Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Timeline
Generic

Cynthia Pace

Summary

An energetic utilization review nurse/case manager with a compassionate history of achievement in documentation analysis. Motivated leader with strong organization and prioritization abilities. Strengths include being detailed oriented, a team player, and an effective communicator.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Case Manager

Monument Health
06.2022 - Current
  • Discuss and determine options based on the patient's needs, goals, and choices.
  • Coordinate appropriate inpatient care and post hospital level of care services based on funding availability.
  • Coordination of outpatient services including IV infusion, prescription drug assistance, dialysis, wound care, home health, DME, hospice, and local resources.
  • Coordination post-acute care facility referrals and transfer including SNF, TCU, and ALF.
  • Concurrent review of clinical documentation to justify the continual admission.

Utilization Review Nurse/Case Manager

Delta Health
09.2015 - 06.2022
  • Drive hospital financial viability by assessing documentation to determine appropriate level of care per MCG Indicia Guidelines to ensure optimal reimbursement for services.
  • Improve quality by performing concurrent stay reviews to limit unsuitable extended stays and unnecessary procedures, research 30-day readmissions rate, and perform inpatient care coordination.
  • Chair the multi-disciplinary Utilization Review Committee tasked with improving quality of care and reimbursement, partner with the physician champion to conduct physician coaching.
  • Serve as subject matter expert by educating physicians and staff to improve documentation of care, coordinate and prepare physicians for Peer to Peers with admission criteria.
  • Compose letters to appeal denial cases to stop recoupment of payment by Federal, State, and private payers.
  • Assist in implementing a CLinical Documentation Department in rural hospital by creating effective policies and procedures for CDI specialists.

Case Manager

Hopewest
02.2014 - 09.2015
  • Provided hospice care to a case load of 12 patient s in the home, nursing home or assisted living setting.
  • Responsible for primary care including medication management.
  • Practiced ethical and independent decision making consistent with medical protocols.


Registered Nurse, Medical-Surgical Unit

Delta Health
02.2012 - 01.2015
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
  • Orchestrated quality-driven, cost-effective care in rural hospital setting.

Education

Bachelor of Science - Nursing

Grand Canyon University
Phoenix, AZ
06.2019

Associate of Applied Science - Nursing

Colorado Mesa University
Grand Junction, CO
12.2011

Skills

  • Care Coordination
  • Effective Communicator
  • Physician Engagement
  • Meeting Facilitation
  • 3M and Coding
  • Meditech/Epic operator
  • Clinical Documentation
  • Administrator of MCG Indicia
  • Medical Terminology

Accomplishments

    ACDIS CDI Apprenticeship Scholarship winner-Completed the program 08/2021

Certification

  • Licensed RN - 204007-09/2024
  • Certified BLS 225414207163-04/2024

Timeline

Case Manager

Monument Health
06.2022 - Current

Utilization Review Nurse/Case Manager

Delta Health
09.2015 - 06.2022

Case Manager

Hopewest
02.2014 - 09.2015

Registered Nurse, Medical-Surgical Unit

Delta Health
02.2012 - 01.2015

Bachelor of Science - Nursing

Grand Canyon University

Associate of Applied Science - Nursing

Colorado Mesa University

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Cynthia Pace