Diane L. Hanson

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

Goodyear AZ *5338

Education:

Diploma of Registered Nursing. Lutheran Deaconess Hospital School of Nursing 1982.

Employment:

Care National contracted to Phoenix Health Plan Feb 2015-March 2015

Randstad Health Care contracted to Aetna Dec 2014 – Jan 2015

Concurrent review RN. Reviewed inpatient hospital, SNF and LTAC for medical

necessity of continued stay using Milliman criteria. Authorized continued stay as

appropriate. Referred cases not meeting criteria to Medical Director.

Randstad Health Care contracted to Cigna Health Care July 2014 – October 2014

Registered Nurse, Utilization Review. Reviewed inpatient hospital, SNF and LTAC cases for

medical necessity of continued stay using Milliman criteria. Referred cases not meeting criteria

to Medical Director.

Care National contracted to Tri-West Health Care June – July 2014

Registered Nurse, Medical Documentation Review. Reviewed medical documentation for

Veterans. Verified provider, date of service and that services were received. This was a

temporary position of unknown duration

Mayo Clinic Hospital June 2012-April 2014

Registered Nurse Case Manager cardiology/solid organ transplant. Responsibilities include

reviewing all new admissions for Medicare/Interqual criteria for correct admission status and

level of care. Discuss cases where status/criteria is not met with attending MD and adjust

accordingly. Daily multidisciplinary transplant rounds to discuss plan of care, barriers to

discharge and discharge needs. Work with MSW, patient and family to arrange SNF, Acute

Rehab, LTAC, Hospice, Home health as appropriate. Function in the role of primary discharge

planner as needed. Complete Initial and concurrent reviews utilizing interqual criteria while

patient is in house. Provide initial and concurrent reviews to commercial payers as requested.

Obtain prior authorization for Acute Rehab, SNF, LTAC, HHC, Hospice, Specialty Drugs and

DME from commercial payers. Be aware of and assist with providing out of town lodging

information to Patient and Families as needed.

West Valley Hospital: August 2009- March 2012

Registered Nurse Case Manager. Responsibilities include reviewing charts of all new admissions for

Medicare and Interqual criteria of inpatient admission and observation status. Discuss cases where

criteria is not met with Hospitalist and adjust admission status accordingly. Daily multidisciplinary rounds

with Hospitalists, staff nurses, physical, occupational, speech and respiratory therapists, pharmacy and

dietary to discuss and plan discharge needs. Work with patient, family and appropriate vendors to set up

discharge needs when patient is unable to discharge to home ie: hospice, SNF, rehab, and home health.

Review charts and compile reports using Interqual criteria for admission, concurrent and discharge

reviews. Review charts and compile reviews for insurance companies when requested. Provide patient

with any durable medical equipment needed.

Diane L. Hanson

15861 W Diamond St

Goodyear AZ 85338

Blue Cross Blue Shield of Minnesota: February 2008 – August 2009

RN Case Manager, Prior Authorization. Responsibilities included prior authorization and concurrent

review of skilled nursing facility, home health care and hospice services for medical necessity. Monitoring

and documenting cost savings. Retrospective review of claims for services that did not receive prior

authorization. Requesting, organizing and summarizing medical records for medical director review in

cases with questionable medical necessity. Participated in a pilot program combining case management

and disease management called ‘Whole Person Health Support’.

Medica: May 2007 – February 2008

RN Case Manager, prior authorization. Responsibilities included prior authorization and concurrent

review of scheduled surgical admissions and testing . Worked collaboratively as a member of an 8 nurse

clinical review team. To compile, organize and summarize information for review by a 7 doctor team of

medical directors when medical necessity is not readily determined. To actively participate in the ongoing

evaluation and review of clinical review policy.

America’s TPA: February 2007 – May 2007

RN Case Manager. Responsibilities included general customer service, performing utilization review,

prior authorization of scheduled surgical admissions. Authorizing emergency medical admissions,

screening for and providing complex case management services, High risk maternity management and

disease management (asthma, diabetes, cardiac disease). Claims review, special projects and employee

education.

Sunrise Assisted Living: 2000 – 2001

Cottage RN. Responsibilities included care planning, family conferencing, providing medical treatments

to residents, arranging hospital admissions and MD appointments including transportation. Ordering and

dispensing medication, arranging hospice services when necessary, training and supervision of

unlicensed personnel.

Independent Contractor-Case Manager : 1997 – 2001.

Provided case management services to John Alden Insurance as an independent contractor. See details

of responsibilities below

John Alden Insurance: 1993 - 1997

Case Manager 1996 – 1997. Responsibilities included prior authorization and concurrent review of

medical necessity of care in complex cases, assisting in discharge and care planning, negotiation of costs

of more expensive treatment ie: chemotherapy, physical rehabilitation, home health care and hospice

Utilization Review Nurse 1993 – 1996. Responsibilities included prior authorization and concurrent

review of medical necessity of hospital admissions, surgeries, outpatient testing and therapies.

Abbott Northwestern Hospital: 1982 – 1993

Staff RN. Primary clinical areas included Orthopedics, Rehabilitation, and Cardiology. Responsibilities

included total patient care, Primary Nurse, Charge Nurse, care planning, and care conferencing.

References:

Provided upon request.

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