Home Health Management
Resume:
CARIN CROKER
Cudahy WI ****0
***********@*****.***
SUMMARY OF QUALIFICATIONS
. Successful regulatory compliance which includes state and national
initiatives/certification (NCQA, HEDIS, URAC, CHAP, Magnet, Joint
Commission).
. Budget management $20 million in multiple departments: Home Health
(sixteen counties) Hospice (5 county), Palliative Medicine (two county
community program and tertiary hospital Palliative Consultative
program), Hospice House (eight bed), Palliative Care Unit (fourteen
bed in-patient), Senior Health Service Line, Medicaid PCW program
(sixteen counties).
. Implemented Patient Satisfaction initiatives and publically reported
Quality Measures to National averages in patient care and customer
satisfaction.
. Develop and lead in numerous committees including Community Advisory
Networks, Process Improvement projects, National, State, and Regional
committees for creation of policies and procedures and healthcare
initiatives.
. Expert speaker in various areas for national, state, and regional
conferences: Organizational Quality, Financial, and Patient Outcomes.
. Developed, operationalized and advanced innovative programs:
Telemonitoring, Palliative Medicine in-patient and community based
programs, Senior Health, RN Nurse Navigator, Acute Care for Elders
(ACE), Heart Failure pilot programs, Medicare Advantage program
development, and Medicare Break Even system-wide initiatives based on
Healthcare Reform (readmissions, cost avoidance, Transitions of Care).
. Project implementation, coordination, and knowledge management for
system-wide teams increasing departmental efficiencies. Cross-
functional team leader in large organization for Skilled Nursing
Facility collaboration, Medical Home initiatives, tertiary hospital
Case Management models.
. Develop and operationalize Healthcare Reform initiatives: Readmission
prevention, End of Life programs with Advanced Directives, Transition
of Care, Medical Home, Hospital at Home, and Telemedicine (rural area
initiatives).
. Implement Pay for Performance and Payment Reform initiatives in
preparation for governmental requirements in multiple healthcare
settings.
. Involvement in acquisition of Home Health agency in Michigan.
. Managed coding and billing for Home Health, Hospice, Palliative
Medicine organizations. Medicare, Medicaid, and Commercial insurance.
. Proficient in various healthcare payment models (OASIS/HHRG, MDS/RUGS,
Hospital/DRG, Family Care/MA, IRIS, Medicare Advantage and Special
Needs Plans).
EDUCATION
Doctorate in Organizational Management & Leadership
. Graduation date: 2015
Masters of Science in Nursing, 2006
University of Phoenix
. Practicum in Healthcare innovative Program Development
Bachelor of Science, 1998
Alverno College, Milwaukee, WI
. Minor-Management
Wisconsin State Certified Case Manager, 2003
PROFESSIONAL EXPERIENCE
Managed Health Services November 2012
. NCQA, HEDIS, MC Advantage, Skilled Nursing Facility payment
initiatives, Model of Care implementation, Case Management cost
savings initiatives, Medicaid payment management, and develop program
initiatives (Sickle Cell, Patient Care Conferences, PCW cost
savings/monitoring, MetaStar survey).
Aspirus VNA Home Health May 2005-present
Aspirus VNA Home Health & Comfort Care Hospice Oct, 2007 -
July, 2012
Aspirus Palliative Medicine
Oct,. 2007 - Sep, 2012
Director of Patient Services
. Implements certification and regulatory initiatives: NCQA, CHAP, JC,
Magnet
. Hires, supervise, and oversee Home Health, Extended Care PCW,
Palliative Care Unit/Palliative Medicine Consultative Program, Senior
Health Service Line, and Hospice House.
. Creates and supports process improvement methods for a large system:
Medical Home, Case Management in a large tertiary hospital.
. Develops new clinical programs: Telemonitoring, Transition of Care
system-wide and in collaboration with MC Advantage products, Medicaid
cost avoidance initiatives (Hospital at Home for HF, Cellulitis).
. Provides direct marketing to community building relationships (ADRC,
Skilled Nursing Facilities, and Assisted Living Facilities).
. Develops strategic goals, objectives, and budgets on a department and
organizational level.
. National, state, and regional presentations for state and national
associations: VNAA, National Financial Outcome Conference, NHPCA,
CAPC, Wisconsin Home Care Organization.
. Creates and manages budget ($20 million).
. Implements clinical policies and guidelines for national organization
(VNAA).
Northcentral Technical College and Upper Iowa University - Adjunct Faculty
2009 - 2013
. Wisconsin Certified Nursing Assistant Program
. Wisconsin Certified Medication Assistant Course
. Healthcare Management
. Medical Terminology
Community Development - Riverview Terrace 2007 - 2013
. Resident Assessment in RCAC
. Medication Management
. Registered Nurse Duties such as but not limited to: Referral
coordination, family meetings, and care coordination.
Harmony Living Centers LLC November 2004-April 2005
RN-North Central Area Health & Wellness Coordinator (CBRF and RCAC)
. Weekly auditing of facility medication system.
. Teaching of medication class monthly to meet state guidelines.
. Review resident Individual Service Plans.
. Assessing residents who self-administer as needed and annually.
. Assist and coordinate referrals to home health care agencies, hospice,
and therapies.
. Communicate effectively with Physicians, pharmacists, and facility
managers.
. Quarterly psychotropic medication review for residents.
. Monitoring and assessing residents for changes and need for services.
Wausau Benefits Inc. April
2002- March 2005
Senior Clinical Quality Specialist (May 2003-February 2005)
Case Management Specialist (April 2002-May 2003)
. Promoted to Senior Clinical Quality Specialist, developed policies and
procedures for case management and claims processing.
. Developed and implemented staff education programs, focused on HIPPA
compliance and general operating procedures.
. Extensive knowledge in hospital bill review and negotiations.
. As Case Management Specialist, implemented individual case management
programs as a part of administering benefits for self-funded
companies.
. Evaluated requests for authorization of medical services and promote
health education.
. Identified health care related organizations and resources for
customers.
. Implemented effective oral and written communication to establish
strong customer rapport.
. NCQA, URAC compliance
Marshfield Center July 1999- March
2002
Assistant Director of Nursing
. Management and budget responsibilities, including budgeting, staffing,
and collaboration with physicians, nurse practitioners, and therapist
to deliver quality patient care.
. Created and implemented multiple programs: Restorative Program,
Dementia programs
. State survey management
. RUGS, MDS, Therapy Utilization
Publication/Articles:
. VNAA Nursing Policy & Procedure Manual 2007-2008
. VNAA Nursing Policy & Procedure Manual 2008-2009
. Home Health Line, October 6, 2008
. Home Health Line, October 13, 2008
Presentations:
. CAPC: Palliative Medicine, 2012
. 29th Annual Visiting Nurses Association Conference, April 2011
. National Home Care Financial Outcomes Conference, April, 2009
. Rotary Club (2008), Assisted Living Leadership Conference (May, 2009)
. 26th Annual Visiting Nurses Association Conference, May 2008
. Wisconsin Home Care Annual Convention, May 2008
. National Home Care Quality Outcomes Conference, November, 2008
. Nurse Staffing and Patient Outcome: Implications for Policy,
Leadership, and Research, November 2007
Organizational Membership
. W-ONE
. CMSA
Contact this candidate