Rebecca Tapp
Greenfield,Indiana
Summary
Accomplished Registered Nurse with acute care, long term care, and managed care leadership.experience highlighted, Led teams to positive outcomes for Utilization and Case Management outcomes within Medicaid, Medicare, and Commercial Populations. Extensive history including clinical nursing, clinical oversight, training, program development and implementation, process development and improvement, budget responsibility, regulatory quality compliance, as well as exceeding customer and regulatory expectations. Committed to developing and maintaining a positive work culture while combining cost control and nursing best practices. Achieved organizational accreditations under JCAHO, NAEYC, NAFCC, TJC, NCQA, and URAC guidelines. Achieved certification as a CPHM (Certified Professional Healthcare Management in 2008. Certified Milliman user and proficient in InterQual clinical criteria.
Overview
38
38
years of professional experience
Work History
Utilization Management Program Director
Health Care Excel
07.2014 - Current
- Given additional responsibilities for 50+ certified coders.
Utilization Management Program Director
Health Care Excel
05.2014 - 07.2014
- Responsible for developing a Utilization Management Program
- Developed and implemented Policies and Procedures for the UM program
- Developed a Quality Tool to conduct audits for Medical Necessity and Coding
- Developed and implemented a training program for physicians, RNs, and Coders
- Created a Dashboard Report for UM activities
- Clinical oversight of Production and Quality for 75 RN Contract Nurse Reviewers.
- Responsible for assuring Utilization Management compliance and staff education for URAC Accreditation.
Director of Case Management
Centene/ Managed Health Services
12.2008 - 05.2014
- Responsible for Case Management Activities for over 200,000 Medicaid lives with a Case Management staff of licensed nurses and non-clinical staff.
- Responsible for assuring case management compliance and staff education for NCQA Re-Accreditation
Utilization Management Nurse
Hancock Regional Hospital
06.2007 - 12.2008
- Utilization Management Nurse for entire hospital with responsibility for evaluating all hospital patients for appropriateness of status, gathering medical data and sending medical reviews to government agencies or insurance companies.
- Utilized InterQual criteria to determine medical necessity, appropriate level of care and appropriate length of stay
- Successful in decreasing the number of denials and increasing the number of denials overturned through an appeal process.
- Responsible for collaborating with Physicians and Case Managers to assure appropriate length of stays.
- Maintained data utilizing Excel spread sheets, regarding Discharge Delays, Readmissions within 30 days, Denials, Appeals, Notices, and Observation Hours
- Presented information regarding collected data via Power Point Format to the Utilization Management Committee.
- Provided education to physicians regarding Utilization Management issues
RN Charge Nurse
Hancock Regional Hospital
04.2003 - 06.2007
- Charge Nurse for a 12-bed acute Geriatric Psych unit with responsibility for overall patient care through a team of nurses and mental health technicians.
RN Indiana Regional Child Care Health Consultant
Indiana University
05.2004 - 07.2005
- Provided coaching and professional development for individuals involved in the provision of services to early care and education providers to improve the standards of care on a state wide level.
- Developed and implemented training programs regarding the health, safety, and nutrition for children.
- Conducted focused surveys to assist facilities with compliance issues regarding health, safety, and nutrition.
- Researched and developed new policies and procedures and initiated revisions in existing documents to ensure Performance Improvement in the state.
- Provided seminars regarding health, safety, nutrition, and risk management in collaboration with the National Association for the Education of Young Children, Indiana Association for the Education of Young Children and National Association of Family Child Care Homes.
Director of Nursing
Extendicare Healthcare
12.1998 - 12.1999
- Promoted to Director of Nursing.
- Twenty-four hour accountability for 40 bed long-term care unit with 20 nursing staff
- Completed MDS/Care Plans for all residents.
- Achieved deficiency-free survey
Director of Nursing
Norton Healthcare East
12.1993 - 11.1998
- Promoted to Director of Nursing.
- Twenty-four hour accountability for a 122 bed SNF/ICF facility with 80 nursing staff.
- Achieved 2 deficiency-free surveys.
- Budget responsibility
RN Charge Nurse
Community Hospital East
12.1992 - 12.1993
- Managed a 12-bed medical/surgical unit with high acuity patients
RN Director of Nursing
Cambridge Healthcare
10.1990 - 12.1992
- Twenty-four hour accountability for a 143-bed sub-acute facility with supervisory responsibility for over 100 nursing staff
- Achieved deficiency-free survey. State Board of Health chose facility for training of surveyors.
- Budget responsibility with successful Increased Medicare reimbursement for company by maintaining MDS and Care Plans at optimum levels interfacing directly with therapies.
RN Director of Nursing
Beverly Enterprises, Brandywine Manor
06.1987 - 10.1990
- Promoted to Director of Nursing
- Twenty-four hour accountability for this 132 bed Skilled Rehab Facility with 60 nursing staff
- Budget responsibility with successful Intermediate and Skilled Nursing Care bed reallocation maximizing reimbursement.
- Policy development and implementation
- Functioned as liaison with local, state and national organizations including Medicare and Medicaid
- Developed new-hire training program for orientation to facility and achieved Red Cross certification as Nurse-aide program trainer.
Education
Bachelor of Science -
Spalding University
Louisville, KY05.1987
Skills
- Utilization Management
- Case Management
- Disease Management
- Long Term Care Management
- Regulatory Compliance
- Training
- Accreditation
- Business Ownership
- Med/Surg
- Geriatric Psych
- Accreditation Experience
- Proficient in MS Word
- Proficient in Excel
- Proficient in Power Point
- Proficient in Visio
- Operations oversight
- Group and individual instruction
- Compliance management
Licenses Skills
- Indiana State RN license, #28100672A
- Certified Professional Healthcare Management (CPHM), 2008
- Certified Milliman User, 2009
- Certified CPR Instructor, 1997-2010
- JCAHO, NAEYC, NAFCC, TJC, NCQA, URAC
- Proficient in MS Word, Excel, Power Point, Visio
Timeline
Utilization Management Program Director
Health Care Excel
07.2014 - Current
Utilization Management Program Director
Health Care Excel
05.2014 - 07.2014
Director of Case Management
Centene/ Managed Health Services
12.2008 - 05.2014
Utilization Management Nurse
Hancock Regional Hospital
06.2007 - 12.2008
RN Indiana Regional Child Care Health Consultant
Indiana University
05.2004 - 07.2005
RN Charge Nurse
Hancock Regional Hospital
04.2003 - 06.2007
Director of Nursing
Extendicare Healthcare
12.1998 - 12.1999
Director of Nursing
Norton Healthcare East
12.1993 - 11.1998
RN Charge Nurse
Community Hospital East
12.1992 - 12.1993
RN Director of Nursing
Cambridge Healthcare
10.1990 - 12.1992
RN Director of Nursing
Beverly Enterprises, Brandywine Manor
06.1987 - 10.1990
Bachelor of Science -
Spalding University