Susan Muller

*** ******* *****

Norman, OK *****

Home# 405-***-****

Cell# 405-***-****

acxft2@r.postjobfree.com

Professional Summary

Most recently I have over 13 years of experience in field based and telephonic Workmans’ Compensation Case Management. I have had extended field case management experience with catastrophic injury management. I also worked with Soonercare clients at the Oklahoma Health Care Authority as an Exceptional Needs Coordinator, in the field and telephonically.

I have been a Nurse for 30 years. I have had extensive clinical experience in the past in acute care hospital settings providing Orthopedic care and acute post-operative care post orthopedic surgery, Post-operative Care, Oncology with Chemotherapy Certification with out-patient clinic work. I have also had a long history of providing a variety of skilled nurse home care such as infusion services, wound care services, wound care management, and diabetic care and management in the past. I also performed Intake services for about 3 years with a large home health care company making certain that I had referral information correct and that patients qualified for services, and worked with third party payors clarifying insurance benefits, pharmacy needs, and skilled services needed, negotiating rates for skilled services, pharmaceuticals, and IV infusion services. Most recently, but not included on my resume, I worked weekends for a large home health care company from 2010 through 2013. I performed skilled nursing assessment, wound care and management, as well as diabetic care, management, and teaching.

Licenses

Oklahoma Registered Nurse; certificate# R 0046225

Professional Experience

RN Field Case Manager

C.A.R.E. January 6th, 2016 to 11/09/2016

Obtain complete health and medical histories from patients including medical, surgical, and mental health histories. Provide care and treatment plan information to patient by providing information, education, and reassurance. Discuss any diagnostic testing and give information as to how the testing is performed, options if available and any associated risks, and /or benefits to assist patients in making informed decisions. Determine and/or coordinate treatment plan by requesting & reviewing diagnostic test results and medical records as they became available. Perform complete initial and supplemental patient interviews as needed to obtain comprehensive patient medical histories and document findings. Assess patients' psychological or emotional needs such as those relating to stress, fear of test results, financial issues, to make referral recommendations or assist patients in managing test outcomes. Refer patients to specialists or community resources as required. Evaluate or make recommendations for standards of care, clinical operations, and ensuring compliance with applicable regulations, ethics, legislation, Oklahoma Diagnostic Guidelines or policies. Attend physician, Physical Therapy, and Orthotic/Prosthetic appointments as needed for each patient.

Telephonic On Site Nurse Case Manager

August 2012 to March 15th, 2015

GENEX Services, L.L.C. Oklahoma City, OK

I was a dedicated case manager for the City of Oklahoma City Police Officers and Firefighters, and had an excellent relationship with clients and adjusters. I was located on-site with the Risk Management team of adjusters and worked within the Certified Workplace Medical Plan (CWMP) guidelines and the Oklahoma Disability Guidelines. I gathered all medical records and injury information that was pertinent and any special requests per adjuster’s. I provided telephonic supervision and coordination of the injured worker’s medical care and treatment, as well as facilitation of medical care and treatment with in-network providers. I made referrals to specialists and kept up to date on the specialist outcomes with medical care and surgical intervention. I used the Official Disability Guidelines to assure medical care/treatment being recommended was appropriate and in accordance with best practice guidelines. I also case managed medical maintenance files as requested by the adjusters, for ongoing care with prior catastrophic injuries. I worked towards satisfying and appropriately ending medical care for all involved parties by providing timely and appropriate medical care with appropriate communication to all involved parties throughout the case management life of the file and injury. I also identified cases that required field based case management for an improved outcome.

Exceptional Needs Coordinator

February 2008 to July 2012

Oklahoma Health Care Authority Oklahoma City, OK

Traveled mid and eastern, central portion of Oklahoma frequently to evaluate and re-evaluate severely disabled children, from infant to 21 years of age, for new or continued state paid skilled nursing services. The skilled nursing services made it possible for the caregiver to keep the child in the home setting. Many of these clients were ventilator dependent and severely handicapped.

I also performed telephonic case management for Sooner Care members. I provided pregnancy and infant management and assistance, disease management, ER visit case management, and member eligibility issue assistance. Facilitated and justified numerous types of specialty physician referrals and assistance for travel requests, if referrals out of state due to no ability to provide the necessary physician services in Oklahoma.

