Medical Manager

Katrina Hasbrouck RN CCM Contact: *-***-

***-****

Summary of skills:

Goal oriented professional with both strong clinical and administrative and

managerial skills. Ability to work independently. Excellent presentation,

communication and relationship building skills. Professional strengths

include:

. Utilization Review Pre and Post service review. Coding Review and

incorporation

. JCAHO/URAC/ HIPPA/HEDIS/ ERISSA/OSHA and State Regulatory compliance

. Program evaluation/Program management/ Computer software pilot within

clinical setting

. Formulation and implementation of policies and procedures

. Training and staff development

. Budgeting, planning and employee scheduling.

. Vendor Marketing and contract negotiation for cost effective and

quality of patient care delivery

. Patient and Company Risk Management review and plan of action for

patient safety and liability

. Legal and ethical Case Management liaising with Attorneys, Deposition,

and file preparation

. Knowledge of Minimum Care Standards and Domiciliary care standards UK

Education:

1972 - 1979 Selwyn School for girls, England

1979 - 1981 Alton Sixth Form College, England

1982 - 1985 Basingstoke District Hospital Nursing School, England

1985 - 1987 Ann May School of Nursing, New Jersey

1985 - 1987 Monmouth college New Jersey

Professional Experience Summary:

Maranatha Health Care - Volunteer

September 2009 - Present

Assist staff with dietary menus, change to whole foods and vegetarian, low

cholesterol meals. Budgeting, food and household shopping. Creation of 4

week cycle of menus and lists. Interaction with residents, assist with

field trips and daily needs and activities. Assist clinical staff for

Occupational and Physical therapy, visiting physicians. Reporting of

medical and nutritional change in status and consult with staff and educate

regarding changes and needs. Cooking education and catering of events

provided. Consult and educate regarding State regulations for residential

homes.

Atena Health Insurance - Disease Manager.

July 2009_September 2009

Contacted at risk clients per diagnosis. Provided ongoing educated and

followed up with clients at risk for catastrophic diseases. Referred at

risk and high cost clients to Case Management. Educated and liased with Co-

workers regarding needs of client for Case Management as needed. Responded

to new client inquiries and set up appointments for new contact by DM.

Provided educational material as needed for specific diseases. Including

Mental Health. Remained in compliance for URAC standards. Contacted

Medical Director as needed regarding warrented cases. Performed peer

review QA and QI and reported to supervisor. Provided medical support and

education to both member and Physician to improve care compliance and

quality of life while reducing needs to report for urgent care as able and

provided vendors within policy to ensure cost savings to client and

company.

Goldsborough Home Care - Branch Clinical Manager Domiciliary Care Agency,

UK Feburary 2008 - May 2009

Scheduling staff to meet client needs across age continuum 24 hours 7 days

per week coverage

Meeting targets set for new clients and staff, hours scheduled per week

Marketing with Online sites, Newspapers and liaising with County councils,

PCT, Physicians, Social work, other Case Managers and Hospital discharge

planners. Increasing client and referral base.

Liaise with referring staff and physicians and family for care needs,

changes and individual careplanning with life care planning. Weekly and

monthly spread sheet reporting, meeting KPI and Quality standards and set

targets

Staff monitoring and quality assurance with review of Staff and Client

files for CSCI compliance and education needs. Hiring, firing, action

plans, reviews and 6 monthly assessments. Risk management, environmental,

client and staff.

Monthly business planning review with action plans for each quarter with

last quarter reporting

Close liaison with Regional consultant, Financial officer and Managing

Director.

Client contracts, Private pay, and Social service band and rate negotiation

per contract.

Debt resolution, contract review and vendor contact and accountable for new

vendors and contracts,

Onsite client assessments and reviews with spot checks to ensure quality

care and needs met.

Liaising with internal and external customers, maintaining positive

relationships within referral and client base.

QA, QI and TQM, with outcome and ROI. Accountable for entire branch

budget, Payroll and equipment procurement in

Strong It skills, including spread sheets and PowerPoint presentations.

Researching for new premises within budget that meet work health and safety

compliance.

