Pamela D. Bearden RN

**** ********* *****, ********, **. 33809

Telephone: 863-***-****

Cell Phone: 863-***-****

acqss9@r.postjobfree.com

Experienced health care Professional with a diversified background in Acute, Sub-acute, Home Health, Hospice, case management & utilization review. Currently working in the capacity of District Managed Care Case Manager for five Kindred facilities. Extensive experience utilizing, interqual to determine appropriate level of care for Medicare and Commercial referrals. Focus mainly on maximizing reimbursement and increasing revenue. Authorization rate over the last 6 years is 50- 60 %, Execute Letters of agreement and rate negotiation when applicable. Previous certification in billing and coding. Proficient with Micro Soft programs, Excel and Outlook.

Employment

Kindred Hospital S.E. Region

Jan/2/2009 - Current

District Managed Care Case Manager

Review clinicals and determine appropriate level of care based on Medicare guidelines and interqual criteria.

Maximize reimbursement based on DRG and DX.

Maintain close communication with insurance case managers and Medical Directors to discuss admission and continuation of care.

Verify benefits via Passport, Availity and Medicare’s CMS web site

Provide daily updates to all five Kindred facilities to include CEO’s and the Executive Director of Florida.

Execute Letters of agreement and rate negotiation when applicable

Baycare Health Systems

Home Health Division

9/2014 – Current

Patient Care Supervisor, Clinical Nurse II

Coordinate and supervisor clinical staff for Hillsborough and Polk counties

Responsible for continuity of care and appropriate quality of service

Triage patient calls and assign appropriate staff

Maintain nursing schedules within reasonable patient load.

Review clinical documentation and coordinate services

Field emergent calls and determine course of action

Provide direction and leadership to clinical personnel

Physicians United Plan

12/23/07 1/1/09

RN Case Manager

RN Case Manger responsible for determining appropriate level of care for hospitalized members.

Assisting social workers, physicians and hospital case managers with discharge planning and disposition.

Oversee an assigned patient load and engage in activities of medical management in order to support members with acute and chronic illness and disabilities, thereby effectively reducing re-hospitalizations.

Concurrent and retro reviews targeting high cost members and conditions requiring complex case management.

Heartfelt Home Care

4/1/05 12/12/07

RN Oncology Case Manager

Oncology / Medical home health case manager responsible for the coordinating patient care and obtaining member specific services

Maintained close communication with physicians and team members to prevent exacerbation of illness through education and appropriate intervention and disease management.

Triaged patients according to highest level of need, Evaluate and implement proactive treatment per MD order and recommendation Proficient with Oasis and Medicare guidelines, ICD 9 coding and DRG

Alliance Health Care

2/1/00 4/1/05

RN Oncology Case Manager

Home healthcare case manager working within a specialized highly trained team providing complex case management to oncology and diverse medical patients.

Maintained close communication with physicians and staff to reduce the risk of re-hospitalizations due to preventable conditions.

Evaluate and implement risk reduction by addressing patient’s immediate needs.

Maintained supervisory position coordination services and assigning patient load when necessary.

Proficient with Oasis and Medicare guidelines, ICD-9 and DRG’s

Life Path Hospice

9/9/98 1/2/00

RN Case Manager

Weekend Baylor RN responsible for complex case management of terminally ill patients.

Identify patient and family needs related to the end of life process

Teach and instruct regarding care and comfort of terminally ill patient.

Provide emotional support to patient and family.

Maintain close communication with MD, order appropriate equipment and services as indicated.

Lakeland Regional Medical Center

1/1/1989 8/20/98

RN Staff Nurse

Clinical staff nurse with periodic rotations of ICU, Ortho, Neuro, Oncology and CCU.

Maintained a small four bed, post surgical recovery unit

Proficient with central lines including: Ports, Piccs, Triple lumen caths, Hickman’s etc.

Administration of chemotherapy, blood products

Gessler Clinic

12/2/1987 12/1/88

LPN Staff Nurse

Worked float position in family practice, cardiology, orthopedics and oncology. Assisted physicians with inarticular injections and closed reductions. Cast applications and fitting of assistive devices.

Assisted with stress tests and physical assessments

Followed Medicare and workman’s comp guidelines

Maintained accurate billing and coding

Summary

Experienced health care professional with a diversified background in Acute, Sub acute Home health and Hospice. Thrives in both independent and leadership positions within diverse team dynamics. Utilizes strong, organized, multi-task prioritization and management abilities and performs well under pressure. Previous certification in billing and coding utilizing CPT, ICD-9 and HCPCS manuals. Currently working in the capacity of District Managed Care Case Manager for five Kindred facilities. Authorization rate maintained @ 50-60% over the last 6 years with increased revenue and reimbursement. Execute Letters of agreement and rate negotiation when applicable.

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