LPN

Deborah Harrison

**** ******* ***** **** ********, FL. 34234317-***-**** **********@*******.***

Healthcare professional with over 2 decades combined case management and nursing experience in planning, organizational development, training, building teamwork and mentoring. Reputation as a self-directed professional with superior problem solving, communication, and management skills. Successful in managing time, prioritizing tasks, and organizing projects to improve the quality of patient care. Experienced in facilitating change in workforce to support reengineering initiatives and meet organizational operating, financial and quality objectives.

Professional Skills

Managed Care

Medicaid

Inpatient

Elder Care

Social Services

Case Management

Social Services

Community Outreach

Healthcare

Chronic Illness

Harm Reduction

Mediation

Clinical Research

Behavioral Health

Medical Social Work

PROFESSIONAL EXPERIENCE

(Humana American Elder Care) 12/2015 – Present

Care Manager /Clinical Advisor

Coordinate formal and informal services and resources with in network providers and monitors delivery to ensure effective and timely service provision in accordance with care plan.

Orient new members and/or their caregivers to provide full explanation of individualized care plan and the use of the handbook and provider directory.

Advocate for the members’ needs, addresses concerns, resolves issues and complete 701 B assessments.

Advocate for members that are temporarily housed in acute care facilities by communicating monthly and as needed with the facilities to identify and document barriers and to play a role in discharge planning to ensure placement in a less restrictive setting if the member is able to do so physically and mentally for safety reasons.

Document all interventions, interactions within 3-5 calendar days of event and in compliance with all contract standards & expectations, and company requirements.

Facilitate the completion of Medicaid and other benefits programs eligibility application process for members and monitors the process.

(Sunshine Health) 9/2013 – 12/2015

Case Manager

Case Management for the Diversion Plan and then with LTC program.

Case managed up to 140 new enrollees with LTC then case load to decreased up to 100 members, completed authorizations, home and facility visits as required every 3 months, completed 701 B assessments, maintained accurate, up to date records of monthly calls to evaluate members care and well being.

Initiated member transferring from nursing facility to ALF or from ALF and or nursing facility to home.

Developed a case management plan collaboratively with the member, family/caregiver, health care providers, the payer, and the community to maximize healthcare responses, quality care, and cost-effective outcomes with appropriate use of available resources

Setup and authorized all home services, checked home for appropriateness of member returning home.

Provided information to member and members family of what our program offered, available to members and their families for support, questions and or concerns.

Collaborated with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services

(Managed Health Services) 2/2013 – 9/2013

Utilization Review Prior Authorization Nurse

Performed MHS Phone authorizations for Medicaid recipients requiring in patient stays, durable medical equipment, surgery, imaging, injections, home health care, etc. Milliman Certified 2011, complete quarterly IRR's.

Worked from faxes and phone calls from MD offices, Home Health Agencies, DME companies, Hospital, etc.

Worked in Tru Care, CCMS, IAC, Milliman, MHS Policies and Procedures, MHS Pain Management Policies, use Right Fax .

(Managed Health Services) Repucare Staffing 4/2011 – 2/2013

Utilization Management Nurse

Received requests for prior authorization of services, inpatient admissions, inpatient/outpatient rehabilitation & outpatient services, skilled nursing, home care, inpatient/outpatient elective procedures, & services of any type by out-of-network providers

Completed authorization process against plan review criteria and benefit guidelines

Communicated and interacted with providers via phone & fax to facilitate and coordinate the UM/PA

Referred cases to the Medical Director for medical necessity review when service requests cannot be approved

Recognized potential opportunities for referrals and refer to case management services

(Advantage Health Services) CFA Staffing 2010 – 2011

Prior Authorization Nurse

Performed phone authorizations for Medicaid recipients requiring in hospitalization stay for illness and or elective surgeries, authorizations for DME equipment.

Worked on 1261 A's for behavioral health.

Spoke on phone with MD offices, Home Health agencies, and Hospitals.

Worked in Indiana Aim system and used Milliman care guidelines.

(Wishard Health Services) 2008 – 2010

Clinic Nurse

Triage, phone, fax, computer, scheduling, prescriptions, docs for docs, notify patients of test results, relay health, prior authorizations, letters, etc.

(Visiting Nurse Service) 2007 – 2008

Triage Nurse

Provided follow-up with physicians, scheduled continuum of care for members, patients, obtained discussed orders, organizations phone, fax services and computers, to patient also and did family reports, etc.

(Tender Care Home Health) 2007 – 2007

Home Care Nurse

Provided total care for homebound patients including ventilator patients

(XL Care) 2006 – 2006

Intake Coordinator

Provided follow-up to case managers, discharge planners and physicians regarding patient care.

Marketed organizations services to case managers, discharge planners and physician offices.

Worked closely with physician offices to obtain new orders and give test results.

Discussed organizations services to patients and family members.

Responsible for ordering all DME equipment relevant to patients need.

(Option Care of SW Florida) 2003 – 2006

RT Supervisor/Care Coordinator

Scheduled all CPAP, auto CPAP, BIPAP, Apnea monitors, overnoc oximetry, and humidified oxygen setups.

Completed setups of CPAP, auto CPAP, BIPAP, Apnea monitors, over noc oximetries, humdified oxygen setups, suction machines, trach patients and nebulizers along with enteral feeding setups and mask fitting.

Assisted sales representatives with marketing organizations services and equipment. Attended conferences related to positon.

Education

Indiana Vocational Technical College: LPN Bloomington, IN February 1988

University of Indianapolis: Medical Secretary Courses Indianapolis, IN.

University of New York: Prerequisites for Associate Degree New York, NY

Correspondence Courses for Associate Degree

Additional Work History Upon Request

Contact this candidate