Kimberly Tollakson
Somerset
Summary
Advocated for patient health and wellbeing within a collaborative team care model. Partnered with physicians and healthcare professionals to achieve optimal patient outcomes. Demonstrated commitment to improving patient experiences through effective communication and teamwork.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Utilization Management Medicaid Appeals
Blue Cross Blue Shield of MN
Eagan
10.2023 - Current
- Reviewed clinical information, applying relevant policies to each request.
- Evaluated claims while adhering to established policy and criteria sets.
- Assess member appeals for enrollment in Restricted Recipient Program.
- Referred members needing assistance with health conditions to case management.
- Collaborated with physicians and leadership on cases requiring thorough review.
- Attended State Fair Hearings to provide necessary insights.
- Collaborate with leadership and other departments to improve processes
RN Care Coordinator
Bluestone Physician Services
Stillwater
01.2023 - 09.2023
- Coordination of MSC+ and MSHO population
- Initial assessment for new enrollees
- Reviewing current health needs, identifying goals, and developing individualized care plans and transitions of care
- Connecting members with resources and services
- Collaborating with medical care teams to ensure health care quality measures are met
- Use of utilization management tools to meet value based goals
Pre-Service Review
Blue Cross and Blue Shield of Minnesota
Eagan
06.2021 - 12.2022
- Review clinical information against medical policies to determine approval, drug and medical reviews for commercial lines of business, collaborate with physicians on cases unable to be approved by nursing, utilizing clinical judgement when sending reviews to like specialty versus internal medicine for review, re-consideration of determinations when additional information is received, assist providers with setting up the appeal process, follow-up with provider regarding clinical information necessary to make a determination on a prior authorization request.
RN Visit Nurse
Allina Home Care
St. Paul
04.2020 - 03.2021
- Evaluate patients for home care services, educate patients on diseases processes, medication management education, collaboration with home care team and physicians, and caregivers, develop plan of care for patient including goals and outcomes, wound care, labs, collaborate with community care management team of patient when applicable, utilize Epic for documentation and communicating with providers.
Registered Nurse
Good Samaritan Home Care
Little Canada
10.2018 - 10.2020
- Admissions, nursing visits, provide education to patients on disease process and management, communicate and collaborate with other members of the care team to produce the best outcome for the patient, wound cares.
RN Care Coordinator
Stillwater Medical Group
Stillwater
08.2015 - 04.2020
- Manage patients with multiple chronic medical conditions through telephone calls and meeting with patients during clinic visits, connecting patients to community resources, providing education to patients and family on disease process and management, working directly with physicians to manage their patient’s chronic medical conditions, assessing for additional home services if eligible, utilization of EPIC for documentation.
Registered Nurse Admissions
Integrated Home Care
St. Paul
01.2014 - 07.2015
- Assessment of patients for home care services, wound care, medication teaching, disease management teaching, collaboration with other members of the care team, communication with physicians on the plan of care and medication reconciliation, lab draws.
Pre-Service Review
Blue Cross and Blue Shield of Minnesota
Eagan
05.2012 - 12.2013
- Review clinical information against medical policies to determine approval, collaborate with physicians on cases unable to be approved by nursing, discuss with the provider and member reason for denial and appeal process, follow-up with provider regarding clinical information necessary to make a determination on a prior authorization request.
Registered Nurse
St. Joseph’s Hospital
St. Paul
12.2011 - 05.2012
- Care of post procedure pacemaker placement, CABG and angiogram patients, telemetry monitoring, collaborating with physicians, managing IV medications, preparing clients for cardiac procedures, educating patients on disease process and procedures.
RN Care Manager
St. Joseph’s Hospital
St. Paul
11.2008 - 04.2011
- Collaborate with physicians, care team, patients, and families to progress the care of the patient for discharge, determine if patient meets criteria for observation versus inpatient status, assist in anticipating discharge needs.
RN Case Manager
Blue Cross Blue Shield of Minnesota
Eagan
02.2006 - 10.2008
- Case management of Blue Cross Blue Shield employee group, work with providers on discharge planning, work with members in setting goals to improve their health and meet those goals, educate members on disease process and management, authorization of home care, hospice, and skilled nursing facilities.
RN Admission Nurse and Educator
Heartland Home Care and Hospice
Roseville
11.2004 - 02.2006
- Assess patients for home care services, blood draws, wound care, collaborating with the care team on plan of care, development of orientation program for new employees, education of new employees on Oasis and ICD-9 coding, education of new employees on policies and procedures, arrange preceptors for orientation.
RN Oncology
St. Joseph’s Hospital
St. Paul
01.2001 - 11.2004
- Charge nurse, chemotherapy administration, accessing and management of port-a-caths, management of PICC and central lines, collaboration with physicians, educating the patient and family on disease process and management, administering IV and oral medications, care of patients receiving radiation.
Allina Hospice Admission Nurse
Allina Home Care and Hospice
Roseville
05.2000 - 10.2001
- Assess and admit patients onto hospice services, educate patient and family on disease process and management, pain management teaching, collaborate with all members of the care team to obtain the best outcomes for the patient. Liaison at Abbott Northwestern Hospital for hospice and assist with transition from hospital to home with hospice services.
Education
Bachelor of Science Nursing Degree -
Rasmussen College
Minneapolis, MN01.2016
Associate Nursing Degree -
College St. Catherine’s
Minneapolis, MN01.1996
Skills
- EPIC charting
- Utilization management
- Care plan development
- Case management
- Clinical assessment
- Health education
Certification
MN Choice Assessor
Credentials
- Registered Nurse MN 1996
- Registered Nurse WI 2015
Timeline
Utilization Management Medicaid Appeals
Blue Cross Blue Shield of MN
10.2023 - Current
RN Care Coordinator
Bluestone Physician Services
01.2023 - 09.2023
Pre-Service Review
Blue Cross and Blue Shield of Minnesota
06.2021 - 12.2022
RN Visit Nurse
Allina Home Care
04.2020 - 03.2021
Registered Nurse
Good Samaritan Home Care
10.2018 - 10.2020
RN Care Coordinator
Stillwater Medical Group
08.2015 - 04.2020
Registered Nurse Admissions
Integrated Home Care
01.2014 - 07.2015
Pre-Service Review
Blue Cross and Blue Shield of Minnesota
05.2012 - 12.2013
Registered Nurse
St. Joseph’s Hospital
12.2011 - 05.2012
RN Care Manager
St. Joseph’s Hospital
11.2008 - 04.2011
RN Case Manager
Blue Cross Blue Shield of Minnesota
02.2006 - 10.2008
RN Admission Nurse and Educator
Heartland Home Care and Hospice
11.2004 - 02.2006
RN Oncology
St. Joseph’s Hospital
01.2001 - 11.2004
Allina Hospice Admission Nurse
Allina Home Care and Hospice
05.2000 - 10.2001
Bachelor of Science Nursing Degree -
Rasmussen College
Associate Nursing Degree -
College St. Catherine’s
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