Lily Sanford
Summary
Accomplished Inpatient Case Manager at Children's Hospital Colorado, adept in HIPAA Compliance and fostering strong relationships. Spearheaded process improvements, enhancing patient transition efficiency. Expert in discharge planning for complex comorbid pediatric patients with and without financial resources. I have experience in both care coordination and utilization review. I have experience with both InterQual and MCG UR criteria tools in EPIC online documentation. I excel in multitasking and maintaining a positive attitude. I am self directed with a strong work ethic ensuring high-quality patient care and streamlined case management processes which include utilization management.
Overview
41
41
years of professional experience
1
1
Certification
Work History
Inpatient Case Manager
Childrens Hospital Colorado
04.2016 - Current
- Collaborates with physicians to secure individualized complex home care planning needs, ensuring optimal transition of care from a critical care setting to home or complex hospice care.
- Reduce discharge delays by identifying comprehensive discharge coordination needs with multidisciplinary teams.
- Participate in process improvement work groups to streamlined case management discharge planning processes for increased efficiency and improved patient experiences.
- Facilitate smooth transitions and critical medical transports between healthcare settings by effectively communicating with all relevant parties.
- Coordinate discharge planning upon admission to ensure a seamless transition from acute and critical care hospitalization to home or other healthcare facilities.
- Educate patients and families on available resources and support services, empowering them to make informed decisions about their home medical support options.
- Maintained accurate electronic documentation of all case management activities, ensuring compliance with regulatory standards.
- Obtain authorization with insurance companies to secure appropriate coverage for patients, minimizing out-of-pocket expenses.
- Collaborate and communicate with insurance verification departments to reduce financial and reimbursement penalties
- Update accommodation codes and level of care mismatches with all patient admission and transfers to PICU
CCBD Case Manager
Childrens Hospital Colorado
01.2006 - 01.2016
- Case Management Care Coordination discharge planning for Oncology, BMT and Hematology patient population involving complex infusion, enteral and nursing and hospice home needs, medication prior authorization, and medical transport.
- Prior authorization of scheduled Chemotherapy inpatient admissions
- Utilization Review and documentation
CICU Staff and Charge RN
Childrens Hospital Colorado
03.1998 - 01.2006
- Staff and Charge RN roles for CICU patient population
- Preceptor in the orientation program for new staff
- Swanz Ganz and hemodynamic Monitoring Clinical Educator for the CICU orientation program
PICU/CICU Staff RN and Charge
Childrens Hospital Colorado
01.1989 - 03.1998
PICU Staff RN and Charge RN
Charlotte Memorial Hospital
09.1983 - 04.1988
Education
Bachelor of Science - Nursing
University of North Carolina At Chapel Hill
Chapel Hill, NC05.1983
Skills
- Case Evaluation
- HIPAA Compliance
- Patient confidentiality
- Clinical Documentation
- Discharge Planning
- Utilization review
- Problem-Solving
- Positive Attitude
- Organization and Multitasking
- Quality Improvement
- Patient Assessments
- Relationship Building
- Emotional awareness
- Email and Telephone Etiquette
- Case Management
Accomplishments
- Current Professional contributions:
- 2024 I am a member of the EPIC Superuser Team
- 2024 I have accepted an invitation by Dr Kisten Eisenman to collaborate with the CHCO Palliative Care Team in the development of a Hospice Discharge Checklist
- 2024 I am a member of the National Epic CCM Steering Board - Discharge Coordination Application Projects. Non CHCO/EPIC Headquarters board membership accepted via application only for 2023 through 2024.
- I have Oriented new CPCU/CICU/PICU & Flex staff
- I am a consistent member of the Peer Interview team
- 2004 Daisy award nominee for CCBD Case Management Role
- Original Magnet Status contributor for CHCO
Certification
- Licensed RN
- Certified Certified Case Manager (CCM)-current through 2028
- BLS
Timeline
Inpatient Case Manager
Childrens Hospital Colorado
04.2016 - Current
CCBD Case Manager
Childrens Hospital Colorado
01.2006 - 01.2016
CICU Staff and Charge RN
Childrens Hospital Colorado
03.1998 - 01.2006
PICU/CICU Staff RN and Charge
Childrens Hospital Colorado
01.1989 - 03.1998
PICU Staff RN and Charge RN
Charlotte Memorial Hospital
09.1983 - 04.1988
Bachelor of Science - Nursing
University of North Carolina At Chapel Hill
- Licensed RN
- Certified Certified Case Manager (CCM)-current through 2028
- BLS
Similar Profiles
George JohnsGeorge Johns
CCMA at Childrens Hospital ColoradoCCMA at Childrens Hospital Colorado
Marissa MagallanesMarissa Magallanes
PFSS at Childrens Hospital ColoradoPFSS at Childrens Hospital Colorado
Wendy MooreWendy Moore
Nurse Consultant at Childrens Hospital ColoradoNurse Consultant at Childrens Hospital Colorado