Registered Nurse
Resume:
DIANNA M. MARSH, RN
Long Beach, CA 90815
H/F 562-***-****
*******@*******.***
QUALIFICATIONS PROFILE
• Twenty-eight+ years’ experience in Case Management.
• Thirty-four+ years’ experience in Case Management, Hospice, Palliative Care, Home Health, Utilization Review and Acute Care
• Ten+ years in Administrative positions.
ADMINISTRATIVE SKILLS
• Managed three departments which included PA, UM Call Center and Correspondence, with clinical/non- clinical personnel (~ 65 persons) including five supervisors within a MHP
• Re-organization of both COC and CBAS departments within a MHP which included many process improvements to ensure improved tracking abilities to meet regulatory guidelines.
• Instituted multiple Regulatory required Letters for both COC and CBAS including writing Quick Reference Guide’s and Templates with in-services for all staff
• Development of processes to identify and track CBAS and Custodial COC’s in accordance with regulatory requirements.
• Development of current Visio workflow for COC Department for a MHP.
• Actively involved with multiple Departments within a MHP to ensure the transition of ASD Members from Regional Centers throughout California to the Health Plan.
• Involved in research and problem-solving with various departments within a MHP such as member services, provider services, prior auth, claims, Case Management, Government Contracting and UM regarding: claims, billing, case management, continuity of care, adult day care issues and quality of care issues.
• Ability to communicate clearly and effectively with Directors of various Departments, facilities, Primary Physicians, ancillary health professionals, family members, and Members.
• Supervise all activities within the COC and CBAS Departments of a MHP.
• Developed the role of Health Care Facility Supervisor for a large Medicare certified Hospice
• Supervised all hospice activities for skilled nursing facility as well as home patients.
• Managed all aspects of Nursing and ancillary care for both a Home Health and Hospice Agency.
• Ability to document thoroughly and concisely.
• Extensive familiarity with home health and hospice regulations, including title 22 regulations.
CLINICAL SKILLS
• Experience in COC/CBAS review, Case Management and Utilization Review, Prior Authorization, Correspondence regulations, Oversight of UM Call Center, Quality Assurance auditing, claims and billing review, Long Term Case Management, and complex discharge planning for Medi-cal, Medicare and private insurance companies.
• Ability to manage/supervise multiple departments within a MHP, Hospice and Home Health agencies
• Extensive direct clinical experience in hospice, palliative care, and home health nursing.
• Ability to work independently or as a team member.
• Preceptor and mentor for new RN staff.
CERTIFICATIONS AND PROFICIENCIES
• Trained preceptor
• Volunteer Ambassador at Molina Healthcare
• Service excellence advisor (included teaching classes to co-workers)
• Participated on the UBT (unit based team) for hospice Page 1of 2
• Participated on the safety committee
• Completion of Labor-Management Partnership training
• Facilitator for Labor-Management Partnership classes
• Certified Hospice and Palliative Nurse via NBCHPN, December 2005
• Home care manager certificate program, CAHSAH, 1995
PROFESSIONAL EXPERIENCE
• March 2016 to May 2017: Manager, Healthcare Services, UM, Prior Auth (Prior Authorizations, Correspondence, UM Call Center included) with Molina Healthcare
• 2015 to March 2016: RN Supervisor for both the COC and CBAS Departments with Molina Healthcare
• 1998 to September 2013 (Retired): Hospice and Palliative Case Manager with Kaiser Permanente
• 1996: Director of Clinical Services, Hospice Services of California, Culver City
• 1995 to 1996: Director of Clinical Services, St Mary Home Health, Cerritos office; Manager St Mary Hospice program, Long Beach
• 1994 to 1995: Skilled Nursing Facility Supervisor, FHP Hospice (Los Angeles/Orange County)
• 1993 to 1994: Hospice Case Manager, FHP Hospice
• 1990 to 1993: Owner/Consultant, Medical Case Management Associates, Long Beach
• 1989: Branch Manager, Homecare Nursing, Whittier
• 1988 to 1989: Director, UM/QA Department, General Med (MHP, Inc.), Los Angeles
• 1987 to 1988: UM Specialist, UM/QA Department, General Med, Los Angeles
• 1983 to 1984: ICU staff/ charge nurse, Saddleback Community Hospital, Laguna Hills
• 1980 to 1983: ICU Clinical Nurse II, California Hospital Medical Center, Los Angeles
EDUCATIONAL BACKGROUND
• Diploma in Nursing; California Hospital School of Nursing, 1980
• Associate of Arts in Nursing; Los Angeles City College, 1980
• Successfully completed several units towards my BSN at California State University, Dominguez Hills
LICENSURE
• Registered Nurse (RN), State of California
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