DENA M. GROSSE, RN/BSN

**** ********* ***. ********, ** 37066. 530-***-****. ad4kaf@r.postjobfree.com

SUMMARY

Compassionate and driven nursing professional with 20+ years of experience coordinating care in the acute and outpatient care setting, including Leadership/Management, utilization management, complex case management, and delivering bedside care in intensive and critical care units. Highly adaptable and resourceful. Seasoned in regulatory language and requirements.

SKILLS

Utilization Management

InterQual

MCG

Manage Care Concepts (Commercial, Medicare, Medi-cal)

EHR Expert – EPIC, All Scripts

Transformational Leadership and Collaboration

Analytical and Process Oriented

Effective interpersonal communication and active listening

Staff training and development

Collaborative, Mentorship, Coaching

Med-Surgical, Tele ICU, CCU, Level 2 Trauma

Complex Case Management

Organized and Creative

WORK EXPERIENCE

INPATIENT CASE MANAGER MARCH 2023 TO PRESENT

EXCEL/MSO PMGSJ

·Manages up to 20-30 patient caseloads and identifies their clinical needs.

·Collaborating with hospital Case Managers and Social Workers for patient needs, resources, and discharge plan.

·Developing discharge plans and needs to patients in the hospital.

·Review appropriateness for hospital admission and proper level of care using Medicare Milliman Clinical Guidelines criteria.

·Conducting daily initial/concurrent reviews for hospitalized patients and appropriate need for continued acute care.

·Ensures compliance with Centers of Medicare and Medicaid Services, and Federal/State regulatory requirements.

·Review needs for Skilled Nursing Facility, Home Health, Sub Acute Contracting Unit, Long-Term Acute Care Centers, and Medical Equipment for each member.

·Manage patient’s health plan coverage, benefits, and services.

·Collaborates with health plan Physician, Inpatient and Outpatient Department

·Participates in daily case reviews and length of stay rounds with Physicians and Leadership.

·Ensures high quality care and coordination is delivered to each of our health plan members.

·Assisting and collaborating with UM Director on improving department policies and workflows.

·Works with team to meet department and organizational goals.

WORK EXPERIENCE

INPATIENT CASE MANAGER SEPTEMBER 2021 TO MARCH 2023

BROWN & TOLAND PHYSICIANS GROUP

·Developing discharge plans and needs to patients in the hospital.

·Collaborating with hospital Case Managers and Social Workers for patient needs, resources, and discharge plan.

·Review appropriateness for hospital admission and proper level of care using Medicare Milliman Clinical Guidelines criteria.

·Conducting daily initial/concurrent reviews for hospitalized patients and appropriate need for continued acute care.

·Manages up to 20-30 patient caseloads and identifies their clinical needs.

·Ensures compliance with Centers of Medicare and Medicaid Services, and Federal/State regulatory requirements.

·Review needs for Skilled Nursing Facility, Home Health, Sub Acute Contracting Unit, Long-Term Acute Care Centers, and Medical Equipment for each member.

·Manage patient’s health plan coverage, benefits, and services.

·Collaborates with health plan Physician, Inpatient and Outpatient Department

·Participates in daily case reviews and length of stay rounds with Physicians and Leadership.

·Ensures high quality care and coordination is delivered to each of our health plan members.

·Works with team to meet department and organizational goals.

WORK EXPERIENCE

ASSISTANT NURSE LEADER/DEPARTMENT MANAGER AUGUST 2018 TO OCTOBER 2021

KAISER PERMANENTE

·Patient through-put upon admission and discharge and resources into the continuum.

·Monitoring discharges and referrals to Home Health, Skilled Nursing/Subacute/LTAC facilities.

·Conducts complex length of stay patient rounds, readmission, and review cases with Utilization Management Chief Lead Physician, Regional and Continuum Leaders to monitor PDR in the medical facility.

·Manages daily operations of department, staffing, payroll, budget, compliance training and department meetings that includes managing up to 30 employees throughout the Coordination of Care Department and daily operations.

·Encourages a work environment of open communication, teamwork, positive collaboration and advocates for employee fairness and independence.

·Follows and ensures compliance with Medicare/Medicaid, Department of Health Services and Managed Healthcare requirements.

·Collaborates with health care providers in medical center, to achieve optimal patient care across the facility and continuum. Researches, identifies, and implements best practice models with other Resource Management departments.

·Investigates and resolves patient/family member concerns regarding patient care and discharge needs.

·Partnering with Hospitalist Based Physicians and Utilization Management Chief Lead Physician to conduct reviews for readmissions and extended length of stay patients in the hospital.

·Reviews, audits, and escalates avoidable days and variance days with Utilization Management Chief Lead Physician.

·Reviews HCAHPS reports and identifies gaps for improvement for transition and discharge information.

·Daily audits for InterQual and 30-day Readmission reviews.

·Review of health plan coverages, notification, and appropriateness of hospital admission.

