acwl7r@r.postjobfree.com 520-***-****

Isela Luna, RN, PhD, CCM

Accomplishments & Awards

Over 16 years of successful leadership experience in diverse health environments

Experienced Leader in leading population health management strategies and change processes within an integrated health network

Clinical expert in Medical & behavioral health issues

Expertise in transitions of care in acute, community, and health plan settings

Clinical expert in developing, implementing, evaluating and publishing nationally-recognized programs for care transitions, chronic disease management, community case management, and telemedicine

Expert in partnership building and community engagement with public, private and government entities

1999 Outstanding Achievement Award for TOT SHOTS, Arizona Partnership for Infant Immunization

1996 Women on The Move Award, YWCA of Tucson

Professional Experience

Director Case Management-Kindred Hospital Tucson, Az. August 2015-Present

Administrative oversight of case management activities within a 60-bed LTAC Hospital.

Responsibilities include: performing concurrent review with public & private payers to ensure insurance coverage; facilitate daily interdisciplinary clinical staff meetings; apply InterQual criteria to ensure effective admission recommendations, continued stay monitoring & timely discharge planning; liaise between medical & behavioral health systems for multi-morbid members; chair of ethics committee.

Decreased high-cost outlier stays by 20% as the result of improved admission recommendations and aggressive discharge planning beginning the day of admission

Increased revenues by 20% 8 out of 12 months by executing timely discharges

Train Hospital staff on use of InterQual criteria for utilization management

Consultant–River Oaks Emergency Medical Center, Houston, TX January 2011– Present

Operational and regulatory consultation for physician entrepreneur related to two free standing emergency medical centers in the metropolitan Houston area.

Established policies & procedures & guides for implementation

Implemented regulatory compliance strategies for the facilities.

RN Case Manager, Behavioral Health & Medical–The University of Arizona Health Network, Health Plans Division, Tucson, AZ September 2011– July 2015

Provision of nurse case management services for Medicaid / Medicare / Marketplace members: Responsibilities included: utilization management, including prior authorization, inpatient review & discharge planning for population with Behavioral Health and Medical issues.

Established, developed, implemented and evaluated “Change of Heart” Disease Management behavioral program for people with depression.

Developed evidence-based, stratified COPD Disease Management program being used in Healthy Together Care Partnership

Specialization in integrated case management for members with complex, co-morbid medical & psychiatric diagnoses.

Utilization Management Specialist,- Community Partnership of Southern Arizona Tucson, AZ April 2013– May 2015

Perform retrospective review for medical necessity of psychiatric inpatient admissions for Medicaid-eligible behavioral health recipients

Worked with RBHA providers in determining utilization reviews

Director of Nursing–Pima County Health Department, Tucson, AZ January 2004 – September 2011

Directed the operation of 6 public health clinics and 3 mobile units serving over 155,000 Pima County residents with an annual operating budget of 2.5 to 5 million dollars

Contracted with AHCCCS to receive reimbursement for immunizations increasing revenue of department by $500,000 first year and doubling the next year to $1 million dollars.

Established Dental Mobile program which provided oral health to approximately 7,000 children per year.

Instituted the use of the National Incident Management System within all Pima County clinics

Established Electronic Medical Record in Department to identify quality measures

Secured ADHHS ($1,500,000) to establish the First Things First Program for children 4 and younger

Increased County immunization rates by 30% through population based programs during Measles epidemic (2009) as well as N1H1 epidemic (2011).

Program Manager, Carondelet Community Trust –Carondelet Health Network, Tucson, AZ January 1998 – December 2003

Strategic management of social responsibility programs for Carondelet Health Network

Increased Immunization rates in targeted zip codes by 25% through the establishment of TOT SHOTS program with Pima County Fire Department as a staff extenders for Pima County. (Flynn Foundation 1999 ($20,000))

Secured NIH ($1,000,000) to establish Diabetes Disease Management program.

In the duration, managed 21 population based projects and 19 of them gained sustainability

Directed the enrollment of over 15,000 families in CHIP program over 4 years

Influenced State Officials from AHCCCS in modifying CHIP application

Prepared Public Policy recommendations for the Arizona Hospital Association related lobbying activities.

Assistant Professor, University of Arizona College of Nursing, Tucson Az

1993-1997

Taught nursing research methods to Undergraduate College of Nursing students

Secured NR ($500,000) to establish ” Obesity in Mexican American Children: An Intervention Study” program for children who are obese.

Additional Clinical & Academic Nursing Experience Tucson, AZ 1983-1997

Psychiatric Nurse, Sonora Desert Hospital, Tucson, AZ

RN, Pediatric Oncology Outpatient Clinic, University Medical Center, Tucson, AZ

RN, Pediatric Intensive Care Unit, University Medical Center, Tucson, AZ

Programming and Software Skills

MCG (formerly Milliman Care Guidelines), Interqual, TCS Acuity, IDX, Siebel, Cerecons, Microsoft Office products, Microsoft Outlook, SPSS statistical analysis software

Selected Grants, Presentations & Publications

First Things First-Arizona Department of Health and Human Services 2010 Isela Luna PI-Child Care Nurse Consultation Training and Services ($1,250,000)

First Things First-Arizona Department of Health and Human Services 2009 Isela Luna, PI-Oral Health Services in Underserved Communities ($250,000)

“The Use of the Omaha System of Documentation in Public Health Programs” Arizona Public Health Association September 2006 Phoenix, Arizona.

“Community Building” National Association of Nurse Case Managers, November 2004, Las Vegas, Nevada.

“Cultural Diversity in Case Management” National Association of Nurse Case Managers, October 2001, Las Vegas, Nevada. (Invited Presentation)

“Documenting Outcomes of Case Management” 29th Annual southwestern clinical Pharmacy Seminar. Feb. 1996. Holiday Inn Palo Verde, Tucson, Arizona.

Luna, I. (2002). Health In Community: Nursing Role. Nursing Today: Transition and Trends. Saunders. 3rd Ed.

Crist, J. D., Heather, C., Lehman, K., & Luna, I. (2016). Evasions in Interactions: Examples from the Transcultural Nursing Research Field. The Qualitative Report, 21(6), 1164-1177.

Education

Bachelor of Science Nursing– University of Texas, El Paso, TX 1983

Master of Science, Child Health Nursing & Psychology - University of Arizona, Tucson, AZ 1988

PhD – Nursing Research - University of Arizona, Tucson, AZ 1993

Licensure

Registered Nurse, Arizona & Texas

RN057046

Certification

Certified Case Manager, Case Management Society of America

4209675

InterQual Certified Instructor

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