Sandra Ellis MSN CCM
Las Vegas,NV
Summary
Motivated professional with over 20 years nursing experience and record of success with process improvements. Solid history balancing team performance, patient service targets, and business objectives. Dedicated to working closely with employees, department leaders breaking silos, and optimize procedures. Polished in evaluating employee performance, accountability, and engagement fostering retention. Forward-thinking Leader with comprehensive experience implementing new processes and managing and planning innovations. Bringing outstanding problem-solving and abilities paired with in-depth knowledge of policies and procedures as it pertains to optimal patient care especially in Utilization Review/Case Management.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Manager/ CM Utilization Review and Discharge
UC San Diego Health
San Diego, CA
2023.11 - Current
- Established processes to ensure efficient workflow in Care Management
- Filled in as Interim Director providing leadership during times of organizational change or crisis situations.
- Resolved conflicts between employees by providing guidance on company policies and procedures.
- Ensured compliance with hospital regulations and policies.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement.
- Conducted performance reviews for team members. Care Manager Supervisor, Care Managers, and Care Manager Associates.
- Coached, mentored, and trained team members in order to improve their job performance related to utilization review and discharge planning/transition and readmission prevention, acknowledging social determinants of health.
- Led team meetings and one-on-one coaching sessions to continuously improve performance.
- Hired Care Managers filling all open position gap identified
Market Director Utilization Review
VHS
Las Vegas, NV
2020.02 - 2023.11
- Covered 5 acute care hospitals, 1 acute access hospital, and 1 free standing urgent care facility
- Provided leadership in developing innovative ideas for promotional department and organization initiatives.
- Crisis Management.
- Developed and created a full internal department restructure and staff hybrid program.
- Provided leadership in developing innovative ideas for improvement and process development.
- Analyzed payer trends and denial activities, identify opportunities for growth and improvement.
- Coordinated with internal teams to ensure successful execution of UR, Denial Management activities.
- Identified potential partnerships with key stakeholders and fostered department collaboration in an effort to remove silos
- Generated reports on campaign performance and provided recommendations for improvement.
- Promoted employee satisfaction and retention. Hired and completed annual employee reviews.
Care Management Consultant
HCS Consulting Co.
Boston, MA
2023.08 - 2023.11
- Offered care management and utilization review consulting to a community hospital in Boston, MA, opening an observation unit.
- Identified areas of risk within existing operations and devised mitigation strategies.
- Participated in meetings discussing research findings, highlighting results, and potential improvement strategies.
- Trained personnel on new procedures related to projects undertaken in order to successfully open the observation unit, working closely with the CM Director, UR department, CNO, Case Managers, ER staff, and physicians.
- Evaluated internal systems and prepared training initiatives to mitigate ongoing problems.
- Observation unit successfully opened first week November 2023 with 10 dedicated observation beds to start
DRG Nurse Auditor
Firm Law Group
Las Vegas, Nevada
2021.07 - 2022.01
- Remote
- Pulled patient records, analyzed the medical plan of care and treatment, and supported the documentation of ranking DRG codes with insurance payers.
- Knowledge of detailed patient clinical information using standard classification systems, evidence-based tools, and research—InterQual, MCG, and up-to-date clinical research.
- Prepared reports summarizing audit results for payer reviews to overturn denials and offer reconsideration.
- Prepared comprehensive written reports summarizing findings from completed audits.
- Interpreted coding guidelines for accurate reimbursement from third-party payers.
Manager/ Interim Director Care Coordination
Dignity Health
Henderson , NV
2016.10 - 2020.02
- Provided leadership during times of organizational change or crisis situations.
- Resolved conflicts between employees by providing guidance on company policies and procedures.
- Leadership for Case Managers, Social Workers, Care Manager Assistants, and Administrative Assistants.
- Ensured compliance with all applicable laws, regulations, and healthcare standards.
- Monitored budgets and expenditures to ensure cost-effectiveness while maintaining quality standards.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement while managing in a union environment.
- Scheduled interviews for potential candidates and conducted reference checks prior to hire.
- Conducted performance reviews for team members.
- Created a multidisciplinary round, which improved LOS and provided patient flow efficiency.
Nurse Shift Manager and PCC-Patient Care Coord.
Dignity Health
Henderson, NV
2012.09 - 2016.08
- Coordinated with physicians, other healthcare professionals and hospital departments to ensure quality patient care.
