Registered Nurse Management

Education

University of Mary

Bismarck, ND

• Bachelor of Science in Nursing April 2007

• Project Management Professional Certification (PMP) December 2012

Work Experience

Aetna

Bismarck, ND February 2012-Present

Health Service Manager

Work at Home

• Provide operational program support to all departments involved in National Care Management to include leading the continuum of care through all programs

• Facilitate, prepare, and lead quality meetings and create workflows for all departments

• Develop and lead implementation plans for the transition to dedicated units including managing the end to end effort

• Perform project and program management services to include being the lead on multiple different projects running simultaneously

inVentiv Medical Management

Augusta, Georgia January 2012-June 2013

Per Diem Team Lead Nurse Auditor

Work at Home- Terminated due to reduction-in-workforce

• Supervise a group of nurse auditors in regards to analyzing production and quality standards

• Develop detailed medical synopsis of a patient’s case to use for RAC review and legal purposes using DRG and coding guidelines, Milliman and Interqual criteria, and CMS guidelines

• Analyzed home health records using OASIS and Episode Management

• Recommend performance improvement plans based on analysis of production and quality data

• Perform quality audits on each nurse every week to ensure each nurse is meeting the standards set forth by the company and following documentation guidelines

• Develop guidelines for different types of reviews, production standards, incentives, and assist in reaching company goals

• Assist in analyzing production, quality, performance improvement, and financial reports

Aetna

Bismarck, ND August 2009-February 2012

Quality Management Nurse Consultant in CCR

Work at Home

• Independently create a high quality, detailed synopsis through research of clinical polices and state/federal regulatory guidelines to determine correct payment of claims

• Educate analysts regarding clinical procedure and medical evidenced-base policy updates to create more efficient workflows

• Virtually mentor new employees and provide educational feedback to create knowledgeable and productive consultants

• Ability to multi-task with proficiency in all Microsoft Office products with excellent written and verbal communication skills

MedCenter One

Bismarck, ND February 2009-August 2010

Stroke Program Coordinator

• Perform data abstraction from medical records and enter into the stroke and trauma registry to ensure compliance with state and federal clinical care outcomes

• Develop protocols and procedures through research to ensure the stroke patient receives quality care through standardization of processes

• Manage a group of employees to ensure the appropriate workflows are utilized when caring for a stroke patient

• Collaborate and present to hospital administration, unit management and a diversity of disciplines to promote and validate consistency in the care of a stroke patient

Certifications and Proficiencies

• Registered Nurse in North Dakota

• Project Management Professional (PMP) Certification

• Proficient in Microsoft Products, including PowerPoint, Excel, Access, Publisher, Infopath and Word

• Proficient in Interqual, Millman, and with CMS guidelines, manuals, and website

• Supervisory experience

• Medical Review experience

• Leadership experience

Contact this candidate