Jean E. Harvey

Silver Spring, MD/Winter Haven, FL

ad4g41@r.postjobfree.com - 954-***-****

Skills Summary:

● RN with 30 years’ experience

● Broad experiences that expand multiple capacities, including Acute setting, Rehab, Emergency room, Charge nurse, Public health/community education, Director of a medical center, Case management, home health care and managed care and utilization management experience.

● Nationally Certified Case Manager (CCM)

● Knowledgeable with Interqual software system

● EPIC electronic medical records system,Facets, CCMS, McKesson Products. Work Experience:

HSCSN/CNMC [The HSC Health Care System] - Washington, DC September 19-present Durable Medical Equipment RN Nurse Reviewer in Utilization Management for Special Needs Children

● Process and Prepare Denial Notifications

● Collaborates with Vendors the Safe and confirmed delivery of approved DME, DMS

● Reviews and process requests for DME, Orthotic Prosthetic, Enteral Nutrition Supplies according to benefits access and utilize interqual criteria for initial approvals and reauthorization.

● Coordinate with assigned Care Managers with modifications and facilitate intervention as needed with ordering physicians, clinics and assigned or non assigned Vendors.

● Participates also in conferences as needed to resolve any identified barriers or related quality occurrences.

● Collaborates with the Medical Director, Managers and the Precertification Team and Provider Relations to effectuate on-time completion of request submitted, whether its an urgent and or a standard request. Community Care Plan - Sunrise, FL May 2018-November 2018 Utilization Review [Temporary]

● Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to appropriate Physician or Medical Director with recommendations for other determinations

● Complete the medical necessity and level of care reviews for requested services using clinical judgement and refer to Medical Directors for review depending on case findings MedStar Family Choice - Washington, DC August 2013-December 2017 Registered Nurse Case Manager

● Serving the Adult and Pediatric Medicaid Eligible Citizens of Washington DC

● Providing Clinician services of Case Management. Additionally

● Collaborate care services with Community Partners which includes local Primary Care Providers, Government Agencies such as Office of the Superintendent of Education for Early Intervention Part C Eligibility. Boston Medical Centre Healthnet Plan - Boston, MA July 2012-March 2013 Nurse Care Select Clinician

● Completed clinical assessments on each member to determine the educational health needs based on their disease process, and monitored their level of adherence.

● Provided and promoted self-management, support including care, integration for members enrolled in the population based program.

● Lead the interdisciplinary team in the development and implementation of the care plan to enhance the members overall health, and to achieve appropriate utilization.

● Assessed, planned, implemented, coordinated, monitored and evaluated care plans, services and outcomes to maximize the health of members.

Children's Medical Services - West Palm Beach, FL August 2009-June 2012 Registered Nurse Specialist

● Provide care-coordination services to special needs children & families and to 'medical homes'/pediatricians they're assigned to.

● Participated as a support liaison for Epic Electronic Medical Records Implementation at Cleveland Clinic, Florida

(Weston)

Hospital Without Walls - Boynton Beach, FL November 2006-August 2008

● Provide comprehensive nursing care (to include clinical observation/ assessment, skilled clinical nursing techniques, education/ instruction and documentation) to patients and family members regarding disease processes.

● Promote patient recovery/ rehabilitation to return patient to maximum level of function Humana Health Plans - City of Sunrise, FL August 2004-August 2006 Health Services Department-Complex Case Manager

● One of senior case managers

● Responsible for precepting new staff nurses

Humana Medical - Miramar, FL August 2000-August 2004 Patient Care Coordinator/Personal Nurse Clinician

● Health Services Department-Personal Nurse Liaison for Skilled Nursing facilities, in tri-county and out of service area.

● Conducted Chart review

● Patient care coordinator, assigned to hospitals in Dade County area.

● Identified risk factors for patients, determined discharge planning, patient follow up for case management

● Liaison between primary care, case managers, authorization department, and patients.

● Utilized Interqual and Millman and Roberts software

● Became a Field Liaison, liaison between rehab facilities determining authorizations and benefits

● Determined whether patients need service, and attended care plan meetings

● Case management of acute, chronically ill, and catastrophic illnesses.

● Clientele includes Medicare, Medicaid, and commercial members.

● Assigned to six major hospitals in Dade County

● Responsibilities include utilization review, concurrent review, discharge planning, pre-certification, liaison with primary care physicians attending/hospitalist, ancillary vendors, home health and D.M.E. companies.

● Identify members for disease state management referrals (i.e. CHF/Core Solutions). Jacobsons Management Group - San Antonio, TX November 1999-August 2000 Inpatient Case Manager Assigned to Hospitalist

● A Managed Service Organization specializing in in-patient hospitalist and case management

● In-patient case manager

● Assigned to Memorial Regional and Hollywood Medical Center; frequently covered other hospitals in Broward County as needed

● Responsibilities included UR, concurrent review, utilized Millman and Roberts,

● Knowledge of DRG contracts, DC planning, care coordination, and liaising with patient, family hospitalist, PCP, facilities CM, MSW, and plans medical director.

United HealthCare - City of Sunrise, FL 1997-1999

Nurse Reviewer/Utilization Management

● Responsible for pre-authorizing service based on medical necessity.

● Evaluated the appropriateness of ongoing care and services

● Monitored medical practice and utilization of health services.

● Educated plan participants regarding appropriate and cost effective medical care and services.

● Utilized Mil and Roberts, Interqual guidelines, Coordinated care with medical director, case managers, and on-site review nurses.

● Improved utilization by evaluating the medical necessity of specific services, assured appropriateness of allocation of resources using strong clinical judgment, coordinated and ensured quality.

● Coordinated all aspects of medical management utilizing national standards.

● Reviewed and assisted in gathering information, handling telephone calls relating to inpatient hospital stays, and communicating with physicians.

Interim Home Healthcare - Cooper City, FL January 1992-January 1997 Home Health Case Manager

● Home Office Nurse

● Multifaceted duties with varied clientele: Medicare, Medicaid, and private insured.

● Initiated, provided, and managed skilled nursing care for varied disease

● processes.

● Coordinated care with physicians, home care supervisor, MSW, PT, OT, HHA and family.

● Initiated case conferences and coordinated discharge planning.

● Special assignments: Member of Diabetic Core of Nurses, Nurse Educator (Broward County School Board) Education:

Diploma/BSN Eligible in Registered General Nursing University of the West Indies Jamaica, IA

1976-1978

Certified Case Manager (National Certification; CMSA) in Case Management, Utilization, Care Coordination CMSA National

2006

Certifications/Licenses:

CCM; National Certification

April 2016-present

Groups

LNC Student

June 2016

Pursuing Legal Nurse Consultant Certification

Licensed Insurance Agent Life, Health, Annuities/215. Florida, Maryland & Virginia August 2009-present

Joined Group of Licensed Insurance Agents in the State of Florida. Additional License in Maryland & Virginia in 2014/2015

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