Lisa Kline

***** ********** **. #****, *****, CA 91708 Phone: 909-***-****

EXPERIENCE

UM LVN CASE MANAGER

Long Beach, CA - Molina Healthcare

**/****-**/****

* Perform utilization and concurrent review of outpatient cases using proper policy criteria per Molina Healthcare guidelines. (Remote)

* Determined medical necessity of the requested treatment of the patient's needs of their medical necessity and requested treatment, if determined criteria was not met it would be forwarded to the MD for further review for approval or denial.

* Maintained ongoing compliance with federal and or state laws in accordance to Medicaid and Molina's Healthcare policy.

UTILIZATION MANAGEMENT CLINICAL REVIEW NURSE

Rancho Cucamonga, CA - IEHP

08/2015 - 07/2019

*Perform utilzation and concurrent review of inpatient and outpatient cases using proper policy criteria. (On-site or Remote)

*Discuss cases with treating physicians, health plans and other healthcare professionals to better understand the plan of care.

*Process Grievance and Appeals requests within a timely manner.

*Refers to the Utilization Medical Director on all cases that do not meet established guidelines for submission.

*Completes data collection, tracks and trends information on denials related to medical necessity. Identifies performance improvement opportunities and collaborates with all levels of staff to develop and implement process improvements.

LVN CHARGE NURSE AND LVN FLOAT (RIVERSIDE HOSPITAL)

Riverside, CA

09/2011 - 01/2015

*Take patient vitals, initial assessment of patient and plan of care and administer vaccines or injections when needed, update EMR, schedule for follow up appointments and referrals as needed. Collecting lab specimens and venipunctures. Charge Nurse supervising MA's and CNA's, scheduling and maintaining leadership standards within the organization.

*Family Practice/Urgent Care/Med Surg/Spine Clinic/Diabetic Clinic and Teaching.

*2 years Outpatient Case Management

KAISER LVN PHLEBOTOMY TECHNICIAN AND FLU CLINIC NURSE

Anaheim, CA

08/2012 - 09/2013

*Pediatric and Geriatric capillary and venipuncture.

*Immunized Kaiser members and their families with the seasonal flu vaccine.

LVN - MEDICAL TECHNICIAN - PACIFICA SENIOR LIVING

Chino Hills, CA

04/2008 - 05/2010

*Passed out medications to residents in a safe and timely manner. Ensured all residents were healthy and safe at all times, supervised caregivers, prepared and documented all necessary paperwork and update medical records.

EDUCATION BRYMAN COLLEGE

Ontario, CA

01/2004-01/2005

Medical Assisant Certification

SUMMIT CAREER COLLEGE

09/2006 - 12/2007

CA LVN License

SKILLS

* Working knowledge of Microsoft Office Suite, including Excel and Powerpoint.

* Knowledge of EPIC, IDX, ALLSCRIPTS EMR Systems, PEGA, Interqual and MCG

* Ability to interact professionally with case management staff, physicians and payers.

* Knowledge of case management, working knowledge of Medi-Cal and Medicare Line of Business, IPA's and private insurance.

* Strong Utilization skills and knowledge, with strong attention to detail.

* Excellent verbal and written communication skills.

* Strong knowledge of ICD-10 and CPT Codes.

* Ability to work independently to meet predefined production and quality standards.

* Strong medical terminology and clinical skills knowledge.

* Highly organized and able to prioritize and follow through on multiple projects in a timely manner.

* Able to act as a role model, demonstrating appropriate problem solving skills and stress management skills.

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