Jama Back

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

Aurora, CO, *****

765-***-****

ad4b4n@r.postjobfree.com

SUMMARY

Versatile, innovative business professional with experience in case management, critical care, consulting project management, contracting, training, and clinical knowledge. Strong communication skills with ability to facilitate collaboration among co-workers and clients in a team-oriented atmosphere, expressing ideas effectively in individual and group situations. Project management experiences include goal setting investigative interviewing/listening, data analysis with clinical/financial implications, communication and education plans. Demonstrated ability to translate visionary, abstract ideas into concrete, strategic materials. Background and abilities include:

EDUCATION

Master of Business Administration

Indiana Wesleyan University, Marion, Indiana

Master of Arts, Nursing, Advanced Medical-Surgical/Critical Care and Education

Ball State University, Muncie, Indiana

Bachelor of Science in Nursing

Ball State University, Muncie, Indiana

PROFESSIONAL EXPERIENCE

DENVER HEALTH AND HOSPITAL AUTHORITY, Denver, CO, (2021-PRESENT)

Manager of Care Coordination

Management of a staff of Registered Nurses that provide Utilization Review and Care Coordination throughout the hospital.

Provided leadership and guidance to a staff of 12

Managed a reorgination from the dyad to the triad model

Oversight of the entire reorganization process

Reorganized the entire Care Management department, including developing job description and workflows for all positions

Hired and trained all Registered Nurses for both UM and Care Coordination

Re-engineering of staff activities for implementation of best-practice techniques with variance analysis, to optimize key clinical and financial outcomes

KAISER PERMANENTE-COLORADO REGION, Denver, CO, (2019-2021)

Manager of Care Coordination, Integrated Care

Management of a staff pf 70 Registered Nurses, Social