REGISTERED NURSE MEDICAL CASE MANAGER ACDIS-CDI APPRENTICE UTILIZATION REVIEW NURSE

As a seasoned Registered Nurse and Certified Case Manager, I excel in providing comprehensive case management, including utilization review, patient advocacy, and resource management. My expertise spans across coordinating care for diverse patient populations, ensuring quality outcomes, and effectively managing healthcare resources. I am adept at navigating complex healthcare systems focusing on accuracy, communication, advocacy, and resource management to promote quality and cost-effective interventions and outcomes to deliver patient-centered care while demonstrating a strong commitment to improving patient health and well-being.

Utilization Review Healthcare Management Collaborative Leadership

Medical Case Management Patient Safety Medical Review

Medicaid & Medicare InterQual & MCG Managed Care

House Supervisor Clinical Auditing Regulatory Compliance

CDI Foundational Knowledge Ethical Principal Core Compliance

KEY ACCOMPLISHMENTS

●Developed and implemented the first Core Measure initiatives at Alaska Regional Hospital for standardizing core performance measures. Developed tracking tools, educated staff and providers on the quality measures, and evidenced based practices. Collected, abstracted, analyzed, and reported data to governing agencies as well as developing action plans when improvement was needed.

●Developed the anticoagulation clinic at The Alaska Heart Institute from the ground floor, inclusive of software deployment, scheduling and patient management, and staff training, which resulted in patient compliance and provided visibility into patient care for physicians.

Recaptured more than $7M in lost revenue at Alaska Regional Hospital through utilization review of unpaid claims; recouped 3X the set goal in half the projected time frame.

EXPERIENCE

CorVel Corporation RN, Medical Case Manager

3/2018 - Present Anchorage, AK

Serves as a liaison between all parties involved in a workers’ compensation claim: Physicians, injured worker, employer, and the insurance provider.

Serving as a crucial liaison managing approximately 25 cases simultaneously.

Successfully facilitating rehabilitation and expedited return to employment for injured workers through proactive problem identification and resolution.

Demonstrates proficiency in Microsoft Word, SharePoint, Excel, and Outlook through efficient case documentation and communication.

St. Elias Specialty Hospital RN, Nurse Liaison

8/2012 - 5/2018 Anchorage, AK

Oversaw patient admissions at St. Elias, a Long-Term Acute Care Hospital (LTACH). Identified and generated lead sources for referrals. Created referrals through networking and educating providers on the continuum of care provided by LTAC services.

Led patient admissions for a Long-Term Acute Care Hospital, leveraging InterQual and/or MCG guidelines to ensure appropriate care.

Established and maintained key relationships with physicians and case managers, enhancing referral processes and patient care coordination.

Obtained and assimilated information (financial and medical) to apply to predetermined criteria for admission, ensuring that needed services were appropriately provided.

Coordinated complex inter-facility transfers, ensuring safe and efficient patient transport.

Alaska Regional Hospital RN, Care Coordinator & Case Management

12/2010 - 8/2012 Anchorage, AK

Provided multi-disciplinary care and coordination for the ICU and CVSU patient population.

•Managed multi-disciplinary care coordination for ICU and CVSU patients, focusing on safe, effective, and timely discharge planning.

•Conducted utilization reviews with insurance companies, optimizing patient care and resource allocation.

Alaska Regional Hospital RN, Utilization Review Nurse

8/2010 - 12/2010 Anchorage, AK

Clinical denials and appeals nurse, responsible for systemwide, retroactive medical necessity reviews.

•Authored clinical reviews for Medicare and Medicaid, as well as private insurance, securing over $7M in recaptured revenue through meticulous utilization review.

Alaska Regional Hospital RN, Clinical Performance Outcome Coordinator

7/2008 - 8/2010 Anchorage, AK

An integral part of the Quality Department team, reporting directly to administration.

•Pioneered Core Measures clinical quality improvement initiatives, enhancing hospital compliance and performance metrics.

•Reviewed, collected, abstracted, analyzed, and reported data to governing agencies.

•Developed and implemented action plans based on data analysis, driving continuous improvement in clinical quality.

Alaska Regional Hospital RN, Charge Nurse (Cardiovascular Services)

8/2006 - 7/2008 Anchorage, AK

Provided all aspects of nursing care according to the standards of nursing practice and established policies and procedures.

