Diana N. Brick

**** ********** **, *********, ** 95747 ■ 925-***-**** ■ ad3poo@r.postjobfree.com

Dedicated and Seasoned RN/UM/CCM Nurse with more than 35 years of experience in fast-paced hospital/IPA environment. Care Management Supervisor experience. Extensive utilization review and case management experience in an acute care hospital and HMO Medical Group. Excellent communication and time management skills. Obtained my CCM Certification in 2010 and active until November 2025. Interqual Instructor (IQCI) with McKesson for 2017, 2018, and 2019. Fast learner and a team player. Experience with remote working. BLS certification with AHA until 12/2025.

Active Listening Supervisor experience

Leadership skills Time Management

Critical Thinking Excellent Communication skills

Writing Team Player

Educator Adaptability

Mentorship Lead Nurse experience

Utilization Management Lead Nurse Coordinator, 01/2023 to 12/2023 Meritage Medical Network – Petaluma, CA

Performed concurrent review for the Medi-Cal population using MCG Guidelines. Referred high risk Members to the case manager for evaluation of ongoing services. Referred high risk Members to the Social Worker for evaluation and assessment. Assisted RN Care Managers on complex cases. Extensive work with Hospital Case Managers for discharge planning to assist in transfer to the next appropriate setting. Referred cases to the Medical Director that did not meet admission or continued stay criteria. Performed monthly audits of Cozeva program Nurse documentation. Train new staff as needed.

Regional Supervisor of Care Management, 08/2021 to 01/2023 Meritage Medical Network – Petaluma, CA

Supervises the care management staff in serving defined populations by using a collaborative process of assessment, planning, implementation, and evaluation to engage, educate, and influence decisions related to achieving and maintaining optimal health status. Onboard and train new staff. Review and approve all time cards. Perform annual review performance of my Team. Perform departmental audits and reporting department productivity. Coach and mentor my Team. Participates in all aspects of the Care Transition Program. Worked with high risk Medi-Cal population. Coordinates care among multiple treating physicians, hospitals, and behavioral health care, as needed.

Prior Authorization Nurse, 10/2020 to 08/2021

Dignity Health Medical Foundation – Rancho Cordova, CA Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care. Educate providers on utilization and medical management processes. Provide clinical knowledge and act as a clinical resource to non-clinical team staff. Enter and maintain pertinent clinical information in various medical management systems. Interact with providers to educate and direct care to participating network providers

RN Educator, 06/2019 to 10/2020

VITAS Healthcare – Walnut Creek, CA

Hired to be the RN Educator for this Hospice Agency. Onboarding of all new Employees including field observation, and hands on teaching depending on need. Educate Skilled Nursing Facilities and Assisted Living Facilitates on various topics monthly. Started our first Skills Lab, created tri fold boards, educational material, skills checklists. Assist with COVID testing of our Staff. Zoom teaching three days a week on topics according to our educational calendar. Fit testing annually of all staff.

Inpatient Care Manager II, 10/2016 to 03/2019

Brown & Toland Physician Services – Oakland, CA

Hired to follow the out of network Members and repatriate back in network once medically stable. Performed 100% utilization review on each Member using Interqual criteria. Referred cases to Medical Director and issued hospital denials when appropriate. Monitored for quality issues, delay in care and completed Quality Indicator Form. Extensive work with Hospital Case Managers to assist with discharge planning and moving to lower setting when medically appropriate. Reviewed for skilled nursing placement using Interqual criteria to ensure Members met criteria. Provided authorizations for Home Health, DME, SNFs, as needed. Referred high risk Members to outpatient Case Manager for follow up. Participated in the On Call after hours and weekend rotation every 4-6 weeks.

Utilization Review RN, 04/2008 to 08/2016

John Muir Physicians Network – Walnut Creek, CA

Performed Initial, Concurrent and Retrospective reviews of our HMO Members on site at Concord Hospital to determine length of stay/medical necessity and ensuring they are at the right level of care. Applied Interqual Criteria guidelines to determine level of care/medical necessity for hospital admission. Worked closely with my Medical Director to ensure our Members are moving along the continuum. Worked closely with Hospital CM to ensure a safe discharge plan was in effect. Reviewed charts for quality issues and referred to Quality Coordinator when needed. Kept log of avoidable/denied days. Assisted with repatriation of our Members at out of area hospitals. Worked closely with varied Insurance Companies to ensure all hospital days were authorized. Sent out weekly readmission report of our Members at Concord Hospital who were readmitted within 30 days so they can be reviewed by our team. Referred all of our Members with high LACE Scores to the appropriate network program to help prevent a future readmission.

RN Case Manager, 11/2003 to 03/2008

San Ramon Regional Medical Center – San Ramon, CA

Hired to start the new Admitting Nurse Case Manager program. Developed the process reviewing all Direct and Emergency Admits for severity of illness/intensity of service using Interqual Criteria and ensuring that Patients are admitted to the right setting: acute care or Observation. Extensive work with Emergency Room MD's and RN's providing education about the process. Coordinated AM Daily Bed Control Meetings with Staff Charge Nurses, OR and Staffing Coordinator to discuss bed availability and ensuring that Patients are moved in a timely manner. Reviewed Medicare One Day Stay Patients and referred cases that did not meet Interqual Criteria to the Physician Advisor. Case Manager for ICU, OB and NICU. Performed 100% Utilization Review/Concurrent Review as needed. Discharge planning as needed for rehab placement for ICU, Ventilator Patients. Home Care Referrals for ICU, OB and NICU as needed. Extensive work with Insurance Companies in providing Initial, Concurrent and Retrospective Reviews in a timely manner to avoid denials. Worked closely with the Multidisciplinary Team to provide the best care and making sure Patients have a safe discharge plan. Referrals to Social Worker as needed. Reviewed Observation Patients with MD's and Staff RN's to ensure strict guidelines are maintained.

RN Case Manager, 9/1985 to 08/2003

Christ Hospital – Jersey City, NJ

Served as RN Case Manager coordinating services for up to 30 orthopedic and pediatric cases: assess new patients and provide initial and on going concurrent reviews to Insurance Companies. Attended weekly Multidisciplinary rounds to develop/update treatment goals, facilitate discharge planning, and provide aftercare placement in SNF's for rehab when needed. Applied Interqual Criteria Guidelines to determine level of care/medical necessity. Appeal Denials and work closely with Physician Advisor on cases that did not meet Interqual guidelines. Preceptor for newly hired RN Case Managers and served as an educational resource to RN's and MD's on case management issues. Worked closely with Social Worker as needed on high complex cases.

Helped patients and family members make ideal choices to best meet needs and work within current capabilities.

Oversaw and documented patient care and care plans for [Type] patients.

Associate of Science: Nursing, Jun 1985

Christ Hospital School of Nursing - Jersey City, NJ 3 year Nursing program. The first two years we were in class at the nursing school and we went to Saint Peter's University three days a week for classes to obtain our Associates Degree. The last year was nursing school where we were completing our practical experience in the hospital five days a week as a student nurse.

EDUCATION

Associate of Science: Nursing, Jun 1985

St. Peter's University - Jersey City, NJ

Associates Degree in Nursing

SKILLS

Microsoft Word, Google Office

Midas, Allscripts, Epic, Cerner

Interqual Instructor 2017, 2018, 2019

BLS certification with AHA until 12/2025.

CCM with CCMC until 11/2025

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