25% growth of client base in one month, taking on up to 500 extra hours

weekly

Clinical Case Manager of Rehabilitation Consultant for new Hospital

Ventilation Weaning Unit Glenside Manor

UK. September 2008 - January 2009

Managed acute rehabilitation unit for head and spinal cord injuries.

Coordinated IDT care, meetings and liaised with external Payer sources and

Case Managers. Negotiated cost and care units. Monitored patient and

staff progress, education, clinical needs and quality of care/ QA/TQM/QI to

meet National standards. Staff hiring, on going review and assessment,

disciplinary action as needed. Scheduling, time reporting, ongoing pilot

studies. Liaised with Administration and Medical Director regarding

patient progress and care planning, up to and including discharge. Liaised

with external facilities and Case Managers for ongoing treatment plans and

therapies. Weekly physician rounds and conference as needed telephonically

Family meetings arranged as required and attended. Coordinated with senior

Nursing officer and architects regarding new Ventilation weaning unit,

including all environmental, ergonomic and health and safety requirements

according to National standards. Capitol requests for all necessary

equipment after assessment of market availability for ICU rooms.

Negotiated contract costs as per budget. Assisted with policy and procedure

development, staffing needs, including all therapy services, training

requirements and ongoing education plans. Onsite visits to referring ICU

facilities to assess potential patients, needs, costs and payer sources.

Interfaced with IT regarding software to meet unit needs for documentation,

care planning and compliance. Review of extension of services to include

LTAC services including wound care, and minor surgical suite. Liaised with

regional acute care facilities and Medical practices for Marketing

purposes, education days for Medical Community, and increasing referral

base with assistance of Medical Director

Director of Clinical services and Hospice personnel Silverado Hospice

November 2006 - July 2007

Director for all staff including Aides, Hospice Nurses, Social workers, and

Chaplains,

Staff education, Interfaced with Medical Director as needed and weekly team

meetings

Set up quality assurance and improvement team. Documentation review, policy

and procedure review

Staffing scheduling, payroll, interviewing, hiring, disciplinary action and

termination

Monitoring standards of care delivery, evaluations and pay raises.

Budget review and cost savings as available. Interfacing with DME and

Pharmacy vendors with contract negotiation

On going Director retreats and education at Corporate offices in

California.

Formulation of vision and Mission statement. Annual goals for company

growth and financial status.

Developed wound care management program, home visits made. Consulted with

all of Hospice team with complex cases

Performed admission evaluations for appropriateness of services, and family

support.

Contact of supportive outside vendors for increased support measures and

arranged inpatient stays for family respite care. Coordinated pain control

management, with Hospice staff and Hospice Medical Director

Ensured State and Federal regulations for Licensure upheld and Monitored

new law changes adjusting policies as needed

Monitored billing practices within state and Federal Guidelines. Increase

in admissions by 25%, cost savings $250,000 first quarter.

Medical Case Manager Federal Employee Program Blue Cross Blue Shield April

2003 - Nov 2006

Case manages all Medical and Surgical disciplines including catastrophic,

mental health, maternal/child, and Neonatal cases, and Oncology. Performs

cost analysis and demonstrated savings on individual basis per quarter.

Average of $500,00. savings per quarter. Coordinates all outpatient

services for Rehabilitation, Home Health and Hospice services, price

negotiation and Durable Medical Equipment. Medical Social work consultation

and intervention with liaison for mobilization of supportive resources

within the scope of client benefits, both private and Government funded

policies including Medicare and Medicaid. Reports to State protective

agencies or referrals made for quality of care issues, neglect and abuse

across the age continuum as necessary for, improved quality of service

delivery, and possible fraudulent practices referred as identified,

referring to risk management policies. Assists in inter-state coordination

of care either by family, facility or treating Physician. Acts as

Utilization Manager and performs pre and post service reviews of claims

with appropriate matching coding use based upon medical necessity criteria

and contract benefit and language. Identifies and reports quality of care

issues, assists members with process and education of review.

