Sheila Kane
Madison,WI
Summary
Registered nurse with a passion for outcome-oriented, evidence-based care. Experienced in hospital, managed care, clinic, and remote settings. Skilled in care management, utilization review, and psychiatric nursing. Self-directed and analytical, I thrive on new challenges.
Overview
38
38
years of professional experience
1
1
Certification
Work History
RN Case Manager III
Dean Health Plan; Dean Health Plan by Medica
Madison, WI
11.2018 - 12.2023
- Telephonic Case Management (CM) for clients in 4 states with acute and chronic medical or serious mental health conditions through engagement, assessment, motivational interviewing, education, care coordination, linkage, advocacy and support
- Employed knowledge of health plan benefits and disease management to enhance client self-management utilizing the appropriate level of services resulting in savings
- Assessment using EMR review, Epic, Cerner, interview and standardized scales
- Developed collaborative care plan with SMART goals
- Collaborated with primary care physicians, specialists, caregivers, and community resources to align case management goals with member’s overall treatment plan
- Managed caseload of 60+ complex case management and chronic care management clients
- Performed transitions of care (TOC) outreach within 48 hrs of hospital and post-acute care facility discharge to assess needs, prevent care gaps and reduce readmission risk
- Maintained compliance with HEDIS and CMS quality measures
- Participated in creation of website content for case management services and job aids to ensure adherence to quality measures as member of department education committee
- Met or exceeded departmental performance metrics annually.
RN Manager
UnityPoint Health Meriter Child and Adolescent Psychiatry
Madison, WI
04.2017 - 09.2018
- Free-standing 20 bed inpatient psychiatric unit with responsibility for leadership, training, operations, program development, compliance, quality, risk management, and safety
- Supervision of 70+ FTE’s: Assistant Nurse Manager, Clinical Specialist, Administrative Assistant, Occupational Therapy, Case Management, Behavior Health Specialists, Registered Nurses, Social Workers, and Security Guards with 24/7/365 accountability
- Collaborated with Finance Director to manage $11,000,00 annual operating budget within 2.5 % favorable margin
- Partnered with fundraising Foundation to identify opportunities for donor projects including therapeutic gardens, Movement Therapy, Yoga, sensory rooms and staff training
- Implemented Trauma Informed Care model, eliminating physical restraint practices
- Maintained regulatory compliance with survey readiness, passing Joint Commission and state surveys without contingencies
- Achieved CAHPS and Press Gainey patient satisfaction scores in top decile.
Manager Inpatient Psychiatry
Community Health System: Vista Hospital and MetroSouth Hospital
Waukegan and Blue Island, IL
06.2015 - 03.2017
- Managed 24 bed Adult and 15 bed Child /Adolescent inpatient units with 46 FTEs at Vista Hospital with responsibility for daily operations, process improvement, and programming
- Leadership and education of RN, SW, Psych Tech, and Case Management staff
- Implemented Value Based Care quality measures including EMR meaningful use (interoperability) CPOE, Patient portal, and patient education documentation workflows
- Transferred to MetroSouth Hospital Senior Behavioral Health, 10 bed med-psych program to manage EMR implementation
- Collaborated with IT to create documentation workflows for CMS and Joint Commission elements of performance and interoperability requirements
- Successfully advocated for RN/Psych tech FTEs to improve patient care, employee retention, and reduce avoidable staff injuries
- Provided free community education programs on aging and mental health
- Developed community relationships through outreach to assisted living and memory care facilities in the south Chicago area.
Manager of Behavioral Medicine
Rockford Memorial Medical Center
Rockford, IL
06.2014 - 06.2015
- 15 bed Adult inpatient psychiatric program with 37 FTE’s including RN, Psych Techs, Counselors, Social Work, Case Managers and Emergency Room Psych Assessors
- Successfully developed and implemented Milieu Management model with enhanced unit patient safety measures to meet Joint Commission survey RFI
- Collaborated with risk management to employ Truven Analytics program to track Hospital Based Inpatient Psychiatric Service (HBIPS) quality measures to monitor completeness of behavioral event documentation
- Developed workflow for transmission of discharge summary to outpatient provider improving quality measure metric from 78%- 96% compliance within 6 months of implementation
- Participated in development of behavioral health model for Population Health, Value Based Care within the ACO embedding a BH LCSW in each medical home to assess patients presenting with mental health concerns.
