Manager Case

NANYUN LEE

**** *. **********. #*, *********, CA. 92833 (310-****-**** - *****@****.***

Summary of Qualifications

25+ years' experience with Acute Care, Managed Care & Home Health Care settings Medicare, Medical & Managed Care Insurance Experience CM/UM Experience - Utilizing the Assessment and Planning of Clinical Care for an identified Pt. Nursing Admin Supervisory Experience - 10+ years

Patient Advocate - to bring satisfaction and quality care while maintaining cost effective manner Educate patient/care giver on disease process to enhance to the level of wellness. Team player with "Can Do" Attitude

Bilingual in Korean

Experiences

Sierra View Medical Center - Porterville, CA- August 2015 to May 2016 ER/Case Manager/Utilization Review Manager - (Contract position) Work collaboratively with ER physicians and PCP to coordinate and screen for the appropriateness of ER admit and continued stays.

Make recommendations to the physicians for alternate level of care if the patient does not meet the medical necessity for inpatient hospitalization

Interact with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan Function as an indirect caregiver, patient advocate and manage patients in the most cost-effective way without compromising quality care.

As appropriate, monitor for frequent ER visit of members and re-evaluate effectiveness of the care plan and modify to reach optimal and better outcomes

Bethesda University ofCA - Anaheim, CA- March 2012 to July 2014 Program Director of Vocational Nursing

Ensure the program adhere to CAVNBoard regulations and improve the student's achievement of NCLEX scores.

Performed Critical Analysis of the curriculum: Identified the multiple problem areas which resulted in Implementations of the new curriculum.

Followed up with outcome evaluation until student's NCLEXSCORESreached to the higher level. LACare-Los Angeles, CA- January 2012 to March 2012 CM/UMReview Nurse (Contract position)

Assess, plan, implement, coordinate, monitor and evaluate the options and serves to meet an individual's Needs, using patient's benefits along with available community resources to provide quality and cost- effective outcomes.

Utilize management criteria, medical necessity and appropriateness of services to ensure reimbursement Little Co. of Mary Hospital- Torrance, CA- November 2010 to November 2011 RNCaseManager/UM (Contract position)

Managing a continuum of care from admission through discharge for assigned patients. Assess, plan, implement, coordinate, monitor, and evaluate the options and serves to meet an individual's needs.

Writing and submitting appeals for denied claims on Medical, Medicare, and Managed Care cases Outcomes: Achieved higher level of approval to 90% or higher on appealed claims Maintaining confidentiality in accordance with HIPPA regulations, while advocating for all patients Angeles College of Nursing - Los Angeles, CA- January 2002 to November 2010 Consultant/Instructor (Part-time)

Implement and perform RN refresher courses for the incoming foreign students in the pre-employment phase.

Consulted in start up VNprogram in 2002.

OUTCOMES: After 6 months to on-going supportive in-service program, retention level of the new RN's In the various hospitals showed 90% or higher.

Kaiser Permanente - West LA/la Metro, CA- June 2004 to November 2010 Nursing Admin Supervisor, WLA Facility/Clinical Nursing Supervisor, Home Health Div. Responsible for all aspects of patient care and supervising the activities of nursing staff, ensured the proper Staffing according to the new state as well as DHSstaffing guidelines Performed on-going QMPROGRAMaccording to the organizational policy while ensuring compliance with Government guidelines

Provided clinical coordination as well as the resources to the staff as needed and participated in the unit Staff performance evaluation process

Clinical Nursing Supervisor, Home Health

Mentor and provide Clinical Supervision, coordinate, supervise day to day patient care and services, This includes multidisciplinary disciplinary functions as well as nursing care. Los Angeles Metropolitan Med Center - Los Angeles, CA- May 2003 to June 2004 Utilization Management/Case Manager (Contract)

Duties included providing a continuum of care from admission through discharge ensuring the appropriate utilization management and care coordination.

Conducting concurrent utilization review; providing first level appeal services on Medi-Cal Mental Health Patients.

Working collaboratively within multi-disciplinary team and assuming the role of patient advocate by ensuring positive customer/patient relations.

Barlow Respiratory Hospital- Los Angeles, CA. - July 2000 - July 2001 Pulmonary Rehab Case Manager/Educator and Relief Admin Supervisor Performed as Case Manager/Educator for Pulmonary Rehab patients by ensuring the quality care and the Appropriate services in the most cost-effective manner Conducted concurrent utilization review and coordinated discharge planning and participated in the CQI Program to ensure quality patient care

Responsible for coordinating the submission of TAR for Medical Patients on site Education:

st. Mary's College, San Jose, CA

Santa Monica City College, Santa Monica, CA

BA degree in Healthcare Administration

AA degree in Nursing

Certifications:

University of Phoenix -

UCLA-

ACLS Certification

Critical Care Nursing Certification

BLS Certification

Case Management Certification Program

Rehabilitation Management Certification Program

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