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Healthcare Management

Location:
Washington, District of Columbia, United States
Salary:
100,000
Posted:
November 30, 2018

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Resume:

Beverly L. Lavoie, LCSW, CCM ** Potomac Avenue SE, Apt 304

Washington DC 20003

Tel: 202-***-****

Email: ac7t7p@r.postjobfree.com

SUMMARY

● 24 years professional experience in care management

● 37 years of healthcare social work experience

● Authentic leader with strong commitment to promoting coordinated, quality healthcare for all with empowered patients central to their process of care.

SKILL HIGHLIGHTS

Personal and professional integrity Creative problem resolution

Conflict resolution In-depth knowledge of healthcare industry

Sound decision-making Strong medical ethic

Confident public speaker Mission-driven/results-focused

Critical thinking Guardianship and advocacy

EXPERIENCE

HEALTHSOUTH REHABILITATION HOSPITAL Newnan, GA 50 bed acute rehabilitation hospital, Interim Director Case Management 3/2018 to 6/2018

Provided training and direction to support Case Manager’s effectively completing assigned responsibilities; managing caseloads, interpreting regulations, policies, operational procedures, and objectives; reviewing operations in assigned area to ensure a high level of quality that is consistent with organizational standards. Also participated in utilization review activities; performed case management analysis; and oversaw concurrent review functions with appropriate follow-up action plan and intervention. Lead a team of 3 Case Managers and one Case Management Assistant.

●Kept discharges to skilled nursing facilities below corporate target of 11% of discharges for all months employed

●Hired and trained a new RN Case Manager.

●Developed and implemented processes to ensure consistent, efficient and effective provision of case management services.

●Managed a caseload of up to 20 patients

●Provided ongoing mentoring and team building to reinforce the CM team’s strengths and minimize their weaknesses.

DUKE UNIVERSITY HOSPITAL Durham, NC 938-acute care bed academic tertiary care hospital, Interim Assistant Director, Case Management, 4/2017 to 12/2017

Plan, develop, implement and assist in managing the Case Management program activities for multiple clinical service units at Duke University Hospital. Lead a team of 60 case managers and social workers including staff in the Emergency Department, Transplant, Cardiology and Outpatient Clinics.

● Evaluated ED Case Management coverage and efficiencies to maximize throughput and readmission mitigation.

● Developed training program for ED Case Managers with focus on principles/practice of Case Management.

● Submitted proposal for ED coverage redesign to support increased volumes, staff to team’s strengths and improve overall CM job satisfaction.

● Facilitated hiring of additional LCSWs to provide adequate coverage for Substance Use, Domestic Violence and Guardianship cases.

● Completed year end performance review evaluations on 60 Case Managers/Social Workers.

● Served on Psych Care Redesign Committee.

● Assisted with training and implementation of EPIC Case Management Module.

● Worked with LVAD team to ensure successful completion of Joint Commission Survey.

● Participated in Durham Crisis Collaborative meetings addressing gaps/barriers in mental health services in the community.

INOVA ALEXANDRIA HOSPITAL Alexandria, VA 318 bed advanced community hospital Director, Case Management, 07/2014 to 02/2017

Provided leadership and strategic planning for the office of Case Management. Lead a team of 27 case management professionals and support staff including MSWs and RN Case Managers and CM Supervisor.

Accomplishments

● Achieved reduction in overall average LOS from 4.03 in 2014 to 3.80 in 2016. Saw Medicare LOS drop from 5.51 in 2014 to 5.28 in 2016.

● Spearheaded and co-led the Readmission Mitigation Committee which provided oversight and direction for hospital readmission reduction initiatives. Significant reduction in avoidable readmissions seen in COPD, Hip/Knee Arthroplasty and CHF patients since 2014.

● Served on Bundled Payment Committee; helped with program implementation and staff education for Hip/Knee Arthroplasty Bundle Initiative.

● Initiated IAH/SNF Collaborative with goal of facilitating safe, seamless transitions of care from acute to post-acute facilities - an initiative which resulted in reductions in SNF readmissions to IAH.

