Manager Management
Resume:
Mary Olsen
Email: abpvdh@r.postjobfree.com
Address: **** ****** **.
City: Denver
State: CO
Zip: 80207
Country: USA
Phone: 303-***-****
Skill Level: Experienced
Salary Range: $67,000
Willing to Relocate
Primary Skills/Experience:
See Resume
Educational Background:
See Resume
Job History / Details:
Mary Malm-Olsen, RN, MSW, CCM
2925 Locust St., Denver, CO 80207
T: 303-***-**** / abpvdh@r.postjobfree.com
Objective: Experienced RN case manager, medical social worker and RN paralegal seeking a position as a RN Case Manager utilizing my 26 years of experience as a Registered Nurse, 12 years as a Medical Social Worker, 18 years of Utilization Review.
AREAS OF EXPERTISE
Critical Thinking and Analysis - Expert case manager and medical social worker with outstanding ability to implement the health care provider programs and processes, adapting quickly and effectively in a variety of assignments and settings.
Knowledge of Health Care Systems - Highly skilled at coordinating care throughout the continuum of health care, implementing effective care planning, quality resource management, discharge planning to maximize care transitions, patient and family engagement and advocacy for all age groups and diverse populations. Excellent internet research abilities.
Verbal and Written Communication Skills - Exceptional ability to problem solve, utilizing an interdisciplinary approach including physicians and stakeholder input. Expert at proficient documentation in a variety of EHR formats, QI/QA systems, coding, and preparing written notices. Improved customer satisfaction ratings at CFMC from 65% to 100% within 6 months of assuming CM role through attentive and timely responses to beneficiaries and families.
Quality Outcomes and Utilization Review - Proven proficiency in performance of investigations, high quality UR reviews using Milliman Care Guidelines, Interqual criteria, the ECIN systems and other customized quality management systems.
Computer and Technology Skills - Efficient with implementation of complex technology in a variety of clinical settings. Skilled in use of MS Word, MS Outlook, MS Excel, Windows 2003 and 2007and other customized systems.
PROFESSIONAL EXPERIENCE
COLORADO FOUNDATION FOR MEDICAL CARE, Denver, CO 2010 - 2012
QIO, Quality Improvement Organization for state of Colorado
Medicare Beneficiary Complaint Case Manager, Team Leader
* Investigated beneficiary complaints regarding Medicare services and managed referrals from OIG, and other federal and state resources
* Utilized Milliman Care Guidelines, Interqual and other standards to identify quality issues based on medical record review. Trained in LEAN basics and other QA methodology.
* Facilitated the peer review process utilizing Medical Officer oversight, preparing written notices within timelines required
* Coordinated re-reviews and facilitated negotiations with beneficiaries and providers using the Facilitated Dispute Resolution process
* Facilitated QI/QA activities with providers when inadequate care was identified
* Appointed to User Committee for Beneficiary and Family Care Center with goal of revising the national CMS complaint review processes
* Provided Immediate Advocacy for Medicare Beneficiary issues, maintaining computerized records, collecting data and contributing to development of program reports
HMC WELLPOINT BLUE CROSS/BLUE SHIELD 2009-2010
Complex Care Case Manager
* Provided telephonic case management of over 100 Medicare and commercial insurance members with complex health issues in several states
* Facilitated quality improvement and cost effective care by optimizing patient use of insurance benefits along with community resources
* Collaborated with interdisciplinary teams, stakeholders, and physicians to improve patient flow, provide instruction to members and families, and promote disease management of acute and long term disease conditions
CENTURA ST. ANTHONY NORTH AND CENTRAL HOSPITALS 2005 -2009
RN Case Manager, Medical Social Worker, Utilization Review, Denial Management
* Performed admission criteria review, LOS management, denial management, discharge planning, utilization review
* Provided case management for uninsured, disabled, Workers Comp. and diverse populations fo all ages
* Participated in clinical education of Family Practice Residency students
* Identifies savings, and participates in client case saving reviews as requested by team.
* Served as case management department liaison for Joint Commission accreditation activities.
Pres. /St. Luke Hospital Corporation of America 2004-2005
RN Case Manager, Medical Social Worker, Utilization Review
* Coordinated/optimized health care team intervention across the continuum of care
* Assisted with development of outcome management goals and system improvement
* Performed admission criteria review, LOS management, denial management
* Provided nursing, utilization management, denial management, social work services for addiction disorders and psychiatric disorders, diverse populations in all settings, including pediatrics, ER, trauma units, Neonatal Intensive Care units
Kaiser Permanente Hospitals, CO and San Diego, CA 2002-2004
RN Case Manager, Quality Resource Coordinator, Medical Social Worker, Utilization Review
* Responsible for admission reviews, LOS, utilization review and case management, denial and risk management, discharge planning in all areas of hospital, including ER, OB/GYN, ICU/CCU and other clinical settings.
* Facilitated appropriate specialty consults, procedures and communication between support services and attending physicians to expedite timely discharge
* Developed reports of re-admission patterns and interventions implemented to address issues
EDUCATION
Colorado State University, Fort Collins, CO Master of Science - Social Work
University of Oregon, Portland, OR Bachelor of Science in Nursing
Denver Paralegal Institute, Denver, CO Certificate - Paralegal Practice
St. Elizabeth School of Nursing, Lincoln, NE Diploma in Nursing
Certificates: CCM since 2000, California PHN Cert. 1977
ACHIEVEMENTS
U.S. Navy Nurse Corps - Letter of Commendation
CFMC 2012 - Performance Excellence - Case Management
CCMC 2009 - National Expert Panel for Book of Knowledge Resource Database
CENTURA 2008 - Case Management Excellence Award
Kaiser Permanente - 2002 Silver Summit Award for Case Management
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