Christina Martin
Frostburg,MD
Summary
An Improvement Specialist with over 20 years of experience in the healthcare industry. Excellent knowledge in performance improvement methodologies, and the Maryland reimbursement model. Proven ability to manage and complete high-level projects. Detail-oriented, and highly organized with a strong work ethic and excellent problem-solving skills.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Improvement Specialist
UPMC Western Maryland
Cumberland , MD
04.2022 - Current
- Leads departmental teams to streamline quality practices, improve operational processes, and maintain continual improvement.
- Collaborates with multidisciplinary teams to develop strategic action plans, identify objectives, set goals, and establish outcome measures.
- Extensive knowledge of quality management, and performance improvement principles and methodologies.
- Leads committee meetings, prepares data, creates presentations, and facilitates meetings.
- Builds, maintains, and analyzes various reports related to readmission, utilization of hospital services, and emergency room metrics.
Lead Case Manager
UPMC WESTERN MARYLAND
Cumberland, MD
02.2020 - 04.2022
- Provided direct oversight of the execution of daily care coordination operations for the Emergency Department and Observation Unit.
- Managed staff schedules, ensuring adequate coverage.
- Oversaw ED and observation care coordination, new hire orientation, and education.
- Promoted productivity and ensured staff adherence to the performance standards.
- Responsible for compiling and analyzing observation statistics to ensure unit metrics are being met.
- Worked with senior leadership to address staffing issues.
Emergency Room Care Coordinator
UPMC Western Maryland
Cumberland , MD
01.2019 - 04.2020
- Performed medical necessity reviews for all inpatient admissions and observation placements.
- Utilized Milliman care guidelines to guide physicians on the medical necessity of inpatient admissions, and appropriate levels of care.
- Performed discharge planning, such as skilled nursing home placement, home care referrals, ED U-turns, referrals to centers for clinical resources, acute rehab placements, and coordinated transportation.
Nurse Advice Line Nurse
UNITED HEALTH CARE
Minneapolis, MN
05.2018 - 02.2019
- Part of a 24/7 Telecommuting Telephonic Triage team
- Assesses patient's current health status and recommends appropriate level of care based on clinical judgement and protocols
- Assesses patient's understanding of their conditions and provides health education on treatment to assist them with making the best decisions
- Uses motivational techniques to encourage patient's to participate in the decision making process
- Assist patient's in selecting facilities to maximize access and quality of care, and manage health care costs
Utilization Review / Case Management Nurse
CONIFER HEALTH SOLUTIONS
Annapolis, MD
01.2010 - 05.2018
- Provides utilization review for self-funded insurance plans by using a set of medical guidelines and plan language to make medical necessity determinations for all acute inpatient admission including but not limited to Medical, Behavioral health, OBGYN, pediatric and NICU admissions
- Completed medical necessity reviews for transitions of care to include admissions to acute rehab facilities and skilled nursing facilities
- Completed Medical necessity reviews for outpatient services to include outpatient surgeries as well as outpatient rehabilitation services
- Reviewed CPT codes to ensure appropriate coding for surgical procedures and DME
- Utilizes protocols, medical guidelines and best nursing practices to assess patient's medical condition and make appropriate referrals
- Collaborated with patients and providers to coordinate care services for patients
- Participate in discharge planning with hospitals and inpatient facilities to ensure adequate and appropriate disposition and smooth transition from one level of care to another
- Coordinated services with medical directors and physicians to complete peer to peer reviews, 1st and 2nd level appeals
- Maintained ongoing compliance with URAC and ERISA guidelines
- Acted as a resource in the assistance of training new employees
Telephonic Disease Management Nurse
NATIONWIDE BETTER HEALTH
Hunt Valley, MD
04.2006 - 01.2010
- Provides patient care by providing telephonic education regarding chronic conditions, including: Diabetes, Coronary Artery Disease, Hyperlipidemia, Hypertension, Chronic Obstructive Pulmonary Disease, Asthma, Arthritis, and Oncology
- Performs assessments, education related to conditions and medications
- Performs referrals to appropriate disciplines, and community resources
- Appropriately uses department software to document calls, and create care plans
- Ability to troubleshoot technical problems with computers and voice over IP telephonic systems
- Proficient in Microsoft operating systems and Office suite
Advice Line Nurse
CAREMARK
Rockville, MD
11.2005 - 04.2006
- Part of a 24/7 nursing team handling inbound, outbound, and after hour patient calls for pharmaceutical companies
- Took information and used nursing knowledge and protocols to assess symptoms and recommend for patient through telephonic support
- Provided information and education telephonically to patients regarding their disease process, and their prescribed therapy
- Handled calls proficiently by appropriately documenting calls and adverse reactions
- Participated on a team with other professionals to develop educational materials and resources for patients on Interferon/Ribavirin therapy
Nurse Clinician- Intensive Care Unit
SHADY GROVE ADVENTIST HOSPITAL
Rockville, MD
04.2005 - 11.2005
- Providing care to acutely ill patients including acute myocardial infarction, respiratory failure, and trauma
- Skilled in maintaining Swanz-Ganz catheter, arterial lines, bedside monitoring, 12 lead EKG, and ventilator care
- Proficient in patient care including assessments, discharges, administrations of medications, and interpretation of lab work
- Educate patients/families on health care needs, conditions, options, and medications
Nurse Clinician - High Level Care
WESTERN MARYLAND REGIONAL HEALTH SYSTEM
Cumberland, MD
07.2002 - 04.2005
- Managing heavy daily patient volume including charge nurse responsibilities, assessing and documenting patient acuity, bed availability, and assignments
- Proficient in all documentation to ensure accuracy and patient confidentiality
- Providing direct patient care, documenting patient history, assessments, medication list, and discharges
- Assessing individual conditions and needs, and advising in changes in status
Education
Associate Degree - Nursing
ALLEGANY COLLEGE OF MARYLAND
Cumberland, MD05.2002
Master of Science - Nursing Administration
CAPELLA UNIVERSITY
Minneapolis, MNSkills
- Project management
- Strong communication skills
- Extensive knowledge of performance improvement methodologies
- Knowledge of the Maryland reimbursement model and HSCRC data tools
- Proficient in the Microsoft Office Suite
- Extensive knowledge of the Maryland quality metrics, and Medicare and Medicaid
Certification
- Certified Professional Health Management Certification, 2013
- Chronic Care Profession Certification, 2006
- State of Maryland Nursing License, 01/01/02, Current
Timeline
Improvement Specialist
UPMC Western Maryland
04.2022 - Current
Lead Case Manager
UPMC WESTERN MARYLAND
02.2020 - 04.2022
Emergency Room Care Coordinator
UPMC Western Maryland
01.2019 - 04.2020
Nurse Advice Line Nurse
UNITED HEALTH CARE
05.2018 - 02.2019
Utilization Review / Case Management Nurse
CONIFER HEALTH SOLUTIONS
01.2010 - 05.2018
Telephonic Disease Management Nurse
NATIONWIDE BETTER HEALTH
04.2006 - 01.2010
Advice Line Nurse
CAREMARK
11.2005 - 04.2006
Nurse Clinician- Intensive Care Unit
SHADY GROVE ADVENTIST HOSPITAL
04.2005 - 11.2005
Nurse Clinician - High Level Care
WESTERN MARYLAND REGIONAL HEALTH SYSTEM
07.2002 - 04.2005
Associate Degree - Nursing
ALLEGANY COLLEGE OF MARYLAND
Master of Science - Nursing Administration
CAPELLA UNIVERSITY
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