Case Manager

Susan's InformationLocation: Fairfield, CATitle: Case ManagerWilling to Relocate: NoMember Since: 2011-07-18

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Susan Rambert- Campbell RN BSN

Susan Rambert-Campbell RN,BSN

Ca. 94533

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Objective: Nurse Consultant /Project Coordinator/ Case Mgmt /UM /QM /Manager

Summary

Versatile, result-oriented, critical thinking Medical Management Consultant/Complex Case Manager. Thirty five years professional nursing with leaders in the Healthcare Industry. Six years progressive management .Experienced leadership. Skilled in in-service education, adult learning, managed care, utilization review, case management, problem -solving, program development, finances, contracts, and negotiations. Achieves cost effective, medically appropriate outcomes across the continuum of care. ICU/ CCU/NICU/transplants expertise.

Professional Experience

Northbay Healthcare - Ca. 2004- 2011

Outpatient Complex Case Manager

Comprehensive CM/UM/PAR/ QM oversight over complex/disease managed members.

Assessed, planned, implemented, monitored and evaluated options and services to effect appropriate, individualized plan for the patient across the continuum of care.

Decreased LOS and readmissions 17% by developing enhanced case management, discharge f/u, action plans and avoidable hospital programs, improving patient outcomes

Identified high-risk patients and ensured that appropriate care is coordinated and delivered through accessing the most suitable resources resulting in 10% decreased

utilization.

Identified billing errors with payor sources on ESRD/complex members with $760K

revenued recovered.

Cited by physicians and Medical director as managed care resource/expert to staff and other departments in problem solving and ability to analyze and think critically.

Improved CM/UM policies/procedures/contracts to minimize & reduce financial risk to NB medical group/healthplan and reduced overutilization.

Awarded National CM recognition in Washington DC for effective case management, patient/family advocacy and outcomes for a pediatric case with Rasmussen's syndrome.

Paradigm- Deerfield, Ill. 2003-2004

Neonatal Intensive Care Case Manager

Field case management of all NICU admissions for at-risk healthplan payors. Reviewed and assigned appropriate LOC. Coordinated d/c with contracted providers and community resources

Reduced LOS 15%, educating physicians /staff/ parents by planning effective discharges applying nationally approved Paradigm's NICU Standards of Care.

Pacificare Health Systems -Concord, Ca 2001 - 2003

Medical Management Consultant

Managed appropriate medical/utilization and bedday reduction to 14 medical groups in Northern California counties .Performed complex system assessments.

Exceeded Pacificare's targeted medical management department goals by 15% through development of effective U/M processes and SNF assessment tool.

Achieved 20% decrease in beddays/thousands by reducing average LOS and inappropriate hospital admissions with effective U/M criteria enforced to MG/hospitals.

Healthnet / Foundation Health-Rancho Cordova, Ca 1996-2001

Complex/ Transplant Case Manager

Managed and authorized healthcare delivery for catastrophically ill Champus Tricare members

Developed Champus Tricare transplant CM guidelines for Region 6,9,10 and 11.

Reduced transplant expenses by 20% negotiating transplant rates & renewing contracts.

Aetna Government Health Plan, Ca. 1995-1996

Utilization/Case Manager

Performed PA, CCR, UM, QM, case management duties on Champus Tricare beneficiaries.

Woodland Memorial Healthcare, Woodland, Ca. 1994-1995

Resource Management Nurse

Controlled resources within accepted risk-assignment with individual payor source.

Worked with various managed care companies with indemnity plans, PPO's, HMO's,

Medicare and Med-i-cal.

Ca. 1993-1994

Sub-acute Clinical Director

Directed full operations of 28 bed sub-acute. Performed fiscal oversight .Managed 18 FTE's.

Developed Sub-Acute Policies/Procedures resulting in passing state survey & received Joint Commission Accreditation .

Kaiser Permanente, Vallejo, Ca. 1982-1993

Functional Unit Manager- Cardiology 1990-1993

Staff Nurse II/ Cardiac Educator 1982-1990

Directed and managed outpatient cardiac clinic for 6 physicians with 14 FTE's. Created, developed, implemented and conducted cardiac educational/rehab/pacemaker and defibrillator program. Advanced clinical expertise in ICU/Critical Care/ NICU/Med-Surg. nursing

Stanford Hospital, Palo Alto, Ca. 1977-1982

Advanced Cardiovascular Nurse III

Education, License and Certifications

Bachelors of Science- Nursing- BSN- Sonoma State, Rohnert Park, Ca.

Public Health Nurse Degree-PHN- Sonoma State, Rohnert Park,Ca.

Case Management Certification - Morton Grove, Ill.

Registered Nurse Diploma - RN-Northwestern University Memorial Hospital- Chicago, Ill

California Nursing License # 275088

BCLS/ACLS certified

Professional Distinctions

American Heart Association - Past President

Case Management Society of America

Kaiser and AHA Speaker's Bureau

Guest speaker on Women and Heart Disease at Women's Health Symposium

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