Pamela (Pam) Sowers
Great Falls,MT
Summary
Skilled case management professional and well-qualified Registered Nurse effective at collaborating across disciplines to meet patients' needs. Knowledgeable about disease management protocols and nursing standards. Detail-oriented and focused on coordinating optimal care and maximize resource utilization for neonatal patients. Experienced in managing health care services to meet the needs of all patients with high-quality and cost-effective medical care. Organized and hardworking. Active nursing licenses- California, Hawaii, Minnesota, Montana, Ohio, Washington
Overview
30
30
years of professional experience
Work History
RN Case Manager
Anthem Blue Cross
Woodland Hills, CA
06.2021 - Current
- I currently work as an RN Case Manager doing Utilization Management reviews for commercial polices in multiple states such as California, Colorado, Montana, New York, Tennessee, Texas, and Washington. As Montana is now a compact state, my active nursing licenses are in Montana and California. I use MCG for UM reviews. I work with a team that includes a discharge planner, case manager and a social worker. My role is very similar to my prior UM positions, but in addition to NICU cases, I also work High Risk OB. I was asked by my manager in Jan. 2023 to be a NICU representative to work with a new Artificial Intelligence (AI) team to provide NICU expertise and feedback during a ground level initiation for this program. I'm currently a super user for this program, being a resource for our team / staff and have recently been asked to expand to the High Risk OB AI initiation. I volunteer to flex or work extra shifts on the weekends or holidays. I work about 12 extra hours ( 3 - 4 hour shifts) per month. I live in the Mountain Time Zone, but work Pacific Standard Time as my current place of employment is in California. I have a great relationship with my manager, senior lead, co-workers and physicians.
Nurse Case Manager
Optum Health
10.2014 - 06.2021
- I worked as an RN Case Manager for UM and CM until these roles divided in the company
- I agreed to transition to CM at that time and worked in this role approximately 9 months before transitioning to a full UM position
- I was trained in MCG and Interqual for UM reviews
- I managed community and state (Medicaid) policies for California, Hawaii and Washington, but have performed this role in multiple states including Arizona, Oregon, Louisiana, Mississippi and Texas
- I was selected by my manager to start a newborn pilot study within the UM role effective 6/1/21
- In my role as a case manager, I assessed comprehensive medical and personal needs of patients and care givers to effectively formulate interdisciplinary plans of care, handled hostility and emotional distress with a level-headed approach and worked to find appropriate solutions, coordinated with medical staff, social workers, health plan CM's and discharge planners to meet unique needs of each patient and ensure a safe discharge home
- I followed disease management processes and established protocols to consistently meet plan of care goals
- I addressed concerns regarding medical necessity with medical directors as well as facility staff in a timely manner
- I scored high on audit scores and work efficiently daily to complete the work assigned
- I developed power points and spread sheets to improve work flow and provide consistency that can be shared with teammates.
RN Case Manager
Alere Health
01.2005 - 10.2014
- Implemented Alere (Paradigm) care management program in Montana starting in Jan 2005
- I worked diligently to establish a successful case management program in the state as well as built professional relationships with the Montana facilities, NICU staff, and case management staff
- I did both on site and telephonic case management reviews
- I established a professional on-going relationship with BCBS MT and participated in person in their yearly value assessments
- Implemented case management program with Coventry health care of Virginia in May 2013
- I worked directly with the health plan case managers to receive neonatal reviews
- I was responsible for explaining the guideline processes with daily reviews
- I worked telephonically doing case management reviews in California, Michigan, Minnesota, and Virginia
- I participated in weekly rounds with the medical director, providing a complex update on current clinical status, barriers to discharge, proactive case management and updates on social barriers to discharge or parent teaching.
Registered Nurse, NICU
Benefis Healthcare
Great Falls, MT
01.1994 - 01.2005
- Entered the NICU immediately after graduation from nursing school
- Less than one year later, I accepted a position as a NICU Flight Nurse
- I was in charge of stabilizing sick babies in remote locations, communicating with physicians and nurses from remote towns, providing report to the receiving neonatologist and executing orders
- I attended high risk deliveries, arranged transports, performed intubations and placed PICC lines
- I was a preceptor for many new employees
- I was on the Vermont Oxford Committee and presented research projects.
Education
Bachelor of Science Nursing -
Montana State University
Prior Certifications
- RNC
- ANCC Case Management
- BLS
- ACLS
- NRP
- STABLE
Timeline
RN Case Manager
Anthem Blue Cross
06.2021 - Current
Nurse Case Manager
Optum Health
10.2014 - 06.2021
RN Case Manager
Alere Health
01.2005 - 10.2014
Registered Nurse, NICU
Benefis Healthcare
01.1994 - 01.2005
Bachelor of Science Nursing -
Montana State University
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