Manager Management

DIANA S. STRAHLER, RN, CPUR, CPHQ, CLNC

**** **** ***** ********* #*** ( Mount Pleasant, South Carolina 29464

614-***-**** ( *****@*******.**.***

SUMMARY: 25+ years of clinical experience with the last several years

focusing on Utilization/Case Management, insurance contracts, denials and

appeals, physician/staff education, government rules/regulations, clinical

criteria, and documentation appropriateness/coding. Strengths include

leadership, management of people, creative writing and communications

skills. Recognized as a leader in this aspect of the healthcare field;

frequently consulted by other health care organizations and insurance

companies. I am an healthcare professional seeking a management position

in Case Management/Utilization Management, Discharge Planning, Denials &

Appeals, Quality Management, Clinical Documentation, and/or Hospice.

PROFESSIONAL EXPERIENCE

Roper Hospital, Charleston, South Carolina

2010-2011

Manager of Case Management

Responsible for inpatient case management program

( Resigned due to personal/family issue in Ohio, now resolved

Berger Health System, Circleville, Ohio

2006 - 2010

Director of Case Management

Responsible for building the inpatient case management program

. Successfully started a complete case management program to

include ED Case Manager, Bed Control and Post Discharge Case

Manager, Discharge Planners, and Social Services

. Trained all Case Managers in InterQual, Milliman, and Clinical

Documentation Program

. Developed RAC Denial and CERT programs

. Actively building Revenue Cycle program with Patient Financial

Services

. Actively participated in Senior Care Days

Director of Berger Hospice Care

Concurrent

Responsible for reviving hospice program and gaining recognition in

community - was asked to fill position

temporarily (1 year commitment) along with being Director of Case

Management

( Actively provided patient care to hospice patients

Licking Memorial Hospital, Newark, Ohio

2003 - 2006

Director of Case Management and Home Health Care

Responsible for the inpatient case management program, community case

management program and the home health care division.

( Successfully started ED Case Manager, Bed Coordinator Role and ED

Social Worker.

( Trained all Case Managers in InterQual and Milliman

( Recovered $35,000/month in Denials and Appeals.

( Actively participated in Flu Clinic and Senior Care Days

Clinical Compliance Auditor and Documentation Specialist

Report to the CFO and VP of Compliance

Conduct chart reviews and audits for charge capture, documentation

insufficiencies, insurance audits ADRs, and CMS CERT program. Worked

closely with Peri-operative Services to develop Picis Program for charge

capture.

Independent Consultant providing chart review and chart auditing for

attorneys and local hospitals 2003 - present

Founder of Associates in Medical Legal Review

Grant/Riverside Methodist Hospitals, Columbus, Ohio

2000 - 2002

UTILIZATION MANAGEMENT MANAGER OF APPEALS AND DENIALS

Responsible for Utilization Management Program at Grant/Riverside. Managed

four Admitting Case Managers and created new and innovative roles in

Surgery and Cardiac Care areas for Case Management. Developed the

Inpatient Appeals and Denials Department for Riverside Methodist Hospital.

Also acted as clinical/technical support for the Emergency and Admitting

Case Managers.

. Expansion of Appeals and Denials Program - three

Appeals/Denials RNs and two Payment Variance Analysts and

expanded to Outpatient Denials.

. Acted as Denial Team Leader for Revenue Cycle to educate

professional and non-professional staff regarding documentation

and third-party payors reimbursement issues.

. Recovered $12 million in FY2000; $11 million in FY2001; and

recovered $11 million in FY2002 and reduced denial rate by 1%

equating to $4.5 million savings..

DIANA S. STRAHLER, RN - Page 2

. Acted as liaison to the government regulatory agencies, KePro,

Tricare, Permedion, and Adminastar as well as clinical and

utilization resource for insurance contract negotiations

. Worked directly with Medical Director in denial and appeal

process, physician education, and practice patterns.

