Management Medical
Resume:
Martha Culbreath
Calera, Oklahoma 74730
Cell: 580-***-****
Email: ****************@*****.***
Summary
An accomplished healthcare professional with expertise in leadership, management, cost-effectiveness, communication, and organizational change methodologies. Expertise in overall management with well-developed skills in general administration, Medicare and Medicaid issues, and TJC standards.
Education
Master of Science Nursing, Texas Woman University, Denton, Texas
Bachelor of Science, East Central University, Ada, Oklahoma
Associate degree, Grayson County College, Denison, Texas
Professional Experience and Accomplishments Quality Management.
Care Management/Case Management
Responsibility included developing and implementing system policies, procedures and work flow processes related to Care Management.
Provide system wide support in addressing system wide clinical appropriateness and utilization of resources, employing best practices in clinical decision making
Responsible to develop a Centralized Utilization Management department to allow unit care management staff to place greater focuses on Traditional planning.
Coordinated a centralized approach for clinical denials and appeals across the enterprise
Coordinated a centralized department through which all incoming and outgoing communications between Care Management team and payers are processed.
Oversight of Medical Necessity, Utilization Review, Discharge planning and Level of Care.
Performed in-depth departmental assessments resulting in a redesign to emphasize the integration of utilization management and resource management.
Utilization Management: Performed hospital retro and concurrent reviews and made recommendations to executive leadership
Identified multiple process improvements: implementation of Case Management in the Emergency Department, Level of Care issue, including in-patient vs. observation, pre-screening for medical necessity
Developed processes for Medicare compliance for Level of Care
Knowledge of InterQual and Milliman criteria
Clinical Documentation Improvement oversight. Increased Medicare Case Mix Index
Throughput: Developed metrics for throughput, measured and monitored.
Oversight of RAC Audits and Appeals.
Established a collaborative culture that enhanced patient care and improved employee satisfaction scores. Employee satisfaction scores improved from the lowest in the health system to one of the highest in nine months.
Restructured Case Management department processes to focus on Medicare Length of Stay resulting in a decrease in LOS by 1.3 days.
Quality Management
Demonstrated skills in health information fundamentals, including application of basis statistical processes, data analysis and reporting. Analysis of data and reported on performance which was measured against set indicators.
Accreditation survey preparation, including survey process, on-going regulatory compliance with Federal and State agencies.
Created and implemented Quality infrastructure which resulted in a successful TJC survey. Strengthen the processes to ensure compliance with TJC National Patient Safety Goals. Responsible for Quality Outcome Management, including clinical and service data trends, identifying variations in evidence-based practice.
Survey preparation included creation of educational booklet for TJC preparation of all staff
Strengthen TJC initiatives for safety and Core Measures. Compliance objectives based on National Best Practices.
Recruitment and Retention
Effectively engaged and established strong working relationships with employees, physicians
Work place harmony and professional satisfaction through better communications and collaboration, which resulted in high employee satisfaction, based on Gallup 12 questions to Measure Employee Engagement.
Operations
Overseen the development and implementation for new free-standing Acute Rehabilitation Hospital
Overseen the development and implementation of a skilled nursing unit and rural health clinics, including all phases of TJC and State requirements
Established operational policies and procedures
Financial
Development of operating and capital budgets, monitored monthly and other financial statements. Took effective corrective action as required.
Management/Leadership
Established a culture of collaboration and integration that enhanced the provision of excellent patient care and improved patient satisfaction. Press-Ganey scores for patient satisfaction increased from one of the lowest in the corporate structure to one of the highest within nine months.
Redesigned the Nursing Care Delivery Model.
Personal Characteristics and Attributes
Ability to understand the physicians’ and caregivers’ perspectives
Openness, accessibility and visibility; approachable to staff.