Interim Admissions Director
HCA Dominion Hospital
Falls Church, VA
05.2012 - 01.2013
- Department leadership of RN and SW team coordinating referrals and direct admissions for freestanding 112 bed psychiatric hospital with step down IOP and PHP programs serving the metro DC area with government agency and military contracts
- Accountable for managing and stratifying outcome of all referred admissions, obtaining payor prior authorizations, including Tricare, using InterQual admission criteria
- Lead daily Flash meeting with unit directors, senior leadership and UM to report intake and admissions data, review concurrent and retrospective UM cases, avoidable denials and appeals
- Initiated Performance Improvement Project involving Admissions, Registration and admitting units resulting in decreased transit time from “Door to Floor” by 30+ minutes.
Behavioral Health Manager
Aurora Sheboygan Memorial Medical Center
Sheboygan, WI
11.2009 - 08.2011
- Leadership of 3 state certified inpatient programs, Adult/ Geri-psych, AODA/Detox and Adolescent, with 50+ FTE’s
- Promoted from PRN RN to Interim manager then manager position through identification of opportunities for improved documentation
- Received accolades from Joint Commission Surveyor upon successful Full Survey without contingencies within 3 months of employment
- Partnered and contracted with 5 counties to accept patients on involuntary detention collaborating with law enforcement and Emergency Department personnel to create workflows to minimize patient time in custody
- Facilitated relations with county corporate council, mental health attorneys, court personnel and judges for weekly mental health court proceedings held within behavioral health unit
- Restructured programming to increase group therapy structure adding DBT group, gender specific CBT- based topic groups and implemented expectation for patient attendance through inclusive culture
- Developed strong working knowledge of Wisconsin mental health code statutes and patient’s rights.
Clinic RN
Fox Valley Children’s Medicine
Batavia, IL
01.1997 - 01.2007
- Physician owned primary care pediatric group serving children from birth to age 18
- Telephonic education, triage and care coordination
- Managed cadence scheduled appointments to optimize provider efficiency, prioritizing patients with acute needs and directing physician flow
- Educated parents and patients on child development and health care topics
- Coordinated referrals to specialists, facilitated hospital admissions and outpatient procedures
- Performed in-office lab draws/ tests administered vaccines and treatments and maintained CLIA and OSHA inspection readiness
- Collaborated with physicians, RNs, and reception to provide excellent patient care resulting in a high degree of patient satisfaction and retention.
Psychiatric RN III
Saint Joseph Hospital
Elgin, IL
01.1992 - 01.1994
- Direct patient care for acute patients including therapeutic group facilitation, milieu management, behavioral management and de-escalation intervention, medication administration and monitoring and multidisciplinary team collaboration.
Psychiatric RN III to RN Manager
Camelback Hospital System
Scottsdale and Phoenix, AZ
01.1986 - 01.1992
- Provided inpatient psychiatric nursing care for children and adolescents ages 5-18 as member of multidisciplinary team using primary RN model
- Developed and implemented programming with focus on milieu and behavioral modification through positive reinforcement for children ages 5-12
- Promoted to Program Manager and collaborated with Psychiatric Medical Director on project to design and open a unit for children ages 5-12, in state custody with behavioral disorders precluding successful foster placement who would benefit from longer term treatment
- Managed and mentored RN, Psych Tech, Activity Therapy, Occupational Therapy staff to build program focused on developing patient resilience through interactive positive adult role modeling, collaborative play, and expressive therapies to promote positive interaction and coping strategies.