- Managed and assigned nursing staff for shift operations.
- Provided direct supervision of nursing personnel during shift assignments.
- Acted as a liaison between patients and families and administration when necessary.
- Served as a resource person for staff seeking guidance on difficult cases or situations.
- Monitored daily operations of the unit and department including staffing levels, safety practices, equipment maintenance.
- Ensured compliance with all applicable state and federal laws regarding nursing practice.
- Participated in interdisciplinary rounds with other healthcare providers to coordinate patient care services.
- Identified potential problems and implemented corrective action plans to improve efficiency.
Case Manager: Critical Care, IMC, and Medical Surg
VHS and Dignity Health
Las Vegas , NV
2011.05 - 2012.09
- Collaborated with other service providers to ensure continuity of care for patients.
- Performed Utilization Review and Discharge Planning.
- Participated in interdisciplinary team meetings to discuss treatment options.
- Developed individualized care plans with input from patients and their families.
- Provided referrals to appropriate health care providers or other community resources.
Critical Care RN
Spring Valley Hospital
Las Vegas , NV
2009.04 - 2012.05
- Carried out physician orders regarding tests or medication administration accurately and safely for critically ill patients.
- Performed physical examinations and assessments of patients' medical histories.
- Educated patients on health maintenance, disease prevention, and treatment options.
- Maintained accurate documentation of patient records in accordance with HIPAA regulations.
Asst. Nursing Director
Desert Care Center SNF
Las Vegas, NV
2008.03 - 2009.05
- Developed and implemented strategic plans to ensure quality patient care in a Skilled Nursing Facility.
- Managed RNs, LPNs, and CNAs in 150+ patient bed including vent unit.
- Recruited, trained, supervised, evaluated, and mentored staff.
- Ensured compliance with all relevant regulations, policies and procedures.
Critical Care RN Traveler
Aureus Medical and UMC
Las Vegas, Nevada
2006.09 - 2008.03
- Provided direct care to critically ill patients in a variety of clinical settings. Medical, Neuro, Surgical, Burn, ICU units, and ICU ED overflow unit.
- Monitored patient vital signs and administered medication as prescribed by physician.
- Maintained accurate records of patient medical histories, treatments, medications, test results.
- Performed assessments of physical, mental, and emotional conditions of patients.
- Assessed changes in patient's condition during shift assignments and reported findings accordingly.
Education
Certificate of Completion - 2019 Formal Leadership Training
Duke University
Durham, NC- Online 2019-12
Master of Science - MSN with a focus on APN
South University
Savannah, GA2016-06
Bachelor of Science - Nursing
South University
Savannah, GA2014-05
Skills
- Performance Management
- EHR- Cerner, Epic, Allscripts
- Staff Development
- Complex problem-solving
- Cross-functional team management
- Performance Evaluations
- Promoting Key Performance Indicators
- Crisis Management during pandemic and hospital cyber-attack
- Coordinate, analyze, make sound decisions, and meet deadlines in a detail-oriented manner
Accomplishments
- Daisy Award Winner
- Humankindness Award Nomination
- Member of Community Board member for Community Awards and Project Improvement in the Las Vegas and Henderson area
Certification
- Nevada and California Registered Nurse License
- CCM Certification
References
References available upon request.
Timeline
Manager/ CM Utilization Review and Discharge
UC San Diego Health
2023.11 - Current
Care Management Consultant
HCS Consulting Co.
2023.08 - 2023.11
DRG Nurse Auditor
Firm Law Group
2021.07 - 2022.01
Market Director Utilization Review
VHS
2020.02 - 2023.11
Manager/ Interim Director Care Coordination
Dignity Health
2016.10 - 2020.02
Nurse Shift Manager and PCC-Patient Care Coord.
Dignity Health
2012.09 - 2016.08
Case Manager: Critical Care, IMC, and Medical Surg
VHS and Dignity Health
2011.05 - 2012.09
Critical Care RN
Spring Valley Hospital
2009.04 - 2012.05
Asst. Nursing Director
Desert Care Center SNF
2008.03 - 2009.05
Critical Care RN Traveler
Aureus Medical and UMC
2006.09 - 2008.03
Certificate of Completion - 2019 Formal Leadership Training
Duke University
Master of Science - MSN with a focus on APN
South University
Bachelor of Science - Nursing
South University