Bernice A. Hansen

**** ******* *****

Modesto, CA 95350

209-***-****

Objective

An opportunity that will allow me to utilize my clinical, organizational and interpersonal skills within the

health care industry.

Skills Profile

• Experience in review for correct Clinical Documentation / Case Management/Discharge

Planning/Concurrent Review/Pre-Authorization Procedures/Development of Care Plans.

• Knowledge of ICD9, CPT and HCPCS codes; Interqual and Milliman criteria; familiar with

Medicare/MediCal regulations/DRG’s and compliance issues.

• Strong analytical, assessment and problem solving skills.

• Consistently perform well under deadline demands; adapt well to new responsibilities and

concepts; strong customer relations skills to project a positive company image.

• Work with integrity as a team player or independently to task completion.

• Strong clinical and customer relation skills to project a positive company image.

Experience

Consulting (Malpractice; Erisa); Volunteer Work; Data Entry 11/2012 to present

Catholic Healthcare West (Dignity Health) 9/02 to

10/12

St. Joseph’s Medical Center and St. Joseph’s Behavioral Center, Stockton, CA

Defense Nurse Auditor – (1/2006 to 10/2012)

• Approximate yearly revenue savings - $500,00.00; Health plan defense claim audits; denial

appeals; claims analysis; concurrent review; patient claim disputes; Medicare reviews;

compliance issues; health plan quality issues; health plan contract issues, i.e. HMO, PPO;

monitor physician documentation and charges of the various hospital departments; assist

coders in evaluating physician documentation.

Mercy Medical Center, Merced, CA

Case Manager – (9/02 to 1/06)

• Consistently maintained acceptable patient length of stay; Case Management/ discharge planning

of inpatients/ concurrent review; authorizations; daily interaction with physicians; nursing and

ancillary personnel; interaction with various health plans, IPA’s and Rehab/ Long Term Facilities;

family meetings.

• Peer review screening; assisted with development and implementation of various protocols;

compliance issues.

Valley Physician’s IPA 7/01 to

9/02

Modesto,CA

Quality Manager

• Participated in a successful NCQA accreditation; Health plan audits; medical staff meetings;

physician office site visits; interaction with health plan personnel; appeals; resolution of patient

and physician grievances; peer review screening; QA studies; claims review (ER, OP, and IP);

monitor physician documentation for correct coding; divestiture of the IPA.

Page two – Bernice A. Hansen

Sutter Gould Medical Foundation 4/00 to 7/01

Modesto, CA

Quality Manager

• Participated in a successful Association of Ambulatory Accreditation survey; day to day

operations of the Quality Management Department; health plan audits; medical staff meetings;

budget planning; appeals; daily interaction with third-party payers; QA studies; organizing,

directing and evaluating services of the staff and resolving patient grievances.

• Coding education for physicians, physician office site visits for credentialing, HEDIS

collection, Safety Committee, Infection Control Committee.

MedPartners Provider Network, Inc. 2/94 to 4/00

Northern California Corporate Office, Inc.

Stockton, CA

Utilization Manager, Northern California Region – (9/97 to 4/00 promoted from previous position)

• Day to day operations of the Northern Region Utilization Department to include the divestiture of

the company from Northern California with management and lay-offs of staff of forty (40);

staffing and education of personnel; physician coding education.

• Participated in health plan audits; medical staff meetings; developed policies and procedures;

analyzed physician utilization patterns; participated in a successful NCQA Survey.

• Case management of high risk patients; pre-certifications, concurrent review, follow –up of

denials and appeals; interaction with health plans.

Regional Quality Specialist (2/94 to 9/97 – promoted to above position)

• Performed peer review; physician office site audits; medical record audits; HEDIS collection:

developed audit tools, follow-up of denials and appeals.

• Health plan audits; medical staff meetings; malpractice investigations and compilation of legal

reports; reviewed potential risk management incidents/ possible sentinel events.

Valley Heart Associates, Inc 9/92 to 2/94

Modesto, CA

Director of Clinical Services

• Responsible for staff and physician scheduling; staff education; staff evaluations and counseling.

managed staff of twenty; patient care/ clinical functions; medical staff meetings.

• Responsible for patient satisfaction; QA monitoring; monitoring physician coding .

• Budget and costs responsibilities; ordering of medical supplies and pharmaceuticals.

Doctors Medical Center 7/72 to

9/92

Modesto, CA

• Director of Quality/ Risk Management

• QA/ Utilization Department Manager

• Utilization Coordinator

• Night ER Charge Nurse (Mobile Intensive Care Nurse) and Night House Supervisor

Licensure

• California - 106625

Page three

Affiliations

• California Association for Healthcare Quality

Education

• Monmouth Junior College, Long Branch, New Jersey

• Ann May School of Nursing, Jersey Shore Medical Center, Neptune, New Jersey (Nursing school

has closed.)

• Modesto Junior College – Business Courses

• Hospice Volunteer Training; Dale Carnegie Classes

• Clinical Documentation Training

• Excel

Contact this candidate