Manager Management

PROFESSIONAL SUMMARY

Case Manager Nurse Consultant

Utilizing evidence based guidelines in the case management process, worked

with high risk multicultural populations through risk assessment, care

planning, intervention, evaluation, health coaching and referral to

appropriate community resources. Provided acute and transitional care

coordination, serving as client advocate and liaison in communications with

physicians, insurers, vendors and external resources. Maintained compliance

with federal; state; accreditation regulations and clinical documentation

requirements. Identified and referred quality and risk management issues to

appropriate departments.

CAREER ACCOMPLISHMENTS

. Instrumental in staff hiring, supervision, training and evaluation in

a start-up case management firm. Because of the health teaching and

risk assessment program provided by trained professional staff, 67% of

an MCO's targeted members complied with required follow up care

appointments thereby improving compromised HEDIS scores.

. Participated in the research, design and implementation of the NICU

Case Management portion of the Pediatric Care Management Program of an

MCO, with the anticipated business result of improved patient

outcomes, early intervention for costly, complex, chronic conditions

and reduction in inpatient hospitalizations and ER visits.

. Designed forms for aggregated data collection, statistics, risk

assessments, health teaching for various MCOs.

. Experienced with InterQual and Millerman review criteria, DRG, ICD-9,

HCPCS coding for reimbursement.

. Participated in the planning, design and implementation of the ER

admissions overflow unit, initiating clinical nursing care and

observation of ER admissions prior to bed assignment/availability in

an acute care hospital.

. Promoted from staff nurse to assistant nurse manager in an acute care

setting, ensuring the smooth operation of the shift while maintaining

quality of care.

. Severed as participating member of Case Management

Director's Process/Flow Committee, reviewing problems in systems and

procedures that affect patient care, safety and staff retention.

Results increased program efficiency, patient safety, reduced lengths

of stay and increased employee job satisfaction.

EDUCATION

Bachelor of Science, Psychology/Anthropology, Howard University,

Washington, D.C.

Associate Applied Science, Nursing, S.U.N.Y Upstate Medical Allied Health,

Syracuse, N.Y.

CERTIFICATIONS

Certified Case Manager, Commission on Case Manager Certification, 10/2003

to 10/2013

Board Certified Case Manager, American Nurses Credentialing Center, 05/2008

to 05/2013

Registered Nurse Licenses, Current MD; D.C.; WA State Boards of Nursing

CPR Certified BLS, American Heart Association, 11/2009 to

11/2011

EMPLOYMENT

Inova Fairfax Hospital . Falls Church, VA 22042 . 03/2008 to 07/2010

Regional acute care hospital, part of the INOVA Health System of Northern

VA.

Clinical Case Manager

Provided case management, utilization review and discharge planning

services for high-risk neonates and families in 75-100 bed Level 4 Neonatal

Intensive Care Unit.

Prenatal to Peds . Elkridge, MD 21075 . 10/15/2005 to 03/01/2008

Start-up Case Management Firm providing healthcare services including risk

assessments, health education, case management and life care planning.

Case Management Nurse Consultant /Contractual

Utilized the case management process working with high-risk maternity,

postpartum, neonatal and pediatric populations. Developed policies and

procedures related to targeted populations. Managed contractual

professional and support staff.

AmeriChoice . Elkridge, MD 21075 . 10/2003 to 10/2005

Medicaid MCO Company, member of United Health Care Group.

Complex Care Manager

Utilizing evidence based guidelines; case managed high-risk perinatal

clients telephonically, providing health assessments, education, care

coordination and resource referral.

Group Benefit Services . Hunt Valley, MD 21030 . 06/2002 to 09/2003

Third Party Administrator for Self Insured Companies.

Case Manager

Case management of high-risk OB/NICU clients according to service

eligibility and benefit dollars of the various self-insured companies.

Harbor Hospital . Baltimore, MD 21225 . 10/2000 to 04/2002

Acute Care Hospital located in South Baltimore City

Admission Facilitator

Facilitated adult medical surgical direct and emergency hospital

admissions. Performed physical assessments and completed computerized

nursing admission database. Began clinical nursing care and observation of

ER admissions prior to bed assignment. This was inclusive of IV starts,

medications etc.

Visiting Nurses Assoc. of MD . Baltimore, MD . 12/1999 to 08/2000

Home Health Agency

Quality Systems Documentation Review Nurse . CHN

. Review of admission and recertification documentation for quality, and

compliance to Medicaid/Medicare regulations; HMO/TPA requirements.

. Provided ongoing education to clinical staff on reimbursement and

regulatory requirements.

Sierra Military Health . Baltimore, MD . 05/1998 to 03/1999

DOD Managed Care Contractor

NICU Case Manager / MCH Disease Management

. Case management of high-risk neonates in collaboration with family and

all members of the health care team.

. Coordinated the most appropriate cost-effective services available under

benefit package.

. Participated in the development of the OB Disease Management Program in

this start up organization.

Visiting Nurses Assoc of DC . Washington, DC . 07/1997 to 05/1998

Home Health Agency

Resource / Patient Accounts Manager . CHN

. Review of admission continued stay and recertification documentation for

quality, and compliance to Medicaid/Medicare regulations/ requirements for

reimbursement.

. Provided ongoing education to clinical staff on reimbursement and

regulatory requirements.

MD Dept. of Environment . Baltimore, MD . 11/1994 to 7/1997

Maryland State Government Agency

Community Health Nurse / Program Manager I Childhood Lead Poisoning

Prevention Program

. Care coordination of lead poisoned children by providing oversight and

technical support for local health department case managers.

. Statewide consultant for referral, tracking, and education of CDC

guidelines in childhood lead poisoning prevention.

Washington Hospital Center . Washington, DC . 04/1991 to 10/1994

Regional Acute Care Hospital

Clinical Nurse III, Level 111 Neonatal Intensive Care Unit

. Delivered quality nursing services to high-risk neonates and family

through assessment, intervention, problem solving and evaluation of

patient status.

. Instructed families in the care, rehabilitation and health maintenance of

the neonate.

. Successfully completed PALS certification requirements.

JHHS North Charles Campus . Baltimore, MD . 08/1990 to 04/1991

Community Hospital

Utilization Management Coordinator

. Reviewed medical records to determine legitimacy of admission, treatment

and continued stay criteria.

. Monitored health care delivery to insure efficient utilization of

institutional services to reduce uncompensated days.

Total Health Care Inc. . Baltimore, MD . 1988 to 1989

Community Health Center

Case Manager, Perinatal Grant Program

. Case managed high-risk perinatal clients serving as advocate and liaison

relative to internal and external

resources.

. Implemented program objectives through staff education and training.

. Abstracted data from medical records, maintained statistics, designed

forms for aggregate data collection.

Harbor Hospital Ctr. . Baltimore, MD . 1981 to 1988

Community Hospital

Staff Nurse to Assistant Nurse Manager Levels I and II Nurseries

. Management of professional and non-professional staff in absence of

Manager.

. Coordination of shift activities to ensure quality patient care.

. Cross-trained in Combined Maternal Infant Care, Post-partum, High Risk

Anti-partum and GYN Surgery.

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