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Registered Nurse Case Manager

Location:
United States
Posted:
June 26, 2014

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Resume:

Linda Hall

P.O. Box ****, Sun City, AZ ***** Cell:602-***-****

Objective:

To obtain a challenging and responsible position which will utilize my acquired skills, abilities,

knowledge, and education with a company offering educational and advancement opportunities.

Summary of Qualifications: Background includes clinical and administrative nursing experience

in numerous departments to include Cardiology, General Medicine, Research ( Endocrinology),

Transplant, ER and ICU

Experience:

Oct 2013-present Protocol Staffing Agency (Providence Little Comp of Mary, Torrance, CA-

01/2014-04/2014; CM all units and ED; Sharp Memorial Hospital, San Diego, CA- 04/2014-

06/2014; CM all units). Discussed cases w/MD’s if not meeting inpt criteria. Obtained LOC

status change orders and ordered w/in pt chart (electronic medical record).

May 2010-Feb 2012 Banner Health Plan (Banner Good Samaritan Medical Center, Phx, AZ).

UR, DCP for inpt population w/varied insurance companies. Applied InterQual criteria for

admission and concurrent stay reviews. Contacted Physician Advisors and other medical review

comp related (EHR) reviews not meeting criteria and/or level of care. First held MD-MD

conversations re: criteria and requested further information to support/unsupport denials/

approvals for admissions/continued stays w/outside insurance companies as well as Banner

Health.

Feb 2010-May 2010 Cross Country TravCorps (Banner Good Samaritan Hosp, Phx, AZ. CM, dc

planning for various units as needed (have worked the ortho and ICU thus far)

Jan 2006-Feb 2010 Kaiser Permanente, Modesto, CA (Kaiser) UR in DME dept; refer requests

for UM physician review if needed, based on KP formulary guidelines. Audit of patient files;

audit of benefit/medical necessity denials.

Oct 2004-Jan 2006 Nursefinders, Sacramento, CA. (Blueshield CA, El Dorado Hills, CA).

UR; continuity of care for state run insurance program (CalPERS). (Kaiser, Stockton, CA, and

Kaiser, Modesto, CA). UR/Discharge planning at contracted hospital in Stockton, CA; Interqual

criteria. UR for DME dept in Modesto, CA. Blood glucose, cholesterol screening located in

WalMart, Sacramento, CA

Jan 2004-Oct 2004 Metroplex Surgicare, Bedford, TX.

Staff nurse in preop for ambulatory surg center (5 suite OR), Performed health assessments,

EKG’s, phlebotomy; reviewed cases w/anesthesia as needed, if questionable history, prior to OR.

QA/audit of all patient charts. Would meet w/MD’s regarding needed information/signatures

after further review of clinical records.

April 2003 –Oct 2003 Action Health Care Management, Phoenix, AZ.

UR/CM nurse for multiple insurance groups. Using M&R, Interqual criteria, reviewed med nec

stays/procedures and preauth of such; referred for med review as needed.

Jan 2002-Jan 2003 University Health System, San Antonio, TX.

UR/CM/Staff Nurse for the ER Level 1 trauma center, UR/CM: conferred w/ins comp re: adm,

LOS; dc planning on pts in ER. As staff nurse: total pt care: pt assessments,IV’s, EKG’s; asst

phys w/minor surg procedures, transferred/dc’d pts.Completed study/audit of ER wait times

(from triage to disposition).

Oct 2000 – Nov 2001 RN/UR, NIX Health Care System,San Antonio, TX

UR/dc planning/transferring among other health care facilities; obtaining authorizations with

insurance comp. Work closely with physicians and other health care team members.

Dec 1997 – Apr 1998 Registered Nurse, U.S. Naval Hospital, Okinawa, Japan

Civilian staff nurse of a 6 suite emergency room. Duties included patient assessments, triage

(new arrivals as well as telephone calls), administration and monitoring of medications, IV’s.

Additional responsibilities included assisting physicians with minor surgical procedures.

Aug 1995 – Sept 1997 Foundation Health Federal Service, San Antonio, Texas.

Healthcare Finder/Discharge Planner, Scheduled appointments for invasive and noninvasive

procedures and ECG’s cardiac catheterizations for the Cardiology Department. Also scheduled

patients for the Optometry, Dermatology, and Orthopedic departments, as well as other specialty

clinics. Managed and followed patients from admittance to discharge for the bone marrow

transplant, General Medicine, and ICU areas. Acted as a liaison between hospital staff and

committee regarding treatment choices and/or length of stay. Arranged for any patient needs

upon discharge (home health, medical equipment etc.).

Aug 1994 – Aug 1995 Diabetes Glandular Disease Clinic, San Antonio, Texas.

Research Nurse/CM, Followed pharmaceutical company procedural protocols for the treatment

of diabetes for multi-physician endocrinology clinic. Responsibilities included recruiting,

scheduling, and monitoring of patients for various studies. Provided patient education regarding

all aspects of participation in a study (each protocol varied from 12– 80 patients). Directly

supervised a medical assistant.

Feb 1991 – Sept 1993 University of Arizona, Tucson, Arizona.

Staff Nurse Provided quality patient care, including IV fluid & meds for a 4 bed observation unit

in a General Medicine and Acute Care Center for patients 18 years and older. Conducted and

assisted with assessments, education, minor emergencies, and minor surgical procedures.

Scheduled appointments and follow-up visits.

Apr 1990 – Feb 1991 Women’s Surgical Center, Tucson, AZ

Pt care for 2 OR suite, 4 bed recovery room; GYN procedures, birth control counseling for all

ages.

Jan 1990 – Apr 1990 Tucson General Hospital, Tucson, AZ

Staff nurse for telemetry unit.

RN license current in.AZ; inactive in CA, TX, NV; HI (able to rreactivate if needed);. ADN from

Pima Comm College, Tucson, AZ, Graduated Dec 1989. In process of obtaining BSN through

WGU.



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