Utilization Manager- Behavioral Health
Dean Health Plan; Dean Health Plan by Medica
Madison, WI
- Utilized clinical knowledge and Milliman Care Guidelines (MCG) to conduct prospective and concurrent review for behavioral health/ AODA inpatient admissions to determine appropriate level of service and length of stay based on medical necessity
- Reviewed BH outpatient service requests using MCG and internal medical policies to review requests for IOP or PHP programs or services including ECT, TMS, and neuropsychological testing
- Referred potential denials to Medical Director, facilitated peer review, prepared approval, and denial communications with timely notification to service providers and clients
- Realized significant savings from appropriate level of service and length of stay determinations, resulting in recognition by UM Senior Leadership
- Maintained compliance with NCQA, Medicaid and Medicare quality measures and rules
- Introduced multidisciplinary team rounds between UM and CM and Medical Director to facilitate identification of high-risk patients and ensure coordination of services.
Education
BSN -
Arizona State University
12.1985
Skills
- Utilization Management
- Case Management
- Chronic Disease Management
- Remote Telephonic Work
- Population Health and Value Based Care
- Collaborative Care Planning
- Patient Education
- Care Coordination
- Discharge Planning
- Accurate Documentation
- HEDIS and CMS compliance
- HIPAA Compliance
- Milliman Care Guidelines, InterQual
- Psychiatric Nursing
- Leadership and Management of Inpatient Psychiatric programs
- Budget Management
- Program Development
- Healthcare Regulation
- Continuous Improvement
- Community Education and Outreach
- Microsoft Office
- EMR, Epic, Cerner, Healthcare Applications
- Clinic Nursing
- Direct Patient Care
- Immunizations and Vaccinations
- Multidisciplinary Team collaboration
- Medication Management
- Written Communication
- Interpersonal Communication
- Analytical Skills
- Problem-solving aptitude
- Adaptability and Flexibility
- Compassionate and Caring
- Scheduled for CCM exam in Dec 2024
Certification
- FEMA HICS
- NIMS
- CPI instructor 2017-2020 (inactive)
Scheduledexam
CCM exam Dec 2024
Personal Information
Title: BSN, RN
Timeline
RN Case Manager III
Dean Health Plan; Dean Health Plan by Medica
11.2018 - 12.2023
RN Manager
UnityPoint Health Meriter Child and Adolescent Psychiatry
04.2017 - 09.2018
Manager Inpatient Psychiatry
Community Health System: Vista Hospital and MetroSouth Hospital
06.2015 - 03.2017
Manager of Behavioral Medicine
Rockford Memorial Medical Center
06.2014 - 06.2015
Interim Admissions Director
HCA Dominion Hospital
05.2012 - 01.2013
Behavioral Health Manager
Aurora Sheboygan Memorial Medical Center
11.2009 - 08.2011
Clinic RN
Fox Valley Children’s Medicine
01.1997 - 01.2007
Psychiatric RN III
Saint Joseph Hospital
01.1992 - 01.1994
Psychiatric RN III to RN Manager
Camelback Hospital System
01.1986 - 01.1992
Utilization Manager- Behavioral Health
Dean Health Plan; Dean Health Plan by Medica
BSN -
Arizona State University
Similar Profiles
Nathan HeppNathan Hepp
Configuration Coordinator at Dean Health Plan/MedicaConfiguration Coordinator at Dean Health Plan/Medica
Caitlin JohnsonCaitlin Johnson
Document Management Specialist at Dean Health Plan/MedicaDocument Management Specialist at Dean Health Plan/Medica
Revanth KasulaRevanth Kasula
ServiceNow Developer and Admin at Dean Health PlanServiceNow Developer and Admin at Dean Health Plan
Thomas "Mason" WilliamsThomas "Mason" Williams
Pharmacist at Walgreens Boots AlliancePharmacist at Walgreens Boots Alliance
Ella CookElla Cook
Lifeguard at City of MadisonLifeguard at City of Madison