·Daily discharge call to review early discharges, dispositions, and pending barriers.

·Conducts system review to streamline workflows, referrals, and protocols in department.

·Promotes open, effective communication among staff and medical center partners to ensure seamless health care delivery without delays.

CASE MANAGER/COORDINATION OF CARE JANUARY 2016 – AUGUST 2018

KAISER PERMANENTE

·Develops care plans and discharge plans for patients and families, implementation of education regarding diagnoses and collaborates with physicians, staff, patients, and families for post hospital care.

·Identifies any barriers to patient care and discharges and escalates these needs during multi-disciplinary rounds.

·Conducts system review to streamline workflows, referrals, and protocols in department.

·Collaboration with Medical Social Workers for patient placement, caregivers need and other external resources.

·Completes referrals to Home Health, Allscripts for SNF/Custodial placement, Board and Care, Acute Rehabilitation, Sub-Acute/LTAC placement.

·Conducts Utilization Management daily for admission and completes Inter-Qual guidelines for appropriate level of care for each patient.

·Identify and secure resources and services for non-Kaiser patients and/or transfers to other acute hospital settings.

·Participates in interviewing and gives hiring recommendations of new potential candidates.

·Orients and trains new hires to the department.

·Participates in the Daily Readiness huddle and identifies needs for department.

·Provides assistance to co-workers with complex patients and resources for timely discharges.

INPATIENT ASSISTANT NURSE MANAGER/RHC FEBRUARY 2012 - JANUARY 2016

KAISER PERMANENTE

·Managed daily operations including staffing, quality improvement, standards of practice/care, unit budget and daily flow of units with admissions and discharges.

·Maintained high quality health care by following/implementing department policies and procedures and assuring that compliance is followed with local, state, and federal regulatory requirements.

·Project Participation: Stroke, C. Diff, Delirium and Fall risk reduction in IP units. Implemented new workflows for staff and patient safety throughout the hospital and developed tests of change strategies identified after research and findings for these projects.

·Care Experience Committee: Participating in workshops, coaching with staff and Patient Care rounds with emphasis on HCAHPS and high-quality care.

·Implemented and development of staff morale and skills and conducted morning huddles on units.

·Direct Report rounds, Annual evaluations, Coach and Counseling and Timecard management with staff.

·Maintained standards of care with Core Measures such as CHF, Sepsis, NSTEMI, Stroke and patient care.

·Conducted daily multi-disciplinary rounds with Nurses, Managers and Leadership.

·Chart review, Regulatory and workflow audits, and Identify barriers to patient care and discharges.

STAFF NURSE II - CMU JUNE 2008 – FEBRUARY 2012

KAISER PERMANENTE

·Primary nursing care and delivery of high-quality patient care.

·Core Measure Management: Stroke, Sepsis, NSTEMI, CHF, Sepsis

·Managing multi-organ system failure and implementation of Physician orders.

·Patient Education, discharge, and admission of patients.

·Patient Care Experience Committee.

·Medication administrations, IV medication titration, procedural sedation, Code Blue/RRT response team.

REGISTERED NURSE – CARDIOLOGY CLINIC JUNE 2010 – MAY 2011

PROVIDENCE MEDFORD MEDICAL CENTER CARDIOLOGY MEDICAL CLINIC

·Maintained daily operations of Cardiac clinic, staffing.

·Triaged patient concerns/symptoms and acute medical issues, reviewed medication adjustments, EKG interpretations, coumadin/lipid clinic.

·Coordinated patient care and treatment with Physicians/staff to ensure high quality patient care.

·Post Cardiothoracic surgery, Cardiac catheterization, and pacemaker placement care.

·Maintaining workflow of clinic with patients and procedures for 6 providers.

·Provided patient/family education on diagnose and management at home.

REGISTERED NURSE – NTICU, ICU/CCU, DCU STEP-DOWN JUNE 2004 – MAY 2008

ENLOE MEDICAL CENTER

·Patient care for CHF, NSTEMI/STEMI, ACS, Stroke, Trauma, multi-organ failure management, Pre/Post cardiac catheterization, pacemaker placement, ventilator management, emergent hemodialysis, Code Blue/RRT response team, procedural sedation, OR recovery care., pulmonary embolus, GIB, Cardiac arrhythmia management.

·Relief Charge Nurse: Chart review, Physician orders, scheduling, staffing

·Post Cardiothoracic surgery care in ICU/CCU

·Level 2 Trauma response support team, triage, and primary nursing care.

·Preceptor to nursing students, new graduates, and new hospital employees.

LICENSURE/EDUCATION/CERTICATIONS

California Registered Nurse License # 652037 Expires 3/31/2024.

Tennessee Registered Nurse License # 261582, Multi-State Expires 2/28/2025.

Bachelor Science of Nursing June 2021 Grand Canyon University Phoenix, AZ.

Associate Degree of Nursing May 2004 Butte College. Oroville, CA.

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