● Implemented agreement with local pharmacy to ensure access to critical medications for indigent patients resulting in decreased readmissions for this population.

● Developed excellent working relationship with hospital’s transportation provider and implemented wheelchair van services at IAH resulting in significant yearly reductions in hospital transportation expenses.

● Implemented DME Tech position to facilitate delivery of walkers/wheelchairs/bedside commodes to patients prior to discharge resulting in reduced LOS on orthopedic unit.

THE GEORGE WASHINGTON UNIVERSITY HOSPITAL Washington, DC 371 bed tertiary care, academic hospital

Interim Director, Utilization Review and Care Management – 9/ 2011 to 2/ 2012 and 12/2013 to 7/2014

Lead a team of 30: Social Work and RN Care Managers, support staff and 2 supervisors. Assisted in the design and execution of programs that contributed to reductions in hospital LOS, readmissions and insurance denials.

Accomplishments

●Achieved departmental/hospital goal of reducing LOS by .5 each year from CY 2011-2013. ALOS in 2011 was 6.25 days by end of CY 2013 was 5.2 days.

●Developed policy and implemented procedures to ensure departmental compliance with CMS Conditions of Participation:

Condition Code 44 Notification

IMMs

●Organized medical staff training on “Inpatient vs Observation.”

●Provided oversight for RAC audits/denial management and implemented process improvements

for UR team to increase efficiency/effectiveness resulting in reduced denials.

●Began collaboration with Quality Improvement Organization on initiative to reduce

readmissions with goal of implementing Coleman model at GWUH.

●Developed job proposal and implemented ED Case Management program.

● Organized hospital’s UM Committee.

● Implemented new performance appraisal process.

●Designed and implemented the CHF Care Transitions Project.

Manager, Social Work – 12/2010 to 7/2014

Responsible for operational management and strategic planning for social work services/discharge planning within the department of Care Management. Managed a staff of 16 med/surg social workers, 2 psychiatric social workers and a SW supervisor and had total responsibility for discharge planning at GWUH.

Accomplishments:

● Provided oversight for ED Recidivism Project which was successful in reducing # of ED visits and inappropriate admissions for targeted patients.

● Coordinated meetings between GWUH Admin/Medical Staff and Unity Health Care Clinic Administration/Medical Staff, with goal of facilitating continuity of care for Unity patients.

● Coordinated meetings between GWUH and Chartered Health Insurance re: opportunities for reducing ED recidivism for Chartered Health Plan (Medicaid MCO) patients.

● Developed excellent working relationship with Lifestar Transport Manager and reduced average wait times for ambulance/wc van transports from 2-4 hours to 1 hour

● Implemented Liaison Program with local DME/Home Infusion provider to facilitate timely discharges through easy availability of DME onsite and quicker authorization process

● Implemented agreement with local pharmacy to facilitate access to medications for indigent patients

● Partnered with area HHAs and SNFs to work on projects aimed at reducing readmissions for CHF patients.

● Instituted monthly meetings with hospitalists

● Developed policies and implemented procedures to ensure compliance with federal/state/local guidelines and CMS Conditions of Participation:

Unidentified Patients

Abuse/Neglect/Exploitation of Children and Vulnerable Adults

Domestic Violence

Discharge Planning

Documentation

High Risk Screening

Guardianship

Documentation

MEDICAL UNIVERSITY OF SOUTH CAROLINA Charleston, SC 865 bed tertiary care, academic hospital, Social Work Case Manager – 11/ 2005 to 11/ 2010

● Worked with assigned patients on Cardiology/Cardiovascular Surgery units to ensure optimal health, access to care and appropriate utilization of resources.

● Served as member of heart transplant team presenting psychosocial history information for review and discussion by team in making candidate selection decisions.

● Provided crisis intervention for patients, families and staff.

● Responsible for psychosocial assessments, clinical care coordination and comprehensive discharge planning.

● Provided financial assistance and referrals as well as Medicare/Medicaid/SSDI benefits coordination.

● Skilled at conflict resolution and service recovery.

