NORA M. CARSON, RN, CHCQM acryei@r.postjobfree.com

** ******** ****** *********: 315-***-****

Baldwinsville, NY 13027 Cellular: 315-***-****

PROFESSIONAL SUMMARY

Highly organized Registered Nurse with cross-functional experience as a medical case manager and a certified health care quality manager. Excellent multitasking, information gathering, investigative, and decision-making abilities. A strong patient advocate who will develop win-win solutions for an organization and its clients. Quick learner and resourceful team member. Establish relationships and communicate effectively with staff, providers, and patients.

• More than 15 years of combined experience as a medical reviewer, medical case manager, and home health care agency director ensuring the coordination of timely, quality, and cost-effective patient care services.

• Chaired and served on various Utilization Review and Quality Improvement Committees.

• Background of clinical experience in specialized hospital units, including Orthopedics, Medical-Surgical, Geriatrics, ER, ICU, and Labor and Delivery. Continued involvement in direct patient care as a per diem nursing supervisor within an adult medical/surgical rehabilitation and nursing facility.

• Expertise managing home care agency staff and providing education in federal and state compliance regulations.

• Well-versed in Workers’ Compensation, Disability, No Fault Auto, Third-Party insurances, and Short-Term Disability insurance requirements.

SELECTED HIGHLIGHTS OF EXPERIENCE

MEDICAL REVIEW AND CASE MANAGEMENT:

RN Medical Reviewer for Auto Injury Solutions (7 years to current)

• Review medical records of individuals injured in automobile accidents; assess each case and determine appropriate medical treatment; monitor for possible fraud and misuse of medical services.

• Collaborate with the team of nurse medical reviewers, RNs, the panel of physician reviewers, and the internal quality assurance panel to identify appropriate health care solutions for members.

• Facilitate cost-effective delivery of medical care to clients and a timely return to pre-injury status.

• Oversee and consult with co-workers to ensure fair reviews of all parties involved.

• Conducted quality reviews of co-workers’ performance and provided positive feedback, resulting in increased accuracy of the medical review process.

• Noted discrepancies in billing that saved the company money; made suggestions to adjusters on purchasing long- term versus rental medical equipment, which yielded significant cost savings. Medical Case Manager for Concentra Integrated Services and Wausau Insurance (7 years)

• Strong patient advocate; worked directly with medical providers and employees; updated employers on injured workers’ conditions and medical treatments with goal of returning employees to original positions, or jobs with modified duties.

• Met with Concentra’s Workers’ Compensation clients in their homes, or physicians’ and therapists’ offices to provide ongoing case management services. Communicated in person and telephonically with clients, medical providers, employers, and insurance carriers. Effected timely and safe return to work for numerous employees.

• Performed telephonic case management of Workers’ Compensation files at Wausau Insurance. Achieved more than a million dollars in savings through timely and safe return to work of injured employees. HEALTH CARE AGENCY MANAGEMENT / QUALITY IMPROVEMENT & UTILIZATION REVIEW: Regional Director for Star Multi-Care Services; Branch Manager for Greenpoint Senior Living (3 years)

• At Star Multi-Care Services, progressed from instructor of new home health aides to Director of Patient Services, then Regional Director in charge of daily operations.

• Ensured the delivery of safe, quality home care services and provided nursing supervision in patients’ homes.

• Maintained agency compliance with Federal, State, and Local regulations.

• Chaired the Quality Improvement/Quality Performance Committee for the Central New York region.

• Educated professional and paraprofessional staff in insurance requirements.

• Assisted with development of a home care office for Greenpoint Senior Living and acquired initial licensing through the New York State Department of Health. Supervised and directed all nursing services. Coordinated and integrated policies and procedures that guided and supported provision of care.

• Served as Chairperson for Greenpoint’s Quality Improvement/Utilization Review Committee. NORA M. CARSON, RN, CHCQM acryei@r.postjobfree.com

36 Virginia Street Residence: 315-***-****

Baldwinsville, NY 13027 Cellular: 315-***-****

RÉSUMÉ – PAGE 2

NURSING HOME AND HOSPITAL NURSING POSITIONS:

Elderwood Rehabilitation and Nursing Facility; Community General Hospital (11 YEARS)

• Currently supervise Elderwood nursing staff on a per diem basis in the provision of safe, empathetic hands-on care for geriatric and rehabilitative patients. Assign appropriate staff to each unit to ensure quality care per patient census. Assess changes in patient condition; contact facility physicians on change of status and transfer patients to hospitals or higher levels of care, as needed.

• Worked on a variety of specialized units at Community General, including Orthopedics, Short-Term Surgery, Emergency Department, and Labor and Delivery.

RELATED CHRONOLOGY

AUTO INJURY SOLUTIONS, RN Medical Reviewer, Baldwinsville, NY, 2008-Present ELDERWOOD REHABILITATION & NURSING FACILITY, Per Diem RN Supervisor, Liverpool, NY, 2010- Present WAUSAU INSURANCE, RN Case Manager, Liverpool, NY, 2007-2008 ALL METRO HEALTH CARE, Director of Clinical Services, Liverpool, NY, 2006-2007 SIBLEY NURSING & PERSONNEL SERVICES, Regional Manager, Syracuse, NY, 2004-2006 CONCENTRA INTEGRATED SERVICES, Medical Case Manager, Syracuse, NY, 1998-2004 SENIOR QUARTERS HOME CARE AT GREENPOINT SENIOR LIVING, Medical Case Manager / Branch Manager, Liverpool, NY, 1997-1998

STAR MULTI-CARE SERVICES, Regional Director of Central New York; Director of Patient Services; Nursing Instructor, Syracuse, NY, 1995-1997

ST. JOSEPH’S HOSPITAL HOME CARE, Pediatric Public Health Nurse, Syracuse, NY, 1994-1995 COMMUNITY GENERAL HOSPITAL, LPN/RN Staff Nurse, Syracuse, NY, 1986-1993 EDUCATION

TOMPKINS CORTLAND COMMUNITY COLLEGE, Dryden, NY

A.A.S. in Nursing – Registered Professional Nurse

OSWEGO COUNTY B.O.C.E.S., Oswego, NY

Licensed Practical Nurse

LICENSES AND CERTIFICATION

Registered Professional Nurse, New York and New Jersey American Board Quality Assurance Utilization Review Physicians, Inc. CHCQM – Gold Standard in Utilization and Quality Assurance Reviewing Eligible for CCM – Certified Case Management Certification. Test date: 12/2015 BLS Certification, American Heart Association

COMMUNITY INVOLVEMENT

Volunteer, Rescue Treasures Pet Adoption and Cayuga Dog Rescue