Experience

April **** - present Northside Hospital, Atlanta Georgia

Case Manager

Daily review of medical records and application of clinical

Criteria. Assist patient, family member or authorized representative

with care planning and post discharge needs.

November 2015-March 2015 Ram Healthcare Consulting Group

Case Manager

Care Coordination for Acute Care Hospital. Utilization Review and daily

Discharge planning. Facilitation of daily team conference.

Collaboration with residents and attending physicians.

May 2009 – November 2015 Aetna Better Health of Michigan

Manager, Health Services

Oversight and management for all departmental functions related to utilization management, appeals, prior authorization, claims review. Employee training, mentoring, monitoring and recruitment. Compliance with meeting regulatory and corporate standards. Achieved successful Accreditation. Launched and managed Medicare Duals Program. Vendor monitoring and oversight.

August 2008 – May 2009 Memorial Health University Medical Center, Savannah, Georgia

Case Manager

Provided assistance with managing and reducing ER utilization, diverting admissions, community referrals, prior authorization and discharge planning.

September 2001 – May 2008 OmniCare Health Plan, Detroit, Michigan

Supervisor of Health Services

Supervised activities of personnel (clinical and non-clinical) in health services. Maintained successful business relations. Staff recruitment and retention. Extensive problem solving and decision making. Ensured that NCQA standards and Medicaid guidelines were followed and met.

August 2000 – May 2001 Henry Ford Health Systems, Detroit, Michigan

Case Manager

Community case management. Comprehensive assessment, monitoring, patient and family education. Empowering disease management in patients with chronic illnesses. Care coordination with obtaining community referrals and services. Direct patient care in clients home.

March 1998 – May 2000 Wesley Woods Geriatric Hospital, Atlanta, Georgia

Case Manager

Marketing Liaison Wesley Woods at Emory University Hospital. Responsible for admission screening and appropriate utilization of resources. Collaboration with hospital staff in a varied population of patients; critical care, rehabilitation, intermediate care, psychiatry, skilled nursing and emergency medicine.

Sept. 1997 – March 1998 Charter Behavioral Health Systems, Atlanta, Georgia

Utilization Review

Worked closely with various managed care companies in obtaining authorization for hospital stay; facilitated treatment team meetings keeping team abreast of patients’ clinical status. Primary role was to ensure quality documentation, implement infection control standards. Administrative decision making, nursing administrator on call.

May 1995 – July 1997 Schwab Rehabilitation Hospital, Chicago, Illinois

Case Management

Comprehensive assessment of rehabilitation patient’s discharge needs. Provided family support and awareness of patient’s progress. Care Coordination of community referrals. Sustained collaborative relationship with various members of the healthcare team to effectively coordinate patient’s discharge.

November 1994 – May 1995 Evanston Hospital, Evanston, Illinois

Staff Nurse

Position entailed close observation and monitoring of patients, delegation of nursing tasks amongst coworkers when designated; extensive problem solving and decision making.

August 1993 – August 1994 Emory University Hospital, Atlanta, Georgia

Clinical Nurse Specialist

Managed Research protocols. Independently functioned to coordinate and case manage patients participating in research. Recruitment, screening, protocol adherence, data collection. Extensive collaboration with treatment team members.

July 1990 – August 1993 Veterans Administration, Ann Arbor, Michigan

Clinical Research Nurse Specialist

Responsibilities consisted of interviewing research candidates, organizing and implementing protocol procedures, keeping abreast of current literature. Supervised a research assistant, educational liaison for physicians and support staff.

May 1988 – June 1990 Huron Valley Physicians Assoc., Ann Arbor, Michigan

Case Management Coordinator

Facilitating and authorizing benefit coverage for patient medical services with a focus on cost containment. Managed length of stay and discharge planning.

May 1986 – April 1988 Huron Oaks, Ann Arbor, Michigan

Staff Nurse

Managing substance abuse patient care, supervising treatment staff and coordinating activities for the program.

June 1985 – May 1986 Mercywood Hospital, Ann Arbor, Michigan

Staff Nurse

Open Adult Unit which comprised of psychiatric and chemically dependent patients. Helped patients improve their coping skills, building self-esteem and developing effective problem solving capabilities.

July 1983 – May 1985 University of Michigan Hospital, Ann Arbor, Michigan

Clinician I

Provided direct patient care on a medical unit with an emphasis on holistic care where I facilitated patient care conferences. As charge nurse, I delegated patient care amongst staff members.

Education

1989 Central Michigan University, Dearborn, Michigan.

Master of Science in Administration: December 1989.

1983 Indiana Wesleyan University, [formerly Marion College], Marion, Indiana.

Bachelor of Science degree in Nursing: May 1983.

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