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Manager Medical

Location:
Deltona, Florida, United States
Posted:
January 25, 2017

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CANDIDATE SUMMARY:

Walter Kowalczyk, RN, BSN, CDMS, CCM, QRP, LNC has over 35 years of combined experience in a variety of healthcare settings including case management, psychiatric nursing, medical education and patient care. He has a distinguished track record in medical case management in both hospital and insurance settings; group health insurance and Medicare managed care companies, ensuring injured workers achieve return to work status. He is a self-motivated, problem solver working well independently or with a team to creatively deal with the changing environments in the health care field. He is noted for the ability to listen and a take decisive action.

PROFESSIONAL EXPERIENCE:

USIS, Orlando, FL

Per Diem Telephonic Case Manager

09/2014 to 08/2015

Responsible for providing medical and disability case management services, which included review and evaluation of Workers' compensation claims for vocational and/or delivery of medical services

Worked collaboratively with claims staff, injured worker, employer and health professionals to promote quality medical care and timely return-to work (RTW) to achieve optimum, cost-effective medical and vocational outcomes.

Assess, plan, implement, coordinate, monitor and evaluate medical services and RTW options

Perform utilization review (30 day and 90 day file summary reports, concurrent, prospective and retro)

Orlando VA Medical Center, Central Florida

10/2007 to 01/2014

Orange City Community Based Outpatient Clinic (CBOC), Orange City, FL

Staff Nurse II - Mental Health Nurse

05/2008 to 01/2014

Applies the nursing process to individuals and groups of patients with a variety of mental health and coexisting medical/surgical conditions, including assessment of health history, review of systems and physical/psychosocial assessment utilizing established tools

Coordinate care for Veterans who have PTSD & chronic mental illness

Integrates bio-psychosocial concepts, cognitive skills, and technically competent practice in providing care that fosters mental health rehabilitation and recovery

Manages patient care by promoting positive patient outcomes including the areas of medical and psychiatric emergencies, detox and patient safety

Provides guidance to all caregivers and collaborates with the team members regarding the plan of care and educational requirement as indicated to support patient needs

Reports status of service needs and contributed to problem resolution and modification of processes as necessary

Involved in the administration, treatment planning and discharge process and is a key participant in the maintenance of a safe, stable and therapeutic environment

Functions in a self-directed manner as a team member, team leader as assigned or designated

Orlando VA Medical Center, Orlando, FL

Staff Nurse II - MHICCM Range Case Manager

10/2007 to 05/2008

Assist Veterans who have chronic mental illness and a history of multiple hospitalizations

Performed function such as maintaining medication schedules, performing health assessments, monitoring vital signs and providing IM medications

Visit Veterans in the community or their homes

Provide training to the Veteran to perform routine daily living functions

Educate the Veteran on functions that are essential to personal safety, self-preservation and comfort in the community

Systematically evaluate the clinical needs of Veterans and initiate action to promote optimal level of functioning

Document care provided and submit required data and reports for effective care management

Carry out research studies on his/her own or in collaboration with other members of the team and apply the findings to clinical practice

Coordinate social/recreational outings in the community

Serve on committees and task forces as needed

All Medical Personnel, Orlando, FL

Registered Nurse, Contract Employment

2005 to 2007

United Healthcare/Americhoice, Orlando, FL

Medicare Medical Case Manager

5/2006 to 10/2007

Working in the field to provide Case Management for our members who are more at-risk for hospitalization or serious, permanent or long term effects from their disease.

Interacting regularly with the telephonic case managers, disease managers and social workers

Coordinating care for members

Educating members regarding care

The Hartford, Specialty Risk Services, Orlando, FL

Telephonic Case Manager

06/2005 to 08/2005

Responsible for providing medical and disability case management services, which included review and evaluation of Workers' compensation claims for vocational and/or delivery of medical services

Worked collaboratively with claims staff, injured worker, employer and health professionals to promote quality medical care and timely return-to work (RTW) to achieve optimum, cost-effective medical and vocational outcomes.

Responsible for early medical intervention of lost time cases

Ability to assess, plan, implement, coordinate, monitor and evaluate medical services and RTW options

Perform utilization review (concurrent, prospective and retro)

Intracorp, Orlando, FL

Field Case Manager/Rehabilitation Consultant

2000 to 2004

Responsible for coordinating medical service for injured workers

Perform a thorough assessment for the referring party

Attend provider appointments, met with providers

Perform medical, vocational & psychosocial assessments

Interact with adjusters, employers and provider to determine medical & work status, determine current needs and facilitate return to work

Consult with legal counsel

Prepare monthly reports of the injured worker's medical and work status with recommendation for meeting optimum medical care and return to work

ManagedComp, Maitland, FL

Manager Case Management Department

1998 to 2000

Responsible for the day-to-day operations of a workers' compensation case management department

Generated weekly reports and performed QA on open cases

Developed policies & procedures using ACHA managed care guidelines, acted as the grievance coordinator

Managed 9 RNs & 3 LPNs

Provided computer training on company's case management program and provided computer software training to newly hired personnel

Conducted bi-weekly staff meetings

Conducted or coordinated in-service training

PREVIOUS PROFESSIONAL EXPERIENCE:

Florida Hospital HealthcareSystems, Orlando, FL

Medical Case Manager

1997 to 1998

Humana Health Care Plans, Ormond Beach, FL

Manager, Case Management Department

1996 to 1997

ERS Consultants, Oviedo, FL

Rehabilitation Consultant

1994 to 1995

Sea Pines Rehabilitation Hospital, Melbourne, FL

Hospital Case Manager

1990 to 1991

ConServCo, Orlando, FL

Rehabilitation Consultant

1988 to 1990

MILITARY EXPERIENCE:

U.S. Army Reserves, Army Nurse Corps.

Rank, Lieutenant Colonel, Honorably Discharged

Numerous Awards and Decorations including: The Army Achievement Medal, The Army Commendation Medal and The Legion of Merit Medal

EDUCATION:

Bachelors of Science in Nursing University of Massachusetts, Boston, Massachusetts Bachelors of Arts in Psychology Bridgewater State College, Bridgewater, Massachusetts

LICENSES & CERTIFICATIONS:

Florida R.N. License

Certified Case Manager (CCM)

Certified Disability Management Specialists (CDMS)

State of Florida, Division of Worker's Compensation

Rehabilitation Service Provider

Legal Nurse Consultant Course, Certificate, University of Central Florida, 2001



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