Assisted with Fraud and Abuse department, and identification of Malpractice

and Fraud with coding billing and therapies. Investigated practioners and

practices as requested. Brain injury programs patient and Vendor Marketing

and contract negotiation for cost effective and quality of patient care

delivery. Life care planning for catastrophic illness or congenital

disabilities.

Patient and Company Risk Management review and plan of action for patient

safety and liability

Contract negotiation with vendors and liaison with claims and contracting

departments for appropriate confirmation of contracts billing and payment.

Review claim payments and denials for correct coding. Negotiated out of

contract benefits and alternative inpatient or outpatient benefits and

extension, based upon medical necessity. Participated in ongoing QA, QI and

TQM programs to meet URAC, HEDIS and Federal regulatory compliance.

Performed and liaised with Medical Director, assisted in setting up

protocol criteria for consistent review guidelines regarding Hospice

services, establishment of criteria and evidence based clinical

documentation and incorporated supportive nationally recognized measurement

guidelines for evaluation of approval of Hospice eligibility and on going

treatment and eligibility. Performed in-services and improved knowledge

and job performance of peers and members of Medical Services Department to

improve cost containment and improved care delivery. Participated in pilot

studies for new Computer software programs for increased efficacy of

compliance with clinical documentation, diagnosis, Disease Management,

interfacing medical records, reviews and communication with vendors and

Members. Expediting pre and post service reviews and response timeframe.

Developed strong working relationships with Hospice, Home health and

Discharge planners at all acute and sub acute settings and facilities

Clinical Staff Nurse_______________________Love Health Care Oct. 2004 -

April 2007

Clinical bedside nursing with physical assessment, and total care of

patient, and emergent intervention as necessary in the following areas:

Medical and Surgical Acute Care /Trauma Geriatrics/Geriatric Psych/

Alzheimer's Units

High risk Maternal child/ Level II Nursery/Pediatrics/ Hospice / Palliative

care, Bereavement resources Counseling. Domestic Violence, Elder abuse and

Child abuse and neglect /Substance Abuse/ outpatient counseling

ICU/Telemetry / E/R/ ICU Mental and behavioral health/Substance abuse

Oncology and Transplant Acute care / Pain management Subacute

Rehabilitation/ Tracheostomies Ventilator Care and Weaning Long Term Acute

Hospitals

Extensive Wound Care / Stoma care therapies. TPN and Enteral feedings

Brain Injury programs, Rehabilitation and Hospice HomeHealth, suicidal and

Therapeutic discharge planning

Clinical Staff Nurse Maxim Healthcare

August 2002 - August 2004

Clinical bedside nursing with physical assessment, and total care of

patient, and emergent intervention as necessary in the following areas:

Medical and Surgical Acute Care /Trauma Geriatrics/ Geriatric

Psyche/Alzheimer's Units

High risk Maternal child/ Level II Nursery/Pediatrics Hospice/Palliative

care/Bereavement resources counseling

ICU/Telemetry /E/R Mental and behavioral health/Substance abuse inpatient

and outpatient, pain management

Domestic Violence

Neurological and Brain injury units

Oncology and Transplant Acute care long term acute Care

Hospitals

Acute and Subacute Rehabilitation Ventilator Care and

Weaning

Extensive Wound and Stoma care therapies. TPN and Enteral

feedings

Director of Nursing/Case Manager/Transplant Coordinator

July 2000 - Aug 2002

Medical Management Alliance

Case managed all Medical and Surgical disciplines including catastrophic,

mental health, maternal/child, Hospice, and Neonatal cases. Performed cost

analysis and demonstrated savings on individual basis. Performed Transplant

coordination services pre and post procedure for Renal, Heart, Lung,

Pancreatic and Liver transplants. Coordinated all outpatient services for

rehabilitation, home health and Hospice services, within the scope of

client benefits, both private and Government funded policies including

Medicare and Medicaid. Performed Medical research and clinical advances in

treatment for contracted Insurers for Medical review, Risk Management,and

patient safety within the home. Utilization review, extensive coding

incorporated pre and post service reviews, claims and appeals were

performed in strict compliance with URAC, HIPPA and ERISSA policies,

including but not exclusive to Transplant, Medical, Surgical and

subspecialties including Plastic and reconstruction, Bariatrics,

Neurosurgery, Hospice services, DME, Cardiology, Pulmonary, Transplant and

Gynecology. Performed Workman's Compensation and Disability claim reviews

and liaised with Vendors and Medical Director. Performed bill and claim

review including debt negotiation and settlement with CFO of providers.

