Anita Harrold

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

Stockton, CA ****4

ad11j4@r.postjobfree.com

510-***-****

PROFESSIONAL PROFILE:

●Registered Nurse with 20+ years of experience within a broad spectrum of the healthcare field

●10+ years of experience in Utilization Management, Managed Care Management, and Quality Management, Behavioral Health, Home Healthcare, Palliative Care and Hospice

●10+ years of leadership experience including direct supervision of Nurse Educators in Nursing Academics

●Strong ability to build constructive relationships with patients, family members, physicians, and other health care professionals

●2 years of experience in Travel Nursing subsequently becoming proficient with a variety of EHR/EMR software including EPIC, Cerner, Allscripts, MIDAS, and MEDITECH

●Proficient with Microsoft Office Suite 365, Medical Coding and other technological skillsets

NURSE MANAGEMENT EXPERIENCE (Various Health Care Settings):

OUTPATIENT UTILIZATION MAGAMENT SUPERVISOR (REMOTE)

Community Health Center Network (CHCN)

●Oversight/support to the outpatient UM clinical staff and department adherence to protocol and procedures, regulatory compliance standards

● Ensure productivity and quality metrics are aligned with department goals and objectives

●Perform assessment of clinical staff performance, develop education and performance improvement plans

●Supervision of appropriate application of regulatory requirements, clinical standards and internal/organizational policies, procedures and metrics

04/2023 – 11/2023

PROVIDER QUALITY MANAGEMENT RN (REMOTE/TEMP)

Inland Empire Health Plan (IEHP)

●Conduct clinical audits and development of corrective action plans for contracted providers

●Provide clinical documentation of identified compliance issues

●Analysis reports and resolution management of health plan audits per NCQA

●Appropriate application of regulatory requirements along with organizational policies/procedures.

04/2022 – 07/2022

FACILITY COMPLIANCE REVIEW / POST-SERVICE REVIEW RN (REMOTE)

BEHAVIORAL HEALTH RN CASE MANAGER / FEP PROGRAM (REMOTE)

California Physicians’ Service DBA Blue Shield of California

09/2020 – 03/2022

●Clinical audits and development of corrective action plans for providers

●Analysis reports and resolution management of health plan audits

●Appropriate application of clinical guidelines (Milliman) and department guidelines

●Assessment/evaluation of care for members referred for case management

●Timely collaboration and care coordination for discharge planning FEP members

RN SUPERVISOR (INPATIENT / OUTPATIENT MENTAL HEALTH)

Telecare Corporation / Stanislaus County Crisis Stabilization Unit

12/2017 – 05/2021

●Supervision of staff, management of unit, case management

●Support, counseling, and education regarding symptoms and coping skills

●Client assessments, chart audits, evaluations

●Development/implementation of clinically appropriate care plans

●Coordination of care and referrals to facilitate transition into the community

{INTERIM} HOME HEALTH MANAGER (HOME HEALTH /HOME CARE ADMINISTRATION)

WelBeHealth / Stockton PACE

02/2020 - 06/2020

●Oversee the management of direct and indirect patient care and planning

●Maintenance of EHR documentation, ICD-10 coding. QA compliance

●Development of Policies & Procedures meeting regulatory standards

●Preparation and administration of the organization’s budget

●Staffing and performance reviews

VN PROGRAM COORDINATOR (EDUCATIONAL INSTITUTION)

Gurnick Academy of Medical Arts

06/2018 – 01/2020

●Development/management of Program Effectiveness Plan (PEP) for Academy

●Management of Faculty (Clinical & Didactic Instructors) and staff; performance reviews

●Direct oversight and supervision of student management to ensure satisfactory academic progress

●Clinical site assessments, campus policies/procedures, curriculum standards

PUBLIC HEALTH NURSE / NURSE ADVOCATE (RISK MANAGEMENT& PUBLIC HEALTH)

Patient Advantage / Regional Transit District

05/2014 - 01/2019

●Coordination of wellness / injury prevention program in safety/risk department

●Nursing advocacy to ensure the timely delivery of patient centered, high quality, cost-efficient health services

●Health educational presentations/trainings, health fairs

●Personalized medical research for staff with complex medical conditions

●Analysis reporting to identify wellness efforts & health challenge program effectiveness

