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Donna Pugh was working from her couch when she had a moment of relatable frustration.

“I could not figure out how to implement new changes from one of the regulatory bodies we work with,” the manager on the BlueCare Plus utilization management team recalls. “To no one in particular I asked, ‘Why did I agree to do this job? What is wrong with me?’ My daughter Sarah looked up at me and said, ‘Because you like to solve problems.’”

“I had to say, ‘You know, I didn’t really want an answer,’” Donna recalls with a laugh. “But she was right, even if she likes to throw my words back at me.”

Indeed, problem-solving may be Donna’s defining characteristic. It’s been at the root of a career that’s taken her from the United States Army to charge nurse at a hospital to now helping BlueCare Plus members get the tools and services they need to live healthy lives.

A history of helping others

Born in Charles Town, West Virginia (about two hours outside of Washington, D.C.), Donna grew up in a service-oriented family.

“My mom worked in health care, mostly as a secretary,” Donna recalls. “When I was in high school, she worked in a small doctor’s office. I also worked there a couple of weeknights and every other Saturday. I saw up close the difference this staff was making in peoples’ lives.”

“I’ve always enjoyed helping people, and I wanted to do so in a broader capacity. Right about ninth grade, it hit me that I wanted to be a nurse.”

But first, Donna would honor the other side of her family’s history of service by enlisting in the United States Army.

“During every generation’s war, it seems like someone from my family has been in the military,” she says. “Before me there was my father, who was part of the Vietnam draft era. His father and my mom’s dad fought in World War II. So it made sense that I would join.”

Donna was assigned to the Signal Corps, a division that manages communications and the transfer of classified information. That’s where her knack for problem-solving manifested.

“My job was to set up a campsite with a communications van and generator, then ensure the signal shot up properly and went from this van, to this van, to this van, over whatever distance we were assigned,” Donna says.

She served three years active duty, followed by another nine years in the National Guard and then the Army Reserves.

A lot happened in her personal life during this period, as well.

“While stationed with the Signal Corps in South Korea, I met my husband Keith, a west Tennessee native,” Donna says. “Directly after active duty, I went into the National Guard and was still Signal Corps. Then I came home and had a child, which meant I was done going into the field for a couple of weeks at a time, every few months. From there I entered the Reserves, went to school, and got my nursing degree. A couple years after getting my registered nurse license, I flipped over to the Nursing Corps while in the Reserves.”

An evolving career journey

After completing her duty in the Reserves and moving to Greenfield, Tenn., with her family, she accepted a nursing position in a hospital’s geriatric psychiatric ward. She then moved into medical-surgery nursing and orthopedics/home health before returning to the hospital.

“I went back because I missed bedside nursing, applying those skills, and being able to really help someone at their most vulnerable,” she says. 

Some days as a bedside nurse required constant movement. As Donna was running up and down halls, her knees started giving her trouble.

“I realized I couldn’t do this for the rest of my life, so I started looking into other avenues where I could use my degree,” she recalls. “That led me to BlueCross, Chattanooga and case management, which was my first job here, in 2014.”

As a case manager, Donna followed the same established problem-solving hierarchy that defined her time as a nurse.

“First came the needs of my members, then my co-workers, and then keeping the company vision in mind,” she says. “When I worked in the hospital, it was the same order: patients, co-workers, company vision.”

“Am I doing everything I can to keep things smooth for the members? Is everything in place for them? If not, what do I need to change, or what do I have to implement?”

In 2017, Donna shifted to BlueCare Plus Choice (FIDE), which serves members that have both Medicare and Medicaid.

“This BlueCare Plus population has some of our sickest members, with an average age of 59,” she says. “They didn’t age into Medicare; they have some type of disability or illness that makes them eligible. They’re very low-income, which makes them eligible for Medicaid, as well. These members also qualify for long-term services and supports.”

Entering utilization management

As a manager on the BlueCare Plus utilization management team, Donna looks at medical authorization requests as they come in.

“My job is to make sure the recommended care is appropriate for the member in their current situation, and that it is in fact covered by Medicare,” she says. “If it’s not, there’s a possibility it’s covered by Medicaid. Since our members have both, we might be able to switch it over. The providers might have to do some additional filing, but we try to make it as seamless as possible. We have to be good stewards.”

In her current role, Donna doesn’t have direct contact with members. While she misses it, she’s found that as a leader she can help problem-solve on a more macro level.

“I try to support the people I work with so they can support the people they take care of,” Donna says.  “Ironically, I never thought of myself as a leader in any capacity. Throughout my working career, it seemed that people have been trying to shove me in that direction. They saw something in me that I didn’t.”

Looking back, she believes her time in the military gave her the discipline to one day lead and problem-solve in different ways.

“I’ve never had a problem getting along with people, but in the military, you’re forced to work together,” she says. “It exposed me to a lot of personality types and how to work with them.”

At BlueCross, Donna quickly established herself as someone people could come to for answers.

“Donna works to define a solution and implement it,” says Danny Tester, a fellow manager on the utilization management side and a former supervisor who encouraged her to apply for her current position. “She works alongside employees to help them learn each job function. Donna was often asked to mentor other staff and is never too busy to assist someone in need. She leads her team by example and is fair and consistent with everyone.”

The joys of hangout time

One thing that’s consistent in Donna’s personal life is the value of spending time with her family.

“We’re homebodies, and TV is my vice,” she says. “I spend entirely too much time with it, especially ridiculous slapstick stuff. I also like to take walks with our boxer mix, Rico, a complete hardheaded goofball.”

At home and at work, Donna returns to the comment Sarah made during that particularly frustrating day.

“You know what this all boils down to? I just like being there for people,” she says. “My work, every job I’ve had, and every family decision has been focused on being there for the people I’m responsible for.”