CASE MANAGEMENT

Dynamic, ethical, caring, patient-focused, dedicated professional with a proven track record of success in operations, staff management and clinical services.

Expert in implementing process improvements that increase efficiency without compromising patient care in home-based, employer-based, occupational medicine/work comp, acute-care, and long-term care environments. Recognized as advocate and educator who is able to develop effective training programs for staff and patients. Talented in creating and implementing highly effective treatment and care plans. Committed to providing top quality customer service and resolving patient complaints professionally and efficiently.

Skilled in mentoring, motivating and training new staff members and ensuring patients, visitors, employers, and medical associates are provided with a safe and hygienic environment. Exceptional communication, interpersonal and problem-solving skills; proven ability to succeed in high-stress and challenging environments.

PROFESSIONAL EXPERIENCE

PARADIGM, Field Case Manager, April 2021 to November 2022

• Reported directly to regional management.

• Ensured delivery of quality services consistent with Service Delivery Expectations (SDE) and Paradigm’s culture by optimizing timely, effective services. Coordinated authorized medical care. Collaborated with physicians and other providers to return injured claimants to work safely and effectively. Educated injured claimants regarding all aspects of clinical care.

• Mentored new Field Case Managers (FCM) in providing high-quality, effective, proactive case management services, identifying areas of expertise and of improvement for new FCM’s.

• Identified and recommended costs savings and opportunities to improve service delivered. Participated in regular case management reviews with Regional Manager to identify areas of cost saving and efficacy. Prepared and presented cost-management analysis, high-dollar, and other tracking reports.

• Developed and maintained relationships with providers, employers, adjusters, and other Paradigm departments to better service clientele and increase referrals, and provided timely responses to all internal and external customer inquiries.

COVENTRY WORKERS’ COMP SERVICES, Bakersfield, CA, March 2014 to February 2020

Regional Manager, Field Case Management June 2017 to February 2020

Reported directly to Area Director.

Initiated and maintained compliance with Service Delivery Expectations (SDE), Coventry/Aetna policies and procedures as well as all Federal, state, local, and accrediting bodies’ regulations.

Oversaw fiscal planning, budgeting and cost management. Participated in regular case management reviews with field case managers to identify areas of cost saving and efficacy. Prepared and presented cost-management analysis, high-dollar, and other tracking reports.

Identified potential new customers for area sales manager, assisted in development of marketing for potential customers with area sales manager.

Developed and maintained relationships with providers, employers, adjusters, and other external and internal customers; and provided timely responses to all internal and external customer inquiries.

Evaluated Field Case Managers (FCM) performance on regular, scheduled and as needed bases. Identified areas of success and of opportunity; utilized on-the-spot and structured coaching methods to ensure high-quality, effective, proactive case management services.

Recruited, hired, and trained new FCM in partnership with Coventry/Aetna’s Human Resources. Assigned mentors to new FCM’s to ensure provision of high-quality, effective, proactive case management services. Met with new FCM’s and mentors on regular, scheduled basis to identify areas of success, and to identify coaching/training opportunities.

Field Case Manager, March 2014 to June 2017

Reported directly to regional management.

Ensured delivery of quality services consistent with Service Delivery Expectations (SDE) and Coventry/Aetna’s culture by optimizing timely, effective services. Coordinated authorized medical care. Collaborated with physicians and other providers to return injured claimants to work safely and effectively. Educated injured claimants regarding all aspects of clinical care.

Mentored new Field Case Managers (FCM) in providing high-quality, effective, proactive case management services, identifying areas of expertise and of improvement for new FCM’s.

Identified and recommended costs savings and opportunities to improve service delivered. Participated in regular case management reviews with Regional Manager to identify areas of cost saving and efficacy. Prepared and presented cost-management analysis, high-dollar, and other tracking reports.

Developed and maintained relationships with providers, employers, adjusters, and other Coventry departments to better service clientele and increase referrals, and provided timely responses to all internal and external customer inquiries.

Assisted sales manager in marketing and recruiting potential customers. Presented proposal for case management and utilization review services for City of Bakersfield with area sales manager and regional manager. Directly developed relationship with City of Visalia, which increased referrals from this source.

MAXIM HEALTHCARE SERVICES, Bakersfield, CA, 2004 to 2012

Director of Clinical Services

Reported directly to regional management.

Managed all clinical operations of the Maxim Healthcare office.

Initiated and maintained compliance with Maxim policies and procedures as well as all Federal, state, local, and accrediting bodies’ regulations.

Oversaw fiscal planning, budgeting and cost management.

Established and maintained effective channels of communication with all payor and referral sources, corporate and regional teams, internal staff, and field staff. Reported directly to regional management.

Evaluated personnel clinical competencies on initial, annual, and as-needed basis; instructed and mentored clinical personnel achieving new skills.

Ensured personnel development including orientation, in-service education and continuing education.

Evaluated services and programs; chaired triennial Professional Advisory Board meetings and annual program review meeting.

HANFORD COMMUNITY MEDICAL CENTER, Hanford, CA, 2004

Relief Charge Nurse, ICU/ED

INTELISTAFF STAFFING AGENCY (FORMERLY GENTIVA), Fresno, CA, 2000 - 2004

Relief Staff Nurse, ICU/ED

SANTA MONICA-UCLA MEDICAL CTR. Santa Monica, CA 1999

Manager Medical/Surgical/Oncology Services,

KAISER MEDICAL CENTER, Fresno, CA, 1998-1999

Clinical Coordinator

CENTRAL VALLEY GENERAL HOSPITAL, Hanford, CA, 1995 - 1997

Manager Emergency Services & ICU

BAKERSFIELD MEMORIAL HOSPITAL, Bakersfield, CA, 1994 – 1995

Staff Nurse, ICU/ED,

SKYLINE COMMUNITY COLLEGE, South San Francisco, CA, 1992 – 1993

Instructor EMT & EMT-P Programs

DOCTORS HOSPITAL (FORMERLY BROOKSIDE HOSPITAL), San Pablo, 1989 – 1994

Charge Nurse, ICU

KAISER MEDICAL CENTER, San Francisco, CA, 1988 – 1989

Staff Nurse Cardiovascular ICU

EDUCATION & CERTIFICATIONS

2019-present – Certified Case Manager, Commission For Case Manager Certification

2023 (anticipated) Baccalaureate of Science, Nursing, Capella University

1988 – present – BLS, ACLS, and PALS certifications.

1993-2004 - Trauma Nurse Core Curriculum

1989-2004 - ACLS Instructor; 1992-2004 - PALS Instructor

1986 - Associate of Science in Nursing, Bakersfield College, Bakersfield, CA

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