Management Manager

RESUME

Mary E. Robinson, RN, BSN, PHN, MBA

**** ********** *****, **** ****

Huntington Beach, CA 92646

310-***-**** - Cell

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

EXPERIENCE

Vitas Healthcare, 2006 to Present

Senior Admissions RN

Work with Hospital Case Managers, families, and physicians in the field. Determine hospice

appropriateness, plan of care, and insurance coverage details. Train New RN’s in all facets of

Admissions to Hospice and Case Management.

UCI Medical Center, 2005 to 2006

In-Patient Case Manager

Determined IS/SI per Interqual, Milliman and Robertson Criteria for continued hospital stay.

Worked with families and patients on discharge planning details and insurance coverage.

Interfaced with physicians and multiple disciplines/medical groups for patient discharge

planning.

Saddleback Memorial Laguna Hills and Long Beach Memorial, 2002 to 2005

RN Clinical II/Charge Relief Nurse

Responsible for complete care of Critical Care Patients. ICU/CCU Unit. Intensive Care Trauma

MICU/SICU Unit. Total patient care responsibility.

West Anaheim Medical Center, approximately 2000 to 2002

Charge RN, Medical - Surgical Floor. In-Patient Case Manager

Responsible for discharge planning for Managed Care, Medi-Cal and Kaiser patients.

Healthcare Partners Medical Group, Torrance Office, approximately 1998 to 2000

Consultant and Director, Los Angeles Region Case Management

Responsible for Case Management of 2.5 million member lives, 50+ staff oversight, prior

authorization, in-patient UM, and high risk/catastrophic case management. Consulted with

Healthcare Partners physicians, community physicians and hospital Case Managers regarding

HP denial process management. Managed the Prior Authorization Department, including all

facets of the continuum of prior authorization of services.

Great West Life/One Health Plan, San Jose, CA, approximately 1996 to 1998

Western Regional Director of Utilization Management/Case Management

Managed telephonic UM process. Managed UM Staff conducting NCQA audits of 113 medical

groups. Traveled to the Corporate Office when necessary to meet with Senior Management. Met

with Federal and State Departments as necessary.

Cigna Healthcare, Glendale, CA, approximately 1993-1996

Regional Manager of Utilization Management/Case Management

Managed on-site and telephonic UM/CM staff utilizing Interqual and Milliman/Robertson

Criteria. Conducted appropriateness reviews with Cigna Medical Directors and issued

denial letters when necessary.

FHP Healthcare, approximately 1989 to 1993

Regional Director

Managed six Regional Offices in California for all aspects of prior-authorization and in-patient

and out-patient UM/CM. Managed a staff of 150 personnel, both clinical and non-clinical. Set-

up and designed/implemented high risk/catastrophic case management program.

Provident Life & Accident Insurance Company, approximately 1987 to 1989

Manager of Telephonic Utilization Management

Managed the UM Call Center for commercial employer groups. Managed clinical and

ancillary personnel. Implemented a production reports process for Call Center activity.

EDUCATION

MBA, University of Phoenix, Graduated 1996

BSN/PHN, University of Southern California (Scholarship Awarded), Graduated 1987

RN, California Hospital School of Nursing, Graduated 1984

AWARDS

Recipient of FHP Healthcare’s “Employee of the Year Award” for realizing $1,000,000

savings in the first year of the newly instituted Catastrophic Case Management Program

FHP’s “Western Region Award for Outstanding Employee: Integrity”

Vitas Healthcare’s “Admissions RN of the Year Award - Program 93” for 2008 and 2011

REFERENCES AVAILABLE UPON REQUEST

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