Christian (Cristine) Oliver

* ******* ***** *** #**

Perry Hall, MD 21128

acf3yn@r.postjobfree.com

Education:

Baylor University – Bachelor of Science in Nursing 2005

Professional Experience:

Wexford Health Sources – DPSCS Contractor October 2013 - Present

Statewide Inpatient Nurse Case Manager

1. Monitored and evaluated the medical necessity, appropriateness and efficient use of healthcare services.

2. Provided quality, cost-effective care at the level most appropriate to the inmate.

3. Provided reports and recommendations to medical and facility staff for improved utilization of resources while

maintaining quality care.

a. Utilized InterQual and Milliman criteria.

4. Reviewed all Inpatient cases daily with the UM Medical Director. Provided Onsite Inpatient review as required.

5. Issued notices of non-coverage for inappropriate hospital days or levels of care to the hospital UM department,

attending physician, and billing office of hospital. Prepared appeals of non-covered services.

6. Maintained clinical information along with entering and updating computer system to obtain a reference number

for hospital billing and claims payments.

7. Reviewed clinical information with appropriate medical director and site physician to facilitate discharges back to

the infirmary, correctional institute, or appropriate level of care.

8. Submitted Inpatient trends to UM Director. Prepared statistical reports for UR and Operations personnel and

worked with Medical Directors to identify areas of concern and areas for quality improvement.

HMS – Program Integrity and Healthcare Cost Containment May 2012 – August 2013 (large scale layoffs)

Medicaid RAC – Nurse Reviewer

1. Determined medical necessity of inpatient stays and wrote denial letters accordingly

2. Assisted in the development and presentation of appeals cases

3. Determined whether specific DRG guidelines/criteria were met

4. Worked to streamline the efficiency of nursing staff

5. Helped train new employees to needed software

a. Experience in: InterQual/Milliman, ImageNow, PIE, Orion and Mars software

Trailblazer Health Enterprises, LLC, Dallas Texas July 2011 – May 2012 (Company Closed)

Redeterminations - Part A - Medical Reviewer III

1. Performed medical review of clinical/medical information provided by physicians/providers according to

established protocol sets or clinical guidelines per The Centers for Medicare and Medicaid Services (CMS) for

accuracy of coverage and coding, and medical necessity.

a. Experience in: FISS, MEDS, Microsoft Windows, 3M and InterQual/McKesson software

Bedside Nursing Experience 2005-2011

Neurovascular/Orthopedic Med/Surg Unit with telemetry monitoring

1. Cared for patients with new and old CVAs/TIAs Including NIH stroke scale assessment

2. Monitored for acute neuro changes-including new and worsening symptoms

3. Managed post-surgical orthopedic patients

4. Served as charge nurse as needed

Medical/Surgical/Pulmonary/Chest Pain/Step-down Telemetry Unit

1. Interpreted Telemetry Patient Rhythms

2. Educated patients regarding newly diagnosed cardiac conditions

3. Assisted in the care of patients directly from emergency department with Acute Chest Pain

4. Calculated and Administered Cardiac and Blood thinning Intravenous Drips

Medical/Surgical Oncology Unit

1. Administered Chemotherapeutic Agents

2. Assessed, Planned and Implemented Patients’ Care involving multiple teams including, but not limited to:

a. Medical Physicians, Surgical Physicians, Physical Therapy, Occupational Therapy, Respiratory Therapy,

Radiation Therapy involving transport to separate facility, Dietician Services, Social Work, Specialty

Physicians, Inpatient and Home Health Hospice Services

3. Educated patients regarding newly diagnosed Cancers

Endoscopy Services

1. Monitored patient recovery after receiving sedation including complete anesthesia

2. Monitored patients during procedures; including sedation level, vital signs, and positioning

3. Participated in travel cases in other areas such as the emergency room and medical/surgical intensive care unit

Labor and Delivery

1. Managed multiple actively laboring patients, including high risk deliveries

2. Scrubbed and Circulated in operative procedures

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