. Served as resource person to support and educate other hospital

areas, such as Admitting, Billing, Coding, Case Management, and

Nursing, regarding Utilization Management and insurance issues.

UTILIZATION MANAGEMENT SPECIALIST 1996 -

2000

Responsible for the Utilization Management Program Grant/Riverside and the

Appeals and Denials Department, Grant Medical Center. This role included

education of all Case Managers in principles of Utilization Management,

Case Management, patient chart review, documentation and criteria usage.

. Acted as On-call expert for UM/CM and criteria questions.

. Developed Appeals/Denials Department

. Trained as MIDAS Systems Manager (back-up).

Grant Medical Center, Columbus, Ohio

UTILIZATION MANAGEMENT SPECIALIST/MANAGER 1988 -

1996

Responsible for nine Unit-Based Case Coordinators in a 544-bed hospital and

two Admitting Case Coordinators to coordinate Case Management Staff in

problem resolution and application of utilization guidelines/criteria.

.

. Coordinated physician response to Medicare, Medicaid and third-

party payor denials.

. Developed and implemented methodologies for compliance with

external regulations and guidelines

. Oversight hospital's role in Peer Review, HealthPro and ProWest

on-site and off-site activities.

. Served as liaison representing Utilization Management process

in hospital-wide utilization/case management program.

. Served as resource person to support and educate other hospital

areas, such as Admitting, Billing, Coding, Case Management and

Nursing, regarding Utilization Management and insurance issues.

SENIOR UTILIZATION REVIEW COORDINATOR 1985 -

1988

Supervised six Utilization Review Coordinators and developed Utilization

Department.

. Acted as liaison to third-party payors and regulatory agencies,

such as Medicare and Medicaid.

ADMITTING NURSE

1982 - 1985

Responsible for all elective and direct admissions to hospital and

developed the "gatekeeper" role as to appropriateness of admissions.

. Received physician orders for elective/direct admissions.

. Acted as resource person for ancillary personnel in area.

. Provided care and comfort to patients waiting to be admitted.

. Served as Bed Manager and had hospital-bed priority control.

OPTION 12 ONCOLOGY NURSE 1980 -

1982

. Chemotherapy certified.

. Weekend charge nurse for 34-bed oncology unit.

OFFICE MANAGER - OB/GYN practice 1974 -

1980

Responsible for the solo practice for a Physician/Attorney.

Managed the office, patient records and four staff members.

. Assisted with medical-legal research.

. Responsible for all insurance claims, payment of bills, and

practice management.

Other Clinical Experience:

Labor and Delivery Staff Nurse

3-11 Charge Nurse for 50-bed Pediatric Unit

DIANA S. STRAHLER, RN - Page 3

EDUCATION

Grant Hospital School of Nursing, Columbus, Ohio

Certified Professional Healthcare Quality (CPHQ)

Certified Professional in Utilization Review (CPUR) by

InterQual

Certified Legal Nurse Consultant (CLNC)

Pursuing additional educational opportunities at Franklin

University and University of Phoenix

Extensive management education through OhioHealth

Clinical Documentation Management Program

Other Skills:

Knowledgeable in InterQual ISD-A Criteria, as well as, Milliman, MCAP

criteria. computer experience with Word, Microsoft Office, Windows XP

Professional, HBOC, ChartStat, SMS, InterQual on-line, Medicare on-line,

and MIDAS Utilization Management System, Clinical Documentation Program.

PROFESSIONAL LICENSE

Registered Nurse - Ohio (active); South Carolina (active); Georgia

(inactive)

PROFESSIONAL ORGANIZATIONS

Past President Grant Hospital School of Nursing Alumni Association; Current

Vice President

Member of Chapter 5 Quality Review Coordinators of Ohio

American Red Cross - Fairfield County

Stroke Group - Fairfield County

Association of Clinical Documentation Specialist

American Case Management Association

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