Negotiated and successfully acquired contract with National Pharmacy and

infusion company for significant cost savings to vendor in Home Infusion

Therapies and management of high dollar chronic disease processes.

Including Cardiac and Lung diseases, Bleeding disorders, Rheumatoid and

Colonic diseases to reduce cost and improve quality outcome. Assisted with

Marketing and establishment of resources for vendor and MMA. Education of

Medical Staff in the community.

Establishment and implementation of internal policies and procedures, and

TQM/QI/QA program. Performed and arranged on going Education and in-

services for staff and intake technicians on medical updates, healthcare

government changes and guidelines. Reviewed and evaluated new product

hardware and software for essential functioning to expedite delivery and

quality of care.

Acted as Director of Nursing, established interview process,

disciplinary action process and liaised with Human Resource Vendor to

maintain established legal processes and guidelines for hiring process

and termination. Performed quarterly productivity reviews, and annual

job performance reviews.

Senior Clinical Staff Nurse Aug 1997 - July 2000 University of Utah

Medical Center. GI Lab.

Care and coordination of services of patients 24 hours 7 days per week in

all Endoscopic procedures including ERCP providing clinical support to

Physicians and airway management and protection of sedated patient.

Assisted with Laser procedures and acted as Laser safety officer. Assisted

staff as preceptor, and education with care of acute and complex patient

while under conscious sedation and recovery. Supported nursing and

ancillary staff in Emergency procedures both in ICU, O/R and ICU/Trauma

settings including ventilator supported patients, with emergency

intubation, extubation and manual assistive airway and oxygenation support

as needed. Monitored physician coding per procedural review. Liaised with

Nurse Manager and Medical Director and Director of Anesthesiology for In-

service needs and assisting with elevating standards of care by staff and

protocol to meet American Association of Gastroenterology Practice

guidelines. Established program for certification of staff in conscious

sedation delivery, EKG and ACLS certification. Maintained Risk

Management program with on going monitoring and policy changes based on TQM

findings Educated and trained on all computer assisted technology and data

entry to meet practice guidelines.

Participated in CQI/TQM program, JCAHO accreditation policy updates and

audits.

Clinical Director Feb 1996 - July 1997

University of Utah Medical Center. Outpatient Surgical/ Renal

Transplant/Dialysis Clinics Pre and Post Transplant

Coordination of services and daily functioning of all general surgery

clinics and subspecialties, Dialysis and pre and post renal transplant

Clinic. Performed training and continuing education of both Nursing staff

and residents. Developed new clinic services including trauma services and

gang related Tattoo removal clinic and training and certification of staff

and Plastic Surgery residents in Laser operation and safety. Liaised with

General Surgery and Burn Surgical Physicians to develop follow-up Trauma

Clinic, with standards, protocol and staff education to meet needs of

Trauma Patients care. Coordinated on going in-services to maintain

compliance with JCAHO standards and educational needs as acuity of patients

increased. Monitored all Physician coding per procedural and clinic visit

review for accuracy and appropriateness.

Developed education program for MA's to expand role function within Clinic

setting. Liaised with Nursing Officer and Medical Director regarding clinic

remodeling and maintaining ADA and OSHA standards. Worked with Human

Resources in the Hiring and termination process to follow Facility

guidelines and disciplinary actions.

Attended Team leadership and training courses, Communication and

Management and Motivation classes. Implemented team communication,

motivation classes, and accountability projects for staff and on going

quality team to meet clinic needs and standards.

Administrative duties included meeting annual and monthly budget

constraints, and submitting quarterly and annual budget requests,

implementation of CQI/TQM program. Remained consistently within budget

constraints and reduced clinic costs. Ensured compliance with JCAHO, OSHA,

HIPPA standards for continued accreditation.