Telephonic Nurse Case Manager

November 2005 to February 2008

CompCHOICE Oklahoma City, OK

Telephonic supervision, coordination, and facilitation of medical care and treatment for injured workers in Oklahoma and surrounding states with numerous accounts within CWMP network/guidelines. Gather all medical records and injury information that is pertinent and any special requests per adjuster’s. Provide telephonic supervision and coordination of the injured worker’s medical care and treatment, as well as facilitation of medical care and treatment with in-network providers. Refer to specialists and keep up to date on specialist outcomes with medical records to assure medical care/treatment being recommended is appropriate. Work file to an appropriate end of medical care for all involved parties by providing timely and appropriate medical care with appropriate communication to all involved parties throughout the case management life of the file.

Identified cases that required field based case management for an improved outcome. Managed the field based cases and worked with the case managers to keep all care within the CWMP network. I was then re-located on-site with the Risk Management team of adjusters and worked within the Certified Workplace Medical Plan (CWMP) guidelines and the Oklahoma Disability Guidelines. I was a dedicated case manager for the City of Oklahoma City Police Officers and Firefighters, and had an excellent relationship with clients and adjusters. I gathered all medical records and injury information that was pertinent and any special requests per adjuster’s. I provided telephonic supervision and coordination of the injured worker’s medical care and treatment, as well as facilitation of medical care and treatment with in-network providers. I made referrals to specialists and kept up to date on the specialist outcomes with medical care and surgical intervention. I used the Official Disability Guidelines to assure medical care/treatment being recommended was appropriate and in accordance with best practice guidelines. I also case managed medical maintenance files as requested by the adjusters, for ongoing care with prior catastrophic injuries. I worked towards satisfying and appropriately ending medical care for all involved parties by providing timely and appropriate medical care with appropriate communication to all involved parties throughout the case management life of the file and injury. I also identified cases that required field based case management for an improved outcome.

Field Based Case Manager

June 2003 to November 2005

PROS and Associates Oklahoma City

Responsible for attending physician appointments in the state of Oklahoma for a group of Workmans’ Compensation clients assigned. Provided case management services including updates after each appointment to individual adjuster’s, as well as updated 30 day reports. Provided supervision and coordination of the injured worker’s medical care and treatment, as well as facilitation of medical care and treatment with adjuster payment approval. Advocated for timely and appropriate medical care. Facilitated and referred to specialists, diagnostic testing, therapies, procedures, and if necessary for specialized recommended surgical intervention. Kept up to date on specialist outcomes with medical care and surgical intervention. Worked the case to an appropriate end of medical care, for all involved parties, by providing timely and appropriate medical care with appropriate communication to all involved parties throughout the case management life of the file.

Telephonic Case Manager

March 1999 through June 2003

CompCHOICE Oklahoma City, OK

Initially I assisted with the development of all company letters. Identified how we would make sure that the medical care recommended was appropriate, with use of the Medical Disability Guidelines. I performed telephonic supervision, coordination, and facilitation of medical care and treatment for injured workers in Oklahoma and surrounding states with numerous accounts within CWMP network/guidelines. Gather all medical records and injury information that is pertinent and any special requests per adjuster’s. Provide telephonic supervision and coordination of the injured worker’s medical care and treatment, as well as facilitation of medical care and treatment with in-network providers. Refer to specialists and keep up to date on specialist outcomes with medical records to assure medical care/treatment being recommended is appropriate. Work file to an appropriate end of medical care for all involved parties by providing timely and appropriate medical care with appropriate communication to all involved parties throughout the case management life of the file.

Identified cases that required field based case management for an improved outcome.

Field Based Case Manager

March 1998 through December 1998

Midlands Injury Management Oklahoma City, OK

Field Based Case Manager

October 1997 through March 1998

Commonwealth Management, Inc.

Utilization Specialist and Central Intake Coordinator

April 1997 through October 1997

Columbia Homecare and Hospice of Oklahoma

Registered Nurse Intake Coordinator

January 1997 through April 1997

Visiting Nurse Association

Registered Nurse Team Leader, Central Intake Coordinator

September 1992 through January 1997

Carter Health Care

Registered Skilled Nurse

December 1990 through August 1992

Central Oklahoma Care At Home

I would be happy to provide you with my complete work history if desired.

Education

Rose State College

1983 through August 21st, 1986

Associate Nursing Degree

Cooke County College

1981 through April 29th, 1983

Licensed Practical Nurse Diploma

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