MEDICAL MANAGEMENT SPECIALISTS (SENIOR ADVANTAGE HEALTH PLAN)

SCAN Health Plan / St Joseph’s Medical Center & Doctors Hospital Manteca

06/2016 - 01/2018

●Chart audits and initiation of care plans for patients with chronic medical conditions

●On-site clinical (concurrent) reviews for appropriate level of care assessments

●Collaboration with IDT to identify barriers and facilitate safe, timely discharge

●Served as a resource to obtain authorizations for services for members in acute hospital

CLINICAL ADMISSIONS DIRECTOR (HOSPITAL DISCHARGE EDUCATION)

Genesis Health Care / Eden Medical Center

09/2015 - 07/2016

●On-site clinical screenings/risk assessments, identification of special needs; clinical consulting for appropriate level of care placement

●Collaboration with case managers to facilitate timely discharges from acute setting per Milliman Care Guidelines

●Collaboration with post-acute committee for strategic planning of difficult placement cases and prevention of hospital readmissions

●Marketing/business development/ community partnerships

TRAVEL NURSING EXPERIENCE:

RN CASE MANAGER - Specialty Area(s): EMERGENCY DEPARTMENT 05/2023 – 10/2023

San Joaquin General Hospital

Screenings /assessments for appropriate level of care for patients in the emergency room

Clinical consultations with specialty providers including Trauma Team

Utilization review with appropriate application of clinical admission criteria (InterQual Guidelines)

Transfers and Care Coordination with interdisciplinary team members

RN CASE MANAGER - Specialty Area(s): INPATIENT PALLIATIVE CARE DEPARTMENT

Kaiser Permanente Medical Center

●Screening /assessments for appropriate level of care for patients with terminal diagnosis

●Care coordination and emotional support to patient (and family) with terminal illnesses

●Patient and family meetings for life care planning and healthcare advocacy

●Patient and family teaching on chronic disease management of life-limiting illnesses

12/2022 – 03/2023

RN CASE MANAGER - Specialty Area(s): DIABETIC & OTHER CHRONIC ILLNESS MANAGEMENT

Natividad Medical Center / Marin Health Medical Center

●Screenings/assessments for appropriate level of care for patient placement to highly skilled and accredited star-rated facilities

●Patient and family education on medication management, blood glucose monitoring, obtaining prescriptions and diabetic supplies

●Patient discharge assessments and planning; patient and family discharge teaching

●MD and other health care team member support for timely discharges to prior living or to lower level of care

06/2022 – 11/2022

RN CASE MANAGER - Specialty Area(s): MEDICAL EMERGENCY MEDICINE / PSYCHIATRIC EMERGENCY MEDICINE

John Muir Health / John George Psychiatric Hospital

●Screenings to assess the clinical appropriateness for admission and appropriate level of care for patient placement

11/2021 – 05/2022

●Electronic submission of referrals requesting placement and coordination of care with acute hospitals/Skilled Nursing Facilities/Home Health Agencies

●Collaboration of efforts, education/teaching on management of chronic diseases, coordination of care with outside hospitals/skilled nursing facilities

●Appropriate application of clinical admission criteria (InterQual/Milliman Care Guidelines Evidence -Based Subsets)

HOSPICE RN - Specialty Area(s): PUBLIC HEALTH / PALLIATIVE CARE / GENERAL INPATIENT UNIT

Hospice of San Joaquin / AseraCare-Amedysis Hospice Care

01/2017 – 04/2022

●Home visits for evaluation/assessments for appropriate level of care for terminal illness

●Quality review of medical records, chart audits, clinical documentation Evaluation/assessments for appropriate (end of life) level of care patient placement

●Admissions, routine, on-call visits to provide palliative care in the home setting

●Float positions: Intake, Triage, Continuous Care, Case Management, GIP symptom management

EDUCATION:

Bachelor of Science, Nursing University of Phoenix - Salida, CA 2013

PROFESSIONAL LICENSURES:

Unencumbered California Registered Nurse License: #95024865 Exp: 04/2025

Unencumbered California Public Health Nurse License: #544292 Exp: 04/2025

PROFESSIONAL CERTIFICATIONS:

ACLS, BLS, IV, CPI (Crisis Prevention / Nonviolent Crisis Intervention)

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