Beth A Campbell, RN, CCM

MCG Certified

203-***-****- ad1yw5@r.postjobfree.com

Objective: To utilize my experience and leadership skills to promote stronger patient engagement, compliance and to minimize fragmentation in the Health Care system while ensuring safe, quality, and cost-effective outcomes.

RN Case Manager

VNA Health at Home, Watertown, CT

February 2023-current

• Manages the plan of care and services of assigned patients.

• Coordinates all disciplines involved in the assigned patients plan of care.

• Partners with others to effect change and produce positive patient outcomes.

• Provides direct care and health counseling and teaching to agency patients.

• Participates in the Agency's Community Wellness Program

• Performs on-call and extended hours activities to meet the needs of the agency as assigned.

• Performs all duties in compliance with applicable federal and state regulations and Agency policies and procedures.

• Provides exemplary customer service to all customer contacts. Manager, Care Management - Transition of Care

EmblemHealth, New York, New York

July 2022-February 2023

Summary of Position:

Managed 18 direct reports, including clinical and non-clinical staff for the insourcing of the Transition of Care and High Utilizer Care Management programs. Developed desk level procedures and departmental policies for the Transition of Care Program. Educated, oriented and mentored staff to care management role and procedures. Responsible for the day-to-day operation and performance of the care management team. Additional responsibilities as below.

• Provided services to monitor team member performance which includes quality, outcome and productivity measures and deploys strategies to improve performance.

• Provided coaching and mentoring to team members to address performance related issues. Uses problem solving abilities to create solutions to operational and clinical issues identified during day-to- day operations.

• Collaborated with the Director and AVP of Care Management and internal audit teams to address audit

related findings and implement performance improvement strategies.

• Collaborated with other functional areas within organization to ensure that care managers were implementing EmblemHealth Health Plans policies, procedures, and all regulatory mandates, consistent with Emblem Health Plans mission, vision, purpose, and value statement. Principal Accountabilities:

• Management of daily operations of the Care Management team including measurement of performance metrics and productivity standards and deployment of strategies to improve performance.

• Trained employees in process operations and precepted newly hired staff. Completed quarterly. evaluations of staff as needed.

• Monitored team caseloads accordingly to meet departmental/organizational needs.

• Monitored timeliness and appropriateness of documentation in clinical systems to ensure documentation met accreditation and regulatory standards.

• Provided oversight of team members managing enrollees across the care continuum, inclusive of behavioral health to ensure that enrollees had access to needed care and services.

• Served as a clinical resource and attended Care Management rounds. Quality and Training Analyst

EmblemHealth, New York, New York

September 2020- July 2022

Summary of Position:

Partnered with the Medical Management Operations Senior Leadership in maintaining an effective quality and training program to ensure clinical and operational regulatory adherence with Federal, State and CMS regulations and NCQA accreditation requirements through monitoring and educational activities. Supported the insourcing of the UM Discharge Planning Team. Developed desk level procedures and auditing program for the Discharge Planning Team. Educated, oriented and audited staff to DCP UM Care Management processes. Obtained MCG certification and educated team to HHC, DME, SNF, IRF and LTACH MCG standards and documentation.

• Performed routine clinical quality monitoring audits, to measure adherence with state, federal, accreditation and business requirements associated with concurrent review utilization management requirements.

• Assisted the Manager in planning and executing against the established concurrent review monitoring work plan.

• Performed clinical components of mock audits, such as CMS, NCQA and State, on a routine basis with attention to the clinical documentation.

• Provided quality results, documenting issues and ensures appropriate corrective actions plans are deployed, including effectiveness therein.

• Assisted the Manager with coordination of the Medical Management Operations team for state, federal, accreditation and internal audits.

• Assisted with the clinical new hire orientation and training, annual training, and ad hoc training for end-to-end concurrent review processes.

• Tracked completions of other trainings and required evaluations annually, including mandatory trainings and clinical evaluations such as interrater reliability studies.

• Maintained a working knowledge of relevant issues, laws, and regulations affecting Medical Management Operations.

• Assisted the Manager in annual review of the regulatory adherence grid, incorporating applicable Federal, State and accreditation decision making and notification timeliness requirements.

