Case Manager

Nina Regina Britton

**** ******* **** ******, ** 80831

Cell: 719-***-****

*********@*******.***

EDUCATION

Master of Health Administration, Webster University, June 2009

Bachelor of Science, Nursing, University of Southern Colorado, May 1993

PROFESSIONAL CERTIFICATIONS AND AFFILIATIONS

Chi Eta Phi Nursing Sorority – Past Vice President of Iota Eta Chapter, Colorado Springs Certified Managed Care Nurse – (CMCN)

CCM – Exam taken Dec 2017 with passing score awaiting official paperwork

QUALIFICATION SUMMARY

Dedicated Retired Military Nurse with a 20 year track record of providing quality, patient-centered care.

Credentialed as a Managed Care Nurse and diversely experienced with a background in Public Health, Same Day Surgery, Med-Surg, Mother/Baby and Case Management. Basic knowledge of Medicare regulations and Insurance Health Plans. Strong interpersonal skills and highly organized and able to efficiently prioritize multiple task. Excellent analytical skills and vast clinical experience.

PROFESSIONAL EXPERIENCE

Silverfox Assisted Living Home February 2017 to Present

Owner/Case Manager

•Developed policies, procedures and individualized client care plans for facility

•Coordinate with other local agencies such as hospice, pharmacy and other assisted living facilities to ensure seamless transition and admission into Silverfox Personal Care Home

•Assist with ADL's, administration/ordering of medications and transportation of clients as needed

•Collaborate with community agencies to coordinate needed resources as identified by patient assessment

AMN- Travel Nursing September 2017 to present

Integrated Care Manager (Optima Health)

Conduct face to face Health Risk Assessment

Collaborate with member to develop Individualized Care Plan

Coordinate services and service planning with other agencies, providers and family individuals involved with the member

Communicate with members about their ongoing or newly identified needs on at least a monthly basis to include phone calls or face to face visits

Broadspire November 2015 to November 2016

Medical Case Manager (Workers Compensation)

•Assist with physical recovery by exploring and discussing options for treatments and services, which have been recommended by Health Care Providers

•Attend medical appointments to gather information and develop a Case Management plan with the participation of the client and Health Care provider

•Meet with employer and coordinate return to work options

•Provide education to clients

Colorado Department of Corrections, Clinical Services December 2013 to November 2015

Nurse Case Manager (Full-time: 40 Hours)

•Establishes collaborative network with relevant partners to provide medical support and resources prior to release for offenders which involve the use of Medicaid benefits

•Advises offenders and Facility Case managers on the Affordable Care Act as it relates to Medicaid benefits for offenders. Responsible for processing all submitted applications for assigned area which included 16 DOC facilities in the southern territories of Colorado. Approximately 300 applications processed per month for eligible parolees

•Coordinate with HCPF to streamline a process which ensures Medicaid benefits are established prior to release for paroling offenders

•Create a process with HCPF and Correctional Health Partners that streamline ensure Medicaid applications are approved for hospitalized offenders

*Implementation of the inpatient DOC Medicaid application process allowed the Colorado Department of Corrections to save over 2 million dollars in medical payments within the first fiscal year, Jan 2014-Dec 2014

Evans Army Hospital, Third Party Billing May 2012 to December 2013

Pre-Certification/Utilization Review Nurse/Nurse Consultant (Full Time: 40 Hours)

•Educate and train Physicians and Administrative personnel on appropriate DoD policies and guidelines regarding Third Party Collection Pre-Certification and Utilization Review activities based on the DoD UBO User Guide, Management Control and Financial Studies division guidelines and DoD coding guidelines

•Compiles and monitors data abstracted from case reviews for internal/external audits and maintains records accordingly

•Develop materials to facilitate ongoing training of the staff, information papers or other written materials as requested

•Coordinates all denials of payment with appropriate members of the medical staff, the UBO Manager and legal department as needed

•Presents detailed reports, findings and recommendations to supervisor, department chief and hospital commander as needed related to Third Party Collection process

