Registered Nurse Quality Assurance

Eileen F. Ponietowicz BSN, RN

*** ******* ** **********, ** 19401

C: 484-***-****

mailto:************@*******.***

www.linkedin.com/pub/eileen-ponietowicz/86/292/945/

• Proven expertise in Case Management, Medicare Compliance, Utilization Review for

acute care and LTAC levels of care, Client Management.

• Registered nurse with exceptional capacity to managing competing priorities with ease

while fostering delivery of superior client services.

• Solid administrative and leadership experience to include training and mentoring, team

building, complex client management, and effective problem solving.

• Demonstrated ability to forge, lead and motivate outstanding healthcare professionals to

provide top quality work and productivity.

Case Management Utilization Review Documentation Specialist

Medicare/Medicaide Compliance InterQual Quality Assurance

Patient Advocacy Team Building Client Management

CAREER HISTORY:

Executive Health Resources Newtown Square, Pa

Manager of Client Services 2009 to Dec 2013

Senior Manager of Client Services 2010-2013

The Manager of Client Service (MCS) provides ongoing guidance and education to client hospitals in

building and maintaining comprehensive Medicare Compliance programs working directly with

Case Management department, as well as quality assurance while offering continued support to

physician teams and client hospitals by coordinating with executive, implementation, clinical

support and account management teams to ensure client needs and requests are fulfilled;

conducts regular analysis of physician team compliance performance and makes

recommendations for process improvement; oversees all client correspondence and reporting,

and provides direction to administrative support personnel.

• Responsible for daily oversight and guidance for a team of nine MCS including but not

limited to quality assurance report reviews, concurrent case reviews, client management,

and special projects.

• Development of tools to investigate client concerns; to include individual case reviews,

interdepartmental collaboration, and development of effective corrective action plans.

• Initial training and orientation as well as continual mentoring of MCS team members and

effective team building.

• Serving as resource for team of 40 Physician Advisors answering complex questions

regarding compliance and EHR processes as needed.

• Participates in all aspects of Compliance reviews cases according to EHR policies and

processes

Kindred Hospital- Havertown 2008 - 2009

Lead Case Manager (March, 2008- 2009)

Responsible for daily oversight of case management department including but not limited to patient

assignments, assuring regulatory compliance requirements, Monitoring hospital resource management

including avoidable day data collection, and maintaining manually reportable logs such as UR log,

discharge tracking log.

• Daily Utilization review via InterQual with IRR experience.

• Performs case management functions within the integrated case management model to

include admission and concurrent reviews to coordinate or facilitate plans of care, as well

as perform discharge planning for patients with severe medical complexities.

• Denial management including appeals letters, issuance of HINN letters, and tracking and

trending of denials.

• Facilitating Interdisciplinary Patient Care Conferences weekly.

• Utilization Management Committee preparation to include individual case reviews,

Physician utilization, avoidable day trending and denial management.

• Clinical Documentation Specialist who critically assesses Physician documentation to

support high quality of care as well as accurately reflects patient acuity and care

provided.

• Maintains a collaborative relationship with centralized coding to assure documentation

processes support appropriate coding

Health Advocate, Plymouth Meeting, Pa 2006 –2008

Personal Health Advocate (May, 2006 – 2008)

Primarily responsible for assisting members navigate the health care system based on their individual

needs and situations by providing education, assistance and support to clients as they advance through the

health care system.

• Coordinate healthcare related services

• Assist members with coverage and benefits issues

• Negotiate fees with healthcare providers

• Identify and locate physicians, hospitals, wellness services, senior care and behavioral

health services

• Represent members during appeals processes, as appropriate

• Provide claims assistance by investigating and solving complex claims issues

• Provide education to members regarding new or existing diagnosis.

• Provide assistance and education in regard to Elder Care resources, including education

regarding acute care discharge planning

Chestnut Hill Hospital; Philadelphia, PA 1981 –2006

Clinical Care Coordinator/Care Manager (1999 – May, 2006)

• Performs case management functions within the integrated case management model to

include admission and concurrent reviews to coordinate or facilitate plans of care, as well

as assess and evaluate patients for discharge planning needs, implement appropriate

referrals to meet patients discharge needs to include Home Care, Durable Medical

Equipment (DME),acute and skilled rehabilitation, Outpatient services and other

appropriate services as needed

• Provide concurrent review to insurance companies to assure payment for

appropriate level of care during acute hospital stay as well as daily Utilization review of

Medicare admissions

• Provide counseling to patients and families regarding end of life issues

• Coordinate and facilitate inpatient multidisciplinary plan of care to ensure

progression through hospital stay and to facilitate a smooth transition to discharge

• ER case management on ad hoc basis, including behavioral health assessments

Staff Nurse, Emergency Department (1988 – 1999)

• Provide all facets of acute emergency nursing care in level II ED

• Committee member for Cooperate Compliance Program development and

hospital presenter of program, Performance Improvement Program and JCAHO Survey

Task Force, Emergency Department Joint Practice Committee, developed and presented

continuing education programs for ED staff.

• Developed Standards of Care for Chest Pain, Change in Mental Status Diagnosis,

Drug and alcohol Intoxication and Photography in the ED.

• Mentor and preceptor to new employees, senior nursing students and EMS

students

Staff Nurse, Medical Surgical Unit (1981 – 1988)

• Planning, assessing, developing, and evaluating patient care on adult/pediatric

medical surgical unit

• Functioned as charge nurse to assist staff with prioritizing, organizing, and

problem solving patient care issues. Served as clinical preceptor to new staff members

and update current practices

PUBLICATIONS:

Ponietowicz, E., & Flaig, M.. (1996). “Emergency Nursing”. Nursing Spectrum, 21(5)

Mitchell, M.B., et. al (2002). “Meeting the challenge of managing vaso-occlusive crisis”.

Journal for Healthcare Quality, 23(4).

PRESENTATIONS:

Presentation of hospital’s Corporate Compliance Program (1998 – Present)

Performance Improvement Update, CHH (Ponietowicz, E. 1998)

First Edition, editor of P.I. Department Newsletter (Editor – 1996 – 1999)

MEMBERSHIP:

National Association of Professional Women

Member of Emergency Nurses Association

Educational Background

Bachelor of Sciences in Nursing BSN (1978)

West Chester University, West Chester, PA

Licensure: Registered Nurse, State of Pennsylvania

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