Susanna Wildt

Primary Responsibilities: Monthly auditing of case management records for long term support services, Medicare DSNP, and MMP programs. Focused auditing to ensure documentation requirements are met for NCQA factors, CMS regulations related to DSNP Mode of Care, MMP Medicare, and Medicaid programs. Using state regulatory requirements. Analyzation of collected data for quality improvement with recommended actions.

Primary Responsibilities: Identifying gaps or barriers in treatment plans to assist and provide necessary services and resources. Provided patient education to assist with self-management. Coordinating services as needed (home health, DME, PCP appointments, Rehab etc.) as well as concurrent reviews. Exhibiting patient advocacy in a dynamic environment requiring strong computer and software navigation skills. Efficient, productive and thorough dealing with members over the phone. Directed appropriate preventive and rehabilitative nursing processes and protocols.

Primary Responsibilities: Multiple positions held during this extended time frame in both CM/DC planning and CDI.

CDI: Implemented the first CDI program at this facility and executed monthly reports for financial, quality and productivity impact. Formulated compliant Physician queries to accurately support the patients SOI and ROM including specificity of principle diagnosis, associated co-morbidities or complications and procedures. Proficient in ICD-9 and ICD-10.

CM/Discharge Planning: Orchestrated the implementation of a new CM Department (including UR) - there was no CM or UR at this facility prior. Primarily responsible for coordination of resources and services starting from admission to discharge including all aspects of discharge planning in response to individual patient needs and fiscal realities. Daily case load averages 18-25 patients; National average at the time was for this position was 15/1.

Previous Experience in Wound Care, CCU, Charge Nurse, ICU, ER and Rehabilitation working as a Registered nurse