Seeking a forward thinking healthcare organization where I can leverage my expertise to optimize patient through put while ensuring the highest standards of medical necessity compliance.
Overview
25
25
years of professional experience
1
1
Certification
Work History
utilization
Evolent
08.2018 - Current
Employed as utilization
Travel nurse case manager
South Austin St. Davids Medical Center
06.2013 - 05.2018
Travel nurse case manager for 3 months, then transitioned full time case manager (UR, discharge planning, discharge planning, and care coordination). Worked 1 year as manager: Management of LOS, Denials, Budget, Appeals, and Reduce Readmissions. Used Midas, Medical Necessity Programs, Curaspan, Microsoft Office Suite, Taleo and Artiva programs.
Currently working in trauma unit and part of multidisciplinary rounds
(300 bed hospital)
Care Coordinator- RN
Parkland Hospital
02.2013 - 06.2013
Travel Nurse contract position working full time as a Care Coordinator- RN, covering different units as assigned. Required Milliman & Roberts for utilization review. Provided discharge planning for each patient as indicated. Utilized EPIC, Physician Order Entry, Word, Accent and Midas programs.
(1000+ bed hospital)
Nurse Manager for Utilization Review Department
07.2009 - 12.2012
Nurse Manager for Utilization Review Department- management of nursing staff and reported directly to CMO for physician advisor and CFO for revenue cycle integrity. Implemented the Admit to Utilization Review Protocol, Direct Admit Protocol and recently opened the Admission/Discharge and Transfer Center. Was able to implement staffing 24/7 for review of medical necessity of all admissions into the facility. Reduced inappropriate admissions and reduced Length of Stay while in house. Utilized Word, Excel and Power Point on a regular basis.
Indian River Medical Center
01.2007 - 01.2012
(335 bed hospital)
Nurse Case Manager
01.2007 - 07.2009
Nurse Case Manager- in the Case Management Department providing discharge planning, care coordination, utilization review, and physician education. Utilized InterQual, Curaspan and Midas programs for completion of job duties.
Rehab Liaison
HealthSouth Rehabilitation Hospital
01.2005 - 01.2007
Working full time as a Rehab Liaison- assessing patients for admission to the hospital for inpatient rehabilitation services. Worked with CMS 13 guidelines, case management assessments and discharge planning. Worked with local hospitals, physicians and discharge planners to facilitate admission to Health South. Also provided education to community through events and health fairs.
Case Manager, Consultant and Life Care Planner
Consulting & Life Care Planning, Inc.
01.2001 - 01.2005
President and Owner of own business. Provision of medical case management services, chart review, attendant care assessments, home evaluations, life care planning, medical cost projections, care coordination and medical research. Facilitated discharges to next level of care transition. Services provided to employers, insurance companies, hospitals, and attorneys.
(Owner)
Education
Post Graduate Course of Study - Life Care Planning for Advanced Catastrophic Case Management
University of Florida and Intelicus
A.S. Degree - Nursing Program (ADN)
Indian River Community College
Florida
01.1984
Certification
State of Texas RN License- 2013 to present
State of Illinois RN License- 2020 to present
State of Alaska RN License- 2020 to present
State of New York RN License- 2020 to present
State of Florida License, Registered Nurse (RN) – 1984 to 2018
Basic Life Support (BLS) - current ongoing
Certified Case Manager (CCM) – 1993 to present
Certified Rehabilitation Registered Nurse (CRRN) – 1992 to 2015
Certified Life Care Planner (CLCP) – 2000 to 2007
Certified Critical Care Nurse (CCRN)- 1986 to 2015
Section name
Letters of Reference furnished upon request
Timeline
utilization
Evolent
08.2018 - Current
Travel nurse case manager
South Austin St. Davids Medical Center
06.2013 - 05.2018
Care Coordinator- RN
Parkland Hospital
02.2013 - 06.2013
Nurse Manager for Utilization Review Department
07.2009 - 12.2012
Indian River Medical Center
01.2007 - 01.2012
Nurse Case Manager
01.2007 - 07.2009
Rehab Liaison
HealthSouth Rehabilitation Hospital
01.2005 - 01.2007
Case Manager, Consultant and Life Care Planner
Consulting & Life Care Planning, Inc.
01.2001 - 01.2005
A.S. Degree - Nursing Program (ADN)
Indian River Community College
Post Graduate Course of Study - Life Care Planning for Advanced Catastrophic Case Management