norm for more than half of my work time to be dedicated to meetings. Working from home creates the vexing paradox of both needing fewer meetings (to make the most of every minute, due to the disadvantage of working in an environment with inherently less access to resources); as well as a need for more meetings (due to the communication silos unintentionally created by working remotely). Administrative responsibilities range from the mundane (e.g., balanced scorecards and timesheets) to the sublime (e.g., process improvement and innovation charters, operational strategies, marketing plans, and the like). By midday, I usually have the inexplicable feeling that I have forgotten something. Nevertheless, I push forward; there's precious little time for contemplation. When a colleague inquires about the very thing that was dangerously close to slipping through the cracks, this is my "ah-ha" moment. This jogging of my memory usually prompts a reprioritization of the latter half of the day.


The day's agenda is also subject to change according to provider or business needs. A high priority provider escalation can suddenly command the attention of myself, the team, and even other leadership. As a part of the Medicare Provider Customer Service Program, the POE's chief priority is to provide high-quality customer service. As customers, providers are far more to us than just recipients of educational services, but fellow stakeholders, and community partners. This dedication to relationship building and service means we must be flexible and accommodating. The ability to see the silver lining in even the most trying circumstances is also requisite, particularly when long awaited personal plans have to be canceled due to unanticipated work events.


Any exempt employee understands that a workday may not end at 8 hours. For me an 8-hour day is a rarity. So many unforeseen factors can influence my day. Reaching a stopping point for me is less about the clock, and more about ensuring work is completed according to the highest quality standards. POE is the most visible aspect of any MAC; therefore, we must wear a number of hats: educator, customer service agent, public relations representative, ombudsman, marketing strategist-whatever is needed. The work my team and I create not only satisfies organizational and departmental metrics, but is representative of the entire Medicare program. Because most people don't typically distinguish the MAC from the Medicare program as a whole, we are the personification of Medicare. This is a tall order that requires dedication and a sense of stewardship, as well as the embodiment of those all-important passions of sharing knowledge, outreach, and connecting with a purpose to serve the greater good, all while building longstanding community partnerships.


The role of POE manager is anything but predictable, and no 2 days are exactly alike. The challenges are numerous, but so too are the rewards. The POE manager position is diverse, with no shortages of opportunities to grow as a professional, and affect changes in our healthcare delivery system and by extension, influence the most fundamental aspect of all life...good health.