•Directed nursing care for cardiac and vascular telemetry-monitored patients, ensuring adherence to established standards and procedures.

•Managed nursing staff, fostering a collaborative and efficient work environment.

Memorial Hospital Gulfport RN, Charge Nurse (Medical/Surgical Telemetry)

7/2005 - 8/2006 Gulfport, MS

Provided all aspects of nursing care according to the standards of nursing practice and the facility’s established policies and procedures.

•Provided comprehensive nursing care for medical and surgical telemetry-monitored patients, prioritizing patient safety and quality care.

•Led a team of medical professionals, enhancing team performance and patient outcomes.

Providence Alaska Medical Center RN, Charge Nurse (Telemetry/Cardiac, Medical/Surgical & Renal)

6/2002 - 7/2005 Anchorage, AK

Provided all aspects of nursing care within established policies, procedures, and professional standards of care.

•Delivered high-quality nursing care to a diverse patient population, including medical/surgical and renal telemetry patients.

•Coordinated staff assignments for admits, discharges, and transfers, optimizing patient flow and care delivery.

Alaska Heart Institute RN, Anticoagulation Specialist

10/2001-08/2002 Anchorage, AK

Anticoagulation management of all aspects of this point of care clinic to meet the needs of patients, payers and physicians.

•Managed anticoagulation care for over a thousand patients.

•Provided patient assessment, education, Protime evaluation, anticoagulation dose adjustment, and crisis intervention.

•Developed quality assurance strategies and patient education materials and programs.

•Implemented and utilized DuPont’s CoumaCare software for data tracking and case management.

•Instrumental in the development of their new point of care clinic.

The Heart Center, P.C. RN, Anticoagulation Specialist

11/1998-08/2001 Huntsville, AL

Anticoagulation management of all aspects of this point of care clinic.

•Anticoagulation management and care coordination of over eight hundred patients.

•Provided patient assessment, Protime evaluation, anticoagulation dose adjustment, patient education and crisis intervention.

•Supervised clinic operations as well as data entry personnel.

•Hosted a patient education seminar on anticoagulation therapy funded by a grant from DuPont.

St. Joseph’s Hospital RN, Charge Nurse and Discharge Educator (Surgical Telemetry Step-down)

08/1995-05/1998 Lexington, KY

Provided all aspects of nursing care according to the standards of nursing practice and established policies and procedures.

•Provided comprehensive nursing care for pre and post-operative open-heart surgery and some medical telemetry-monitored patients, prioritizing patient safety and quality care.

•Provided Discharge Education, in the form of classroom instruction for all open-heart surgery patients and their families.

•Coordinated staff assignments for admits, discharges, and transfers, optimizing patient flow and care delivery.

Care Tenders of the Bluegrass RN, Home Health Care

07/1994-08/1995 Lexington, KY

Provided all aspects of nursing care according to the standards of nursing practice and the established policies and procedures for homebound medical patients.

•Provided case management and in-home care for approximately thirty patients.

•Developing and revising multidisciplinary care plans in accordance with Medicare guidelines.

•Responsible for patient assessments, treatments, and evaluating outcomes. As well as coordinating healthcare services.

St. Joseph’s Hospital RN, Charge Nurse (Orthopedic and Neurology Post-op Unit)

08/1993-06/1994 Lexington, KY

Provided all aspects of nursing care according to the standards of nursing practice and the facility’s established policies and procedures for medical and surgical telemetry-monitored patients.

•Preoperative and postoperative care of orthopedic and neurological patients, with some overflow pediatric patients as necessary.

•Coordinated staff assignments for admits, discharges, and transfers, optimizing patient flow and care delivery.

Central Baptist Hospital RN, Staff Nurse (Surgical Telemetry Step-down)

11/1991-08/1993 Lexington, KY

Provided all aspects of nursing care according to the standards of nursing practice and established policies and procedures for medical and surgical telemetry-monitored patients.

EDUCATION

MIDWAY UNIVERSITY: Bachelor of Applied Science (BASc), Nursing

LICENSES & CERTIFICATIONS

Registered Nurse

CCM Certification

ACDIS-Approved CDI Apprentice

BCLS Certification

Unrestricted License in Alaska

Unrestricted License in Washington

PROFESSIONAL AFFILIATIONS

Alaska Nurses Association Member 2005-present

Alaska Department of Labor & Workforce Development Member 2001-present

CCMC Member 2020-present

ACDIS Member 2022-present

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