• Researched company policies to develop and update desktop procedures and job aids on a regular basis.

Supervisor, Total Population Health

ConnectiCare/EmblemHealth, New York, New York

January 2019-September 2020

• Managed telephonic RN care managers, field care nurses, social workers, and Total Population Health administrative assistants.

• Responsible for the execution of efficient departmental processes designed to manage inpatient and outpatient utilization and quality of care within the benefit plan.

• Collaborated with the team to promote integration of processes and workflows.

• Contributed to the overall success of Total Population Health by promoting the department mission of effectively facilitating care and improving outcomes at all points along the health care continuum, from preventative health and wellness through chronic care management to end of life care in all health settings.

• Mentored and educated staff to ensure compliance with CONNECTICARE, state, federal and NCQA guidelines.

• Developed, monitored, and communicated performance expectations for all direct reports and conducted performance reviews.

• Prepared and participated in NCQA Audit for Complex Case Management Team including: o Validation of universes associated with Federal, State and Accreditation utilization audits

o Preparation of Case Files

o Development of effective corrective action plans with departmental leadership o Assist departmental management in the development of concurrent review processes and procedures and lead efforts to create effective training modules to ensure regulatory and accreditation adherence.

Care Manager, Total Population Health

ConnectiCare/EmblemHealth, New York, New York

September 2018-January 2019

• Provided telephonic nurse care management for Medicare and commercial members.

• Collaborated with members, caregivers, providers, TPH multi-disciplinary team, and health care and community resources to evaluate member needs through a variety of assessments to identify areas of concern and potential gaps in care.

• Identified appropriate goals, strategies and interventions that may include referrals, authorizations, health education, activation of community-based resources, life planning, or program/agency referrals.

• Collaborated with the member, caregiver, providers and TPH multidisciplinary team, to develop, communicate and evaluate medical management strategies and interventions including potential for alternative solutions to ensure high-quality, cost-effective continuum of care.

• Learned and assisted Utilization Management Department with Prior Authorization with cases. RN Case Manager

Coventry Worker’s Comp Services, Aetna, Hartford, CT October 2013-September 2018

• Telephonic and field nurse case management overseeing individuals who suffered from a work- related injury, including oversight and evaluation of plan of care, evaluating client’s clinical status, educating clients regarding diagnosis and treatment plan.

• Maintained communication with insured, adjuster, employer, physicians, and all members of healthcare team to ensure continuity of care to facilitate a safe and timely return to work. RN Case Manager

Charlotte Hungerford Hospital, Torrington, CT

April 2008-June 2018

• Inpatient clinical case manager for all units including Med-Surg, ICU, Emergency Department, and oncology/hospice. Responsibilities included utilizing the nursing process to determine and facilitate the most appropriate level of care and discharge needs.

• Collaborated with physician, social work, and other members of the health care team to fulfill the treatment plan in the highest quality, cost effective manner.

• Responsible for ensuring customer satisfaction; physicians, families, patients, and community resources; homecare agencies, nursing homes, etc.

• Responsible for utilization review, obtaining authorization and coordinating discharge needs.

• Reviewed clinical documentation of inpatient medical records to identify opportunities for improving physician documentation. Queried physicians for clarification of documentation. Attended ACDIS bootcamp in 2013.

Primary Care Nurse

VNA Health at Home, Watertown, CT

February 2006-February 2010

• Managed a case load of 30 patients for routine home care and hospice patients in home care setting.

• Completed admissions, recertifications, resumption of care and discharges using OASIS, evaluated clinical status and plan of care, performed wound care, medication administration, and education of patients/families.

• Collaborated with the patient’s interdisciplinary care team to ensure positive patient outcomes.

• Performed work within Medicare/Medicaid/private insurance guidelines. Staff Nurse

Charlotte Hungerford Hospital, Torrington, CT

May 2001-February 2006

• Performed duties of a staff nurse on med-surg, orthopedic and telemetry units. Education

Excelsior College

Albany, NY

June 2003-June 2006

A.S. Nursing

License/Certification

Certified Case Manager, CCM Certification #4216989 Registered Nurse, State of Connecticut License #79699 References available upon request.

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