Resume

Sign in

Manager Case

Location:
Arlington, Texas, United States
Posted:
September 05, 2019

Contact this candidate

Resume:

Mary E. Dowding, RN, BSN, CCM

**** *** ***** ****

Arlington, Texas - 76016

817-***-****

ac99s8@r.postjobfree.com

Experience:

**/**/**- **/**/13 Molina Healthcare-

Telephonic Nurse Case Manager for Medicaid, Medicare, Dual, CHIP, and CHIP Perinate members.

02/15/11-04/01/11 South Arlington Medical Center

Nurse Case Manager for acute care inpts. Reviewed patient’s medical records utilizing Interqual criteria for medical necessity. Coordinated with payer, physician, patient and family regarding discharge needs and assisted in meeting those needs. 05/19/08-10/01/2010- Centene Corporation-St.Louis,Mo. Nurse Case Manager for Star Health Foster Care Children of Texas Responsibilities: Telephonic maintance of assigned cases of Special Needs Children in Foster Care in the State of Texas. By maintaining frequent contact with foster parent, the primary care physician, the specialists physicians, and/or the Child Protective Custody Worker, the nurse was able to follow the progress of child and access any unmet medical needs such as referrals,availablility of a treatment, and assistance in resolution of those current medical needs The Case Manager utilized the information to develop or modify nursing service plan every 90 days or more frequent if necessary.

Additionally, the nurse case manager served as a source of education of medical issues for foster care parent, the CPS worker and the Behavioral Health Staff of the office. Often, the nurse would need to assist the foster care parent in learning of available community resources such as support groups.

The Case Manager would develop a nursing service plan based on the information gathered from various sources.

09/07 -02/05/08 - Kindred Southwest Fort Worth, Texas Nurse Case Manager - L.T.A.C. inpatients

Responsibilities: Review physician documentation for SI & IS against Interqual criteria; coordinate discharge plans, arrange for aftercare needs. Review physician

documentation in accordance consistent with DRGs, MCCs & CCs coding; query physicians for any

necessary specifics, follow up for same and forward to coder. 08/03- 09/07 - Wausau Insurance- Irving, Tx.

Medical Case Manager Worker Compensation Claims

Responsibilities: Telephonically follow ongoing and planned medical care for worker compensation patients in Texas, Oklahoma, Louisiana, Arkansas, and New Mexico.

Assist physician, patient, and employer

with appropriate return to work solutions in order to return claimant back to work in timely and safe manner as possible. 03/02- 08/03 - Sedgwick Claims - Irving, Tx.

Medical Case Manager Short Term Disability Claims

Responsibilities: Telephonically review short term disability claims for a specific customer;

determine severity of impairment and level of function for disability payment in complex medical and surgical cases. 08/96 - 2001- NYL Care Health Plans of the Southwest-Irving, Tx. Medical Case Manager for HMO, PPO, and Medicare Replacement Plan Responsibilities: Telephonic and onsite review of inpatient medical and surgical cases for continued care needs as well as appropriate LOC utilizing appropriate Interqual criteria. Arrange for appropriate discharge needs within network if possible and negotiate with out of network providers as necessary. 12/95 - 08/96 - Columbia Medical Center of Arlington-Arlington, Tx. Nurse Case Manger for ICU/ CCU and telemetry patients. Responsibilities: Provide medical updates to insurance reviewers for continued stay and at the more intensive LOC; Coordinate and arrange discharge planning with payer, physician, patient, and family. 05/95 - 12/95 - Heritage Southwest Medical Group- Irving, Tx. Utilization Review Manager

Responsibilities: Telephonic medical review of inpatient IPA patients for medical necessity, appropriate

LOC ;arrange for discharge needs, negotiate with providers as needed, collaborate with Medical Director ;

supervise outpatient referral provided by other nurses within the office. 03/94 - 12/95 - Conservco( division of Traveler’s)- Westmont, Ill. Health Care Coordinator:

Responsibilities: Telephonic recertification

and utilization review of multiple self insured groups. 92 - 03/94 - John Peter Smith Hospital-Fort Worth, TX. Medical Care Analyst

Responsibilities: Chart review of inpts.

As related to medical necessity utilizing TMF criteria ; coordinated family and physician conferences ;

assisted social service workers with discharge planning arrangements ; quality reviews as requested per each department. 90- 92- Sanus Texas Health Plan - Irving, Tx.

Utilization Review Coordinator

Responsibilities: Telephonic review of inpts.

(HMO, PPO, Indemnity Plan ) and precertification of medical treatment. MID 60’S- 90- Clinical nurse (LVN until 1983) working in various departments of acute medical centers: Hillcrest Baptist Hospital, Waco, Tx. ; Arlington Memorial Hospital

, Arlington,Tx. ; and HCA South Arlington Medical Center, Arlington, Tx. Education:

1983 Texas’ Woman’s University- Denton, Tx.

Bachelor of Science in Nursing State of Tx,-RN-current Personal& Professional References :

Linda Gibson, RN, MA (Centene -2 yrs) –email

ac99s8@r.postjobfree.com

Sharon Kilroy,RN,BSN,CCM ( WAUSAU -4yrs) 972-***-**** Bill Spence, RN,BSN,CCM (NYL Care -4 yrs)214-***-**** Susan Cox, RN,CCM( Sedgwick)—972-***-****

Previous Employers Confirmation numbers:

Molina Healthcare-800-***-****—comp. code#15009

Centene Corporation-512-***-****,ext 22013:HR

Kindred-800-***-**** –employee # 11916

Wausau_800 996 7566 –code 10667

Sedgwick CMS-901-***-****

NYL Care( no longer exists)



Contact this candidate