SENIOR CHOICES CARE MANAGEMENT SERVICES, Norwich, CT/ Brattleboro,VT Private Practice Geriatric Care Manager, 1/2003 to 11/ 2005

Provided private care management services for elderly clients and their families.

● Reduced risk of unnecessary institutional care by providing comprehensive assessments and service coordination to high-risk clients living in the community

● Completed home study assessments to assist the courts with guardianship decisions.

● Provided monthly monitoring and facilitation of care continuity for clients/families.

DARTMOUTH-HITCHCOCK ALLIANCE Lebanon, New Hampshire

6 community hospitals in VT/NH/MA in alliance with Dartmouth Hitchcock Medical Center with a shared commitment to improve the quality, efficiency, and availability of health care in New Hampshire, Vermont, and western Massachusetts

Director, Regional Care Management – 1/2000 to 8/2002

Served as advocate, facilitator, coordinator and consultant in bringing consistency and standardization of care management practice to the affiliate community hospitals. Worked with DHA community hospitals to provide clinical guidance and consultation in the development and implementation of their care management programs.

Accomplishments:

● Met with CEOs from the six community hospitals quarterly to provide education on principles of case management and to champion care management as the key to improving quality of care and cost-effectiveness.

● Collaborated with care management leadership at affiliate hospitals in developing common practice standards and organized training programs which included:

o Principles and standards of practice for care management

o Policy and procedure development

o MCAP (Managed Care Appropriateness Protocol, UR criteria) – organized

training for staff and physicians

● Assisted 3 of 6 hospitals in transitioning from UR/Social Work model to Case Management model.

● Hired, trained and provided clinical supervision for RN Care Manager providing telephonic case management for Vermont Health Plan members for whom DHA received capitated funds.

● Hired data analyst

MT. ASCUTNEY HOSPITAL Windsor, Vermont 100 bed community hospital and member of Dartmouth Hitchcock Alliance

Director, Case Management / Social Services – February 1995 to December 1999

Provided clinical leadership and supervision for a staff of 6 SW and RN Case Managers and assumed the job responsibilities of Case Manager for patients on the Acute Rehab Unit. Responsibilities strategic planning, program development, fiscal management and staff hiring/training/mentoring. a

Accomplishments:

● Transitioned program from traditional Social Service model to Case Management model with RNs and SWs providing all transitional care planning

● Hired and trained two RN Case Managers.

● Provided training for RNs and social workers in the principles and standards of practice for case management including skill training in advocacy, fiscal responsibility, negotiation, collaboration and communication.

● Developed all policies and procedures for the department

● Recruited by Dartmouth Hitchcock Medical Center to serve as Director of Regional Care Management to help their Alliance hospitals transition to a case management model.

HEALTHSOUTH REHABILITATION HOSPITAL Birmingham, Alabama 100 bed medical rehabilitation hospital

Client Services Manager – 7/1992 to 1/1995

ST. VINCENT'S HOSPITAL Birmingham, Alabama 402 bed community hospital

Manager, Physician Services – 1/1989 to 6/1992

Manager, Social Work Services – 1/1981 to 1/1988

CONCURRENT EMPLOYMENT

COOLEY DICKINSON HOSPITAL Northampton, Massachusetts 140 bed community hospital, Per Diem Case Manager – March 2005 to November, 2005

Provided utilization management and discharge planning for assigned patients. Responsibilities included: Concurrent utilization review using Managed Care Appropriateness Protocol (MCAP), discharge planning, liaison to insurers, coordination of appropriate referrals to post-acute providers and community agencies to ensure continuity and cost effective patient care.

EDUCATION

MSW, Social Work Planning and Administration, University of Alabama

BA, Cum Laude, Speech Disorders, University of Alabama

LICENSES

Licensed Clinical Social Worker, State of North Carolina (License # C010773, Inactive status)

Certified Case Manager (Certification # 00029522, Expires 11/2018)

PROFESSIONAL AFFILIATIONS

Member, American Case Management Association

Member, Case Management Society of Amreica



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