•Program Manager for the Evans Hospital OHI (Other Health Insurance) program which includes marketing, networking and educating patrons and hospital personnel on the programs purpose, regulatory requirements and benefits

•Utilize MCG guidelines to validate the most up to date clinical practices and support reimbursement efforts

*From May 2012- September 2012, responsible for the inpatient collections of $180,700 for fiscal year 2012

*Responsible for the collection of over 290K in fiscal year 2013 from Third Party Collections in patient services, exceeding fiscal goal by 56K

Evans Army Hospital, Multi Service Market Office May 2010 to May2012

Utilization Review Nurse (Full-Time: 40+ Hours)

•Administered utilization review and management of referrals for over 400 Warrior in Transition Unit Soldiers and all Solider Readiness Center deploy/ redeploy Soldiers

•Reviewed and developed process improvements to increase efficiency and accuracy in the WTU referral management process and ensured compliance with the Department of the Army MEDCOM military treatment facility Access Standards for Active Duty Service Members

•Coordinated ongoing training to CRC, WTU/SRC staff, Nurse Case Managers, Medical providers, and Evans Army Community Hospital staff while also serving as a preceptor, trainer and mentor for new UR nurses and CRC staff

•Oversaw appropriate management of command approval authority by screening referrals and ADSM request for proper medical outsourcing needs, anticipated cost/benefits and/or need to defer to DCCS for additional review

•Works collaboratively with the Clinical Operations chief for the Multi-Service Market, and a multi-disciplinary team to ensure appropriate utilization of healthcare resources

•Interfaced with Tricare and local agencies to coordinate services that beneficiaries may be entitled to utilize

•Facilitated care within the MTF and Military Health System, if not available within the system, facilitated in the appropriate civilian sector for beneficiaries assigned to one of the three MTF’s in this area

Life Care Solutions November 2009-May 2010

Care Manager (Full-Time:40 Hours)

•Completed evaluations and comprehensive care plans for individuals

•Served as a single point contact to coordinate care among providers while acting as a liaison with family members to facilitate open communication

•Coordinated and accompanied clients to medical appointments to serve as an advocate when request by client

Colorado Access July 2008-October 2009

Nurse Care Coordinator (Full-Time:40 Hours/Telecommute)

•Collaborated with Clinical Support Service Team to identify members through utilization or disease specific indicators who require care coordination and/or medical management for patrons of the Medicare Advantage plans

•Worked directly with members, families and providers within the Colorado Springs and Southern Colorado area overtime to assist in arranging and managing a complex set of resources required to maintain health and function

•Served as the point of contact for resources within the Colorado Springs area

Evans Army Hospital, Warrior Transition Unit August 2007-July 2008

Warrior Transition Unit Case Manager (Full-Time:40 Hours)

•Demonstrated clinical expertise and knowledge of health care programs to improve the quality of patient care, the use of resources and facilitate compliances with internal and external standards

•Demonstrated strength in the areas of interpersonal relations, critical thinking, problem solving and conflict resolution, collaborating with other case managers, the Interdisciplinary Treatment Team, and other clinical and administrative staff as needed

•Facilitated contact with the soldier and/or facilities and family to assist with a seamless transition across facilities and levels of care to include VA services

•Conducted in depth assessments of functional status, acuity level and prognosis and assessed the need for treatment services and resources

Evans Army Hospital, Preventive Medicine June 2006-August 2007

Public Health Nurse, CYS Program Manager (Full-Time:40 Hours)

•Assisted, coordinated, developed, implemented, monitored and evaluated Public Health programs and classes to include but not limited to: Communicable Disease Programs, Maternal/Child Health programs, Child Development Program Services, Special Needs Resource

Team, Family Health and Sanitation, Health and Wellness Fair, and Discharge Planning

•Program Manager for the Fort Carson Child and Youth Services Program with duties that included: training of employees on health and sanitation issues, monthly site inspections, team member of the Special Needs Accommodation Program, CYS health consultant, coordination of services for clients, development and annual review of Standard Operating Procedures for CYS, development of a monthly Parental newsletter and completion of all reports needed in regards to CYS program status, communication of activities/presentations as needed to senior leadership.

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