Summary
Overview
Work History
Education
Skills
Certification
Awards
fluent in speaking, reading Mandarin Chinese
Languages
Timeline
Generic

Shan Sun

Monrovia,CA

Summary

Nurse Case Manager with valid State RN License. Solid clinical, utilization review and case management experience within managed care environment.

Overview

27
27
years of professional experience
1
1
Certification

Work History

Utilization Management

Inland Empire Health Plan
10.2023 - Current
  • Review medical records of patients who are under treatment for emotional or mental illness to ensure proper utilization of treatment resources; review patient records for proper case documentation, and medical necessity of treatment in relation to federal, state and county regulations
  • Familiar with Nationally recognized criteria such as Medicare Local Coverage Determination, Medicare National Coverage Determination, Milliman Care Guidelines, and Apollo Managed Care Guidelines/Medical Review Criteria.

Complex Care Manager

Inland Empire Health Plan
04.2022 - 10.2023
  • Work with a caseload of members with complex medical needs
  • Assist members with care coordination needs, Complete HRA assessment, enroll mbr to complex care program, develop individualized care plan
  • Communicate with mbr/family/ caregiver/provider
  • Coordinate with internal and external health partners to support mbrs comprehensive care needs
  • Participate in interdisciplinary care team meeting
  • Work with LVN care manager, care coordinators and other team mbrs by engaging in evidenced based communication strategies
  • Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.

RN supervisor

Monrovia Gardens Healthcare
07.2021 - 03.2022
  • Coordinate and supervise activities of nursing personnel
  • Develop and revise care plans, oversee patient-care operations, assign and monitor LVN/CNA and identifying and implementing quality improvements
  • Communicate with physicians/carry out orders, IV therapy.

RN

BALANCED LIVING HOME HEALTH
05.2018 - 12.2020

RN/ Case Manager

HAPPY HOME HEALTH SERVICES
10.2011 - 10.2013
  • Spit time in the office as well in the field with the nurses and patients.

RN

TENDER CARE HOMEHEALTH
11.2009 - 10.2011

Med-Surg RN

COMMUNITY HOSPITAL NORTH
10.2008 - 11.2009

Nursing Instructor

EVEREST UNIVERSITY
05.2007 - 09.2008
  • Provide classroom and clinical instruction in variety of nursing specialties: Med-Surg, Pediatric, and Psychiatric nursing.

Transplant Unit RN

TAMPA GENERAL HOSPITAL
10.2003 - 05.2007
  • Working at Transplant unit which is one of the busiest transplant centers in US, taking care of patients undergoing heart, lung, and liver, kidney, pancreas transplant (pre-op and post-op)
  • CCTN (Certified Clinical Transplant Nurse).

Teaching Assistant

COLLEGE OF NURSING, UNIVERSITY OF KENTUCKY
08.2000 - 05.2003

RN

GENERAL HOSPITAL OF TIANJIN MEDICAL UNIVERSITY (GHTMU)
07.1997 - 06.2000

Education

Master of Science in Nursing - Adult Clinical Specialist Track

UNIVERSITY OF KENTUCKY
Lexington, KY
05.2003

Bachelor of Science in Nursing -

TIANJIN MEDICAL UNIVERSITY
Tianjin, China
07.1997

Skills

  • Microsoft Word, Excel,PowerPoint, OneNote
  • MedHok (Care Prominence)
  • Utilization Management (Prior authorization)
  • Organization and Time Management

Certification

  • Basic CPR
  • ACLS
  • Telemetry
  • CCTN (Certified Clinical Transplant Nurse)
  • AAMCN certificate home study done Dec 2020

Awards

2002-2003 Hatchell Memorial Scholarship

fluent in speaking, reading Mandarin Chinese

fluent in speaking, reading Mandarin Chinese.

Languages

Chinese (Mandarin)
Native or Bilingual

Timeline

Utilization Management

Inland Empire Health Plan
10.2023 - Current

Complex Care Manager

Inland Empire Health Plan
04.2022 - 10.2023

RN supervisor

Monrovia Gardens Healthcare
07.2021 - 03.2022

RN

BALANCED LIVING HOME HEALTH
05.2018 - 12.2020

RN/ Case Manager

HAPPY HOME HEALTH SERVICES
10.2011 - 10.2013

RN

TENDER CARE HOMEHEALTH
11.2009 - 10.2011

Med-Surg RN

COMMUNITY HOSPITAL NORTH
10.2008 - 11.2009

Nursing Instructor

EVEREST UNIVERSITY
05.2007 - 09.2008

Transplant Unit RN

TAMPA GENERAL HOSPITAL
10.2003 - 05.2007

Teaching Assistant

COLLEGE OF NURSING, UNIVERSITY OF KENTUCKY
08.2000 - 05.2003

RN

GENERAL HOSPITAL OF TIANJIN MEDICAL UNIVERSITY (GHTMU)
07.1997 - 06.2000

Master of Science in Nursing - Adult Clinical Specialist Track

UNIVERSITY OF KENTUCKY

Bachelor of Science in Nursing -

TIANJIN MEDICAL UNIVERSITY

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Shan Sun