Pamela J. Elliott, JD, BSN, RN

***** ******** ***, ****** *****, CA 92210

304-***-****

ac6ksl@r.postjobfree.com

CAREER SUMMARY

An experienced Healthcare Executive with extensive experience in root cause analysis, assessment, conflict resolution and program development. Over 20 years of experience as a practicing attorney and extensive knowledge of healthcare regulatory requirements, critically needed in this era of changing healthcare delivery systems and CMS mandates. Successfully designed Acute Case Management Models to establish standards for the delivery of quality and safe medical care across the continuum. As an active participant in the revenue cycle, led system development not only facilitating excellent patient care, but increases necessary revenue required to continue to provide such care. Leadership focus is on utilization review, care facilitation, transitional planning, payor communication, clinical denial management and strong Emergency Department Case Management.

EDUCATION

Juris Doctorate University of Wisconsin Madison, WI

BSN University of Wisconsin Madison, WI

PROFESSIONAL EXPERIENCE/ACHIEVEMENTS

9/2017-12/2017 HcTec

Interim Director of Care Coordination for Dignity Health

Located in downtown Los Angeles at a large trauma center, managed a full staff of Care Coordinators and Social Workers with a dynamic, diverse patient population. Reinforced the fundamental basics of Care Coordination with staff, initiated weekly Complex Case Review meetings to address difficult placement issues, refined daily Multidisciplinary Rounds, and Co-Chaired the implementation of a Readmission Task Force Committee.

2/2017-9/2017 HealthLinx McAllen, TX

Transitional System Director Care Management –South Texas Health System/UHC Transitional Leader

Responsible for Directorship of Care Management at Edinburg Regional Medical Center and Children’s Hospital and McAllen Heart and Regional Hospitals. McAllen Heart is a 60-bed hospital within McAllen Regional Medical Center a 441-bed Level III Trauma Center, Certified Primary Stroke Center and Edinburg Children’s is a 107-bed hospital housed within Edinburg Regional Medical Center a Level IV Trauma Center and accredited Chest Pain Center with an additional 127-beds.

Reporting to the CFO this position is responsible for Care Management across all 700+beds throughout the 4 facilities. Oversight of two managers, multiple RN and Social Workers as well as Utilization Review.

8/2015-8/2016 First String Healthcare Irvine, CA

Interim Director of Care Coordination Mill Peninsula Health Services

Sutter Health is a family of doctors and hospitals serving more than 100 communities in Northern California with comprehensive corporate involvement in standardizing policies and procedures throughout their healthcare system, while maintaining the individual uniqueness of their facilities. Sutter is a not-for-profit organization which invests its earnings in providing value based care.

Recruited and hired Case Managers and Social workers to successfully restructure a depleted department with a 50% vacancy rate of staff to budget to fully staffed to budget within four months of hire

Scheduled frequent staff meetings to collaboratively work in rebuilding staff morale and trust after experiencing a high Director turnover in the past four years

Implemented a solid Emergency Department Case Management plan and schedule to achieve Case Management/Social Work coverage in the Emergency Department for 16 hours per day, 7 days per week

Initiated telephonic daily huddles with all department staff to discuss assignments and top focus patients

Proposed and commenced a Pilot Program for consistent Interqual documentation within 24 hours of admission to promote evidenced based level of care admissions and escalation to the Physician Advisors for equivocal cases to justify medical necessity

Developed a discharge checklist to be utilized jointly by Case Management and Nursing on a daily basis to ensure that all discharge needs were met prior to discharge

Actively participated in a newly formed task force for readmissions which eliminated duplicative, non-reciprocal meetings addressing the same issues without interactive communication

Reinstated and organized daily rounding with Physician Advisor and a weekly Interdisciplinary Complex Case Meeting to discuss outliers and difficult patient placements

Prepared tools and regulatory aids for anticipated JCAHO survey in January 2016.

Updated community resource lists for patients and families to ensure that patients were offered a choice of post discharge services

Reviewed and revised the Utilization Plan and co-chaired the monthly UM meeting. In the process of developing a “best practice” for the UM committee agenda and meeting to incorporate timely and critical information into the standard reporting format of the current meeting structure

1/2015 – 8/2015 Providence Health & Services Torrance, CA

Interim Regional Supervisor – Recovery Advocacy Program

Providence Health and Services, Southern California, is a not-for-profit Catholic Healthcare ministry committed to providing quality services to the communities they serve, especially the poor and vulnerable. As the Regional Supervisor of a new Pilot Program, was responsible for the hiring and training of five full-time RN Advocates, creating a budget as the program developed. Processed appeals for all acute care areas within this large, diverse Southern California area.

Designed, implemented and supervised this new model team of RN Advocates

Responsible for all regulatory and commercial appeals for multiple Southern California Ministries including Saint. John’s, Saint Joseph, Little Company of Mary of Torrance, Little Company of Mary San Pedro, Providence Tarzana Medical Center and Holy Cross Medical Center

Compiled statistics and report findings weekly to the Regional CFO and Regional Director of Care Management

Attended Excellence Council meetings monthly to present findings

Attended Resource Management/UR meetings to discuss trends/denials and collaborate with the Medical Directors and UR Chairperson at each facility to identify root cause for the denials and develop an action plan

Advancing in LEAN and Six Sigma program

7/2007-12/2014 Marina Del Rey Hospital Marina Del Rey, CA

Director of Case Management - Risk Management (2011-2014)

Manage strategic, clinical and operational aspects of the Case Management Department

Responsible for RAC, MAC appeals, and letters of Medical Necessity for commercial denials

Integral member of the Revenue Cycle Team

Redesigned the structure and procedures in the department to improve efficiency and availability, including staggering shifts and weekends to increase the availability of Case Managers evenings and weekends

Initiated and implemented Case Management in the Emergency Department

Case Manager (2011)

Responsible for the coordination and implementation of Case Management strategies

Coordinated care of the patient from pre-hospitalization through discharge

Collaborated with the entire interdisciplinary team

Reviewed care and treatment for appropriateness against screening criteria and for infection control, quality and risk assessment documenting in computerized database

Responsible for authorization of appropriate services for continued stay and through discharge

Provided discharge planning and at home follow-up assessment

Assisted the Utilization Management Department with all utilization activities

Weekend Charge Nurse and Case Manager (2007-2011)

Staff Nurse in Ortho-Spine, Med Surg and Short Stay Surgery

2003-2012 Law Offices of Pamela J. Elliott Los Angeles, CA

Private Counsel, Criminal Defense and Family Law

Certified Los Angeles County Bar Mediator

1999-2003 Law Offices of Healy & Healy Palm Desert, CA

Associate Attorney, General Practice

Specializing in Criminal Defense, Family Law and General Civil Litigation

1995-1997 Law Offices of Myles L. Berman Beverly Hills, CA

Associate Attorney

Specializing in DUI’s and DMV Administrative Hearings in Los Angeles, Ventura, Orange, San Bernardino and Riverside Counties

1991-1995 Law Offices of Kirtland & Packard Century City, CA

Associate Attorney

Specializing in Medical and Dental Malpractice

Thorough interviews and preparation of the doctors and nurses represented

Complex review of charts and supporting documentation

Incorporation of pertinent policies and procedures, local and national standards of care, statutes and regulations

Preparing and responding to all discovery requests and trial documents

Managing court appearances

Conducting depositions

Contact this candidate