Customer Service Management

BARBARA BRZEZINSKI

**** **** ***** *****, *** PORT RICHEY, FL 34655, 727-***-****,

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

DIRECTOR OF CASE MANAGEMENT

Qualified by extensive experience in many aspects of the healthcare

industry including managed care education and clinical settings. An

empowering, customer focused, productive and results-oriented team leader

accustomed to achieving results in fast paced changing environments.

Possesses an ability to create a learning environment to motivate

individuals to high levels of performance.

Professional Experience

MEDICAL CENTER OF TRINITY, TRINITY, FL 2005 to Present

Director of Case Management - Responsible for all Utilization Review,

Discharge Planning and Social Services in a 300-bed Hospital

Key Results:

. Managed hospital's length of stay to one full day reduction from 2008-

2014 by implementing multi-disciplinary approach. Developed

Interdisciplinary Team Meetings to involve Case Management, Nursing and

all appropriate ancillary departments.

. Implemented Inpatient Documentation Integrity Program to review all

Medicare and Managed Medicare accounts in 2010. Increased Medicare Case

Mix Index by 12% during program's first year.

. Developed Division policies and procedures for Medicare Important

Message, Care Coordination and other regulatory requirements.

. Received DDI facilitation certification while developing a Case

Management Training program for twenty-one new Case Managers across the

Division. Responsibilities included Medical Necessity and Observation

modules.

. Established individual physician report cards based on individual lengths

of stay across all payors, avoidable days and complaints. Presented data

to physicians in meetings with Chief Financial Officer and Physician

Advisor and at the Utilization Management Committees.

. Participated in Joint Commission Disease Specific Surveys resulting in

accreditation in seven different survey areas.

. Assumed responsibility for daily rounding throughout the facility to

obtain information regarding delays in care and impending discharges to

assist with throughput. Early identification of discharges assisted Core

Measure abstracters to bring all measures to the "green".

. Implemented program for ER Case Management and Daily ICU Rounding to

assure appropriate statuses and levels of care.

TAMPA GENERAL HOSPITAL - tAMPA, fl 2003 to 2005

Manager of Case Management - Responsible for the management of 50 FTEs

including Case Managers, Social Workers and ER Precert Nurses

Key Results:

. Implemented new workflows to focus on priorities obtaining authorizations

and continued stay reviews including Kepros (now EQ Health)

. Decreased concurrent denial rate by 87% from Fiscal Year 03 - Fiscal Year

04 by strengthening denial language with Managed Care Organizations.

. Developed formal orientation program for Case Managers and Social Workers

and updated policies and procedures for professional feedback

. Increased issuance of Hospital Issued Notices of Non-Coverage (HINNs) by

400% with input from FMQAI.

QUALITY HEALTH PLANS - HOLIDAY, FL 2002 to 2003

Director of Quality/Utilization Management - Responsible for all

Utilization/Quality Management functions of a start-up HMO

Key Results:

. Organized and operationalized a Utilization Management Committee to

provide direction for the health plan.

. Managed the pharmacy program by acting as liaison with the pharmacy

benefit administrator.

CIGNA HEALTHCARE OF FLORIDA, INC. - TAMPA, FL 1998 to 2002

Director of Health Services - Responsible for the operations and management

of a department of clinical and non-clinical staff to assure delivery of

quality, cost-effective care to insured members

Key Results:

. Developed a proactive approach to Utilization Management and Case

Management with direct interventions resulting in cost savings of over

$12,000,000 in 2001.

. Improved customer service metrics by 200% with staffing levels lower than

recommended corporate ratios.

. Reduced accounts receivable attributable to Utilization Management by 90%

by forming "good faith" relationships with facilities.

. Coordinated implementation of Disease Management programs for Asthma,

Congestive Heart Failure and Diabetes that decreased readmission rates by

40%.

BAYCARE HEALTH NETWORK - CLEARWATER, FL 1995 to 1998

Director of Network Services - Responsible for growth and maintenance of a

network of facilities and physicians to service healthcare consumers in the

Tampa Bay area

Key Results:

. Negotiated Managed Care contracts for 16 hospitals and 2200 physicians

for HMO, POS and PPO products to increase membership by 75,000 lives.

. Managed a department responsible for contracting, credentialing, quality

and utilization management, provider relations, data management and

customer service.

. Created a revenue stream by obtaining NCQA accreditation as a

Credentialing Verification Organization.

AETNA HEALTH PLANS - TAMPA, FL 1988 to 1996

Director of Utilization Management - Responsible for a unit of clinical and

non-clinical staff members to provide utilization management services to

insured members

Key Results:

. Co-developed an HMO product in the Orlando/Brevard region with a proven

metrics history that resulted in pricing to be the second lowest in the

corporation.

. Assumed management of the Tampa HMO market demonstrating a 20%

improvement in the Medical Cost Ratio in 4 months.

Prior Experience

Several years experience in the following fields:

. Practical Nursing and Medical Office Assistant Instructor

. Staff Nurse in a variety of clinical settings

Education

. Master Level Courses in Adult Education - University of South Florida,

Tampa, FL

. Bachelor of Science in Nursing - Hunter College, New York, NY

. Registered Nurse, State of Florida

Contact this candidate