Staff Development Coordinator/Medicare Unit Coordinator

June 1994 - Feb 1996 Wasatch Valley Rehabilitation

Responsible for meeting state guidelines for patient care and safety, and

successfully passed state survey. Education of staff to meet standard of

care delivery guidelines per State requirements with ongoing quality

monitoring. Monthly staff meetings. Performed duties as Employee

relations' officer, including hiring, orientation, scheduling and education

of staff, disciplinary action plans and termination. Maintained employee

files to meet regulatory compliance. Developed plans of care for staff to

work light duty following work related injuries and coordinated with staff

Physician for treatment plan and rehabilitation back to work program.

Performed duties related to occupational health including health screening

implemented TB program. Food handlers' license for all staff and BCLS

Implemented inpatient infection control program and tracking system for

infections. Assisted wound care program and monitoring. Assisted with

wound control rounds, fall rounds, on hire physicals. Performed Workman's

Compensation reporting and first report of injury.

Functioned as Managed Care Coordinator and liaison, performing on site

reviews, cost analysis per diem and weekly updates to vendor and

maintenance of quality care standards. Redeveloped Medicare Unit and

reporting system, RN functioning and instituted Primary Care Nursing system

to include increased communication with CNA's and Kardex system to meet

Medicare and Medicaid guidelines and criteria, established Nursing role in

IDT meetings Performed CQI/QA duties and monitoring.

Neurology Office Nurse The Salt Lake Neurology and Headache Clinic__March

1991 - May 1994

Responsible for office staff, hiring, firing and disciplinary action

Assisted with procedures including EEG, 8 - 24 hour monitoring, EMG, and

Nerve Conduction studies

Arranged further testing outside of office, including MRI, CT scans, blood

work as needed

telephonically screened calls to Physician, ordered necessary lab work and

repeat prescriptions

Administered medications for acute migraines and Seizure activity.

Performed clinical trials for drug companies on new Parkinson's and seizure

medication.

Clinical Staff Nurse / Charge Nurse Sept. 1987 - March

1991 University of Utah Medical Center

Acted as preceptor, and educator, charge nurse and participated in QA/QI

process. Liaised with Clinical Social Worker to establish discharge

Planning, Case management liased with appropriate services for patient

support needs. Participated in clinical trials and practice models.

Performed bedside duties and assumed total primary care of acute patients

in the following specialties:

Orthopedics Trauma/ Brain Injuries General Surgery, Hospice,

Gynecology/Oncological gynecology Cardio-thoracic and Vascular

therapies

Internal Medicine and sub specialties therapies Plastic and

reconstructive surgery PEG feedings and Parenteral feeding Ophthalmology

Stoma Therapy and Wound Care teams trauma wound vascular and diabetic

wounds Tracheostomy and Ventilator weaning protocols Palliative and

Terminal Care of terminally ill

Case Management between families and Social work, and appropriate liaison.

Current certifications:

Certified Case Manager 2006

BCLS, ACLS EKG certified

Laser certified /Laser Safety officer

Chemotherapy administration/ IV certified

Regional wound consultant for State of Utah with contracted Nursing homes

to assist with state compliance and Consultation for non healing wounds,

and wound therapy

Conscious sedation administration

CEU accreditation including, but not exclusive to scope of practice and

guidelines for Home Health Infusion therapy, care of Transplant patient,

pre, during and post. Enteral therapies, care of Gastric Bypass. Care of

Oncological patient and pain control

Care of the Hospice patient and pain management issues. Wound care

Management and therapies

Risk management, both per OSHA, patient and staff safety. Legal and

Ethical issues within scope of practice of Nurse Case Manager,

Identification of quality of care issues and practices. Fraud and Abuse

certifications.

Certified CMAG 1 CMSA Case Management Adherence Guidelines

Member of Utah Nurses Association, CMSA, Institute for Health Care

Improvement, ASHRM, AHA and NAHQ. WCI Network. WOCN. Wound Care Education

Institute

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