Cara Giller

Independent medical reviewer of patient records, assessing the appropriateness and necessity of care, and ensuring adherence to clinical guidelines and regulatory requirements.

• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.
• Coordinates with providers and other parties to facilitate optimal management programs and facilitates referral.
• Experience with MCG and Interqual systems.

• Implement and coordinate the delivery of care in collaboration with physician and resource health care personnel.
• Utilize the nursing process (assessment, planning, implementation, and evaluation) in applying nursing knowledge.
• Document all pertinent information regarding nursing care, care plans and observations.
• Maintain a working knowledge of facility infection control procedures.
• Provide functional direction and assistance to LPN's.

• Charge Nurse for 40 residents and Hospice care to average of 10-12 patients.
• Clinical staff educator/orientation for all new Nursing new hires.
• Provide clinical assessments, ongoing care coordination and medical management, wound and treatments.
• Assists physicians during examinations and procedures, operating and monitoring medical equipment as necessary.
• Promote comfort in care with patients and families.

• HEDIS 4-month project.
• Conduct a detailed review of medical charts for medical office visits and other procedures to determine if the quality of care measures per NCQA standards have been met.
• Collected data for 8 disease measures and uploaded into Accellion.
• Abstracted data and entered into Medcapture data system.

• Provided transitional nurse services for patients leaving an alcohol/drug inpatient facility that were on the medication, Vivitrol, and in need of new prescriber and/or injector.
• Provided education on medication to patients and health care providers.
• Provided patient appointment reminder and follow-up calls.

• Responsible for communicating medical/safety information to external customers, primarily healthcare professionals and patients.
• Evaluated and interpreted medical/safety information.
• Documentation of adverse events and product complaints.
• Interact directly with company clients on specific projects.

• Telephonic case management and support for Teva medication, Copaxone.
• Answer inbound patient calls and assist patients with individual needs regarding the medication.
• Compliance patient calls initiated through Shared Solutions.
• Computer documentation through Seibel system of all calls and coordination.

• Conducted training for various Clinical staff positions including service coordinators: nurses and social workers.
• Responsible for all company trainings: New hire orientation, TruCare charting, InterQual, Waiver and Case management specific trainings.
• Responsible for auditing charting for all employees and determining areas for retraining opportunities.
• Developed and implemented job skill competency check offs for process or practice improvements.
• Developed training curriculum, training references and resource materials including development of training manuals.

• Obtain, schedule, and confirm clinical sites for LPN and RN Nursing programs.
• Clinical coordination through site visits to maintain and obtain clinical sites for student clinical rotations.
• Coordinate instructional and community activities for students and faculty.
• Collect, record, maintain and submit student clinical records per college and Board of Nursing requirements.

• Supervise all nursing facility and coordination of clinical and classroom scheduling.
• Coverage of classroom and clinical instruction as needed.
• Direct communicator with Missouri Board of Nursing.
• Establish and maintain clinical facilities.
• Serve as an academic advisor.
• Maintain essential records to evaluate students progress including exams, grading policies and course requirements.

• Call center program specialist supporting Abbott medication, Humira.
• Answered inbound patient calls and assist patient/healthcare questions regarding medication.
• Compliance patient calls initiated through myHumira program.
• Computer documentation of all calls and coordination.

• Professionally develop, coach, train and manage nine clinical nurse specialists.
• Provided clinical coaching to healthcare providers to promote implantable devices.
• Provided case coverage, reimbursement, coding and billing assistance to clinical staffs.
• Spinal Cord Stimulation Presenter Award in 2009.

• Professionally develop, coach, train and manage 8 clinical nurse specialists and sales representatives in two regions, covering 12 states.
• Work with Key Opinion Leaders to provide case coverage and clinical training.
• Provided in-service trainings for healthcare professionals.
• Development and implementation of CEU accredited training courses.
• Development and implementation of annual core competency check offs.
• Provided case coverage, reimbursement, coding and billing assistance to clinical staffs.
• Clinical Specialist of the Year award in 2005, 2007.
• Team Work award in 2008.