Excellent communication, listening, and negotiation skills, inclusive to other’s views
Maturity in judgment, broad thinking and intellectually agile
Work History
11.17 to 1.18 Interim Director Care Coordination St. Bernadine’s Medical Center, San Bernardino, California
03.17 to 10.17 Director Case Management, Wilson N Jones Hospital, Sherman, Texas
07.16 to 11.16 Interim Director Care Management, Cullman Regional Medical Center, Cullman, Alabama
03.15 to 2.16 Interim System Director of Care Management, CHI St. Luke’s Health System, Houston, Texas
Six hospital system
08.14 to 3.15 Interim Director of Case Management, CHI Memorial Hospital of Chattanooga, Tennessee
Two hospital system
01.14 to 6.14 Interim Director Care Management, St. Joseph Medical Center, Eureka, California
Two hospital system, one a Critical Access Hospital
06.13 to 12.14 Interim Director Clinical Resource Management, Palomar Health,
Escondido, California
Two hospital system
11-12 to 04-13 Interim Director Case Management, Kaiser Walnut Creek Medical Center, Walnut Creek, California
08-12 to 11-12 Interim Director Clinical Resource Management, Cayuga Medical Center, Ithaca, New York
02-12 to 07-12 Interim Director of Case Management, St. Francis Medical Center, Lynwood, California
08-11 to 01-12 Interim Director of Case Management, Stanley Regional Medical Center, Albemarle, North Carolina
07-10 to 12-10 Interim Director Case Management, Alvarado Hospital, San Diego, California
07-09 to 03-10 Interim Clinical Resource Management Director, Palomar Pomerado Health, Escondido, California
01-08 to 10-08 Interim Case Management Manager, Lucile Packard Children Hospital, Palo Alto, California
10-06 to 01-07 Interim Quality Management Director, North Hawaii Community Hospital, Kamuela, Hawaii
03-2007 to 8-2007 Interim Case Management Director, Providence St. Peter Hospital, Olympia, Washington
02-2008 - 08-2008 Interim Director Quality Management, Palo Alto Medical Foundation, An affiliate of Sutter Health
09-2005 - 01-2006 JCAHO Consultant, Patient-Response, Inc.
06-2005 - 07-2005 Interim Quality Management. Patient-Response, JCAHO Consultant
10-2004 - 05-2005 Interim Quality Management Director, Palo Verde Hospital, Blythe, California
08-2004 - 10-2004 Interim Chief Nursing Officer, Palo Verde Hospital, Blythe, California
10-2003 - 01-2004 Consultant for Patient Response, Inc. Auditing records for compliance with CMS
04-2004 - 10-03 Consultant for Patient Response, Inc. Case Management
10-2002 - 04-2002 Administrator Destiny: FutureQuest, Hugo, Oklahoma
01-2002 - 10-2002 Director of Nursing Service, Destiny: FutureQuest, Hugo, Oklahoma
08-2001 -11-2001 Interim Nursing Service Administrator, Lovelock, Nevada
01-2001 - 07-2001 Interim Manager for Rehabilitation, Transitional Care Unit and Medical/Surgical units, South Fulton Medical Center, East Point, Georgia
06-2000 to 09-2000 Interim Director of Nursing Service, Hot Springs County Memorial Hospital, Thermopolis, Wyoming
08-1999 - 12-1999 Interim Chief Nursing Officer, Community Health System, Big Bend Regional Medical Center, Alpine, Texas
1996 - 1999 Chief Nursing Officer, Community Health System, Scenic Mountain Medical Center, Big Spring, Texas
1994 -1996 Chief Nursing Officer, Community Health System, Bonham, Texas
1993 - 1994 Director of Nursing, Memorial Hospital of Center, Center, Texas
1978 - 1993 Various positions in staff nursing and nursing management. Texoma Health Care System, Denison, Texas, including, Medical/Surgical Nursing, Intensive Care Unit, Cath. Lab., Emergency Department, Infection Control and Employee Health.
Professional references furnished upon request
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