MARK RAINES

**** ********** **. ********, ** ****3 · 765-***-****

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Triage Nurse - Senior Nurse Case Manager - Registered Nurse - Program Director

• Telephone assessment of patients withing a very busy internal medicine practice within Community Health Network.

• Analyzed difficult medical information to identify mechanism of injury; researched and refined evidence-based medicine to build treatment plans and establish effective target dates.

• Uncovered evidence-based medicine to validate treatment plans; while coordinating care and communications with providers, claim specialists and injured workers.

• Worked with the State of Indiana as a Program Director to provider leadership and supervision to employees and to design QA tools for oversight of large 2.9-million-dollar contracts

AREAS OF EXPERTISE

Case Management Customer/patient Focus Nursing

Critical Thinking Collaboration Coaching

Communication Mentored Others Problem solving

Managing Multiple Priorities Teaching Others Versatility PROFESSIONAL EXPERIENCE

Community Health Network, Carmel IN 2023- present

Telephone Triage RN

• Telephonic Triage for a very busy internal medicine office

• Prior Authorization form work

• Providing education and treatment plans with recommendations for 8000 patients

• Worked in Triage call center to provide telephonic EBM for care needs daily calls varied from 40 to 75 per day

Liberty Mutual Insurance Company, Carmel, IN 2012 –2022 Medical and Disability Nurse Case Manager Commercial Insurance claims (Managed Care)

• Serve as a subject matter expert for medical and disability topics

• Research Evidence Based medicine to ensure the patient is getting the best possible treatment to help promote a safe and smooth transition back to work 2

Liberty (cont.)

• Review claims and assist with ongoing medical management of those claims

• Collaborate with claims adjustor in the medical management of worker’s compensation patients and serve as a medical resource

• Educate patients and claim specialists on the medical plan of care the attending physician has created and assist them in navigating through that plan, educate on co-morbid conditions and their impact on healing/recovery

• Review plans of care in comparison to Medical Disability and Official Disability Guidelines and collaborate with physicians/medical team when there is a discrepancy in that plan, contain cost for both the company and insured

Midwest Surgery Associates, LLC, Anderson, IN 2008 - 2012 Outpatient surgery center affiliated with Ascension Health -RN Pre/Post and Team Lead

• Charge Nurse and Team Leader Responsibilities; Team Leader assisted committee in the development of Occupational Health programs to help in the prevention of injury, worked within OSHA guidelines; Post Anesthesia nursing expertise to patients in a very busy, high acuity ambulatory surgery center

• Work concurrently with pain management and with Indiana Heart and Vascular services to build knowledge base to improve patient outcomes

Clarian Health Partners, IU Health, Indianapolis, IN 2007 – 2008 Teaching hospital located in downtown Indianapolis RN Associate Partner

• Internship within the Medical ICU to develop RN skills Indiana State Government, Indianapolis, IN 1999 – 2007

• Program Director for Agency Oversight

• Direct supervision of staff, matrix supervision of 150 statewide employees through multiple cross connected agencies

• Directed and planned the activities with 21 State prosecuting Attorney’s offices for Adult Protective Services with a 2.7 M budget

• Developed and implemented QA tools to ensure contract compliance with expenditure and stewardship of all identified funding stream

EDUCATION

8/2014 –3/2016 University of Cincinnati (19 Online Graduate credits) Cincinnati, OH 9/2010-10/2012 Western Governors University (online) BSN Salt Lake City, UT 2005-2007 IVY Tech Community College of Indiana ASN-RN Anderson, IN 1986-1990 Purdue University BA W. Lafayette, IN * Double major; Law and Society and Political Science Completed my ASN/ RN, my BSN and the 19 hours of graduate credit all while working full time. Have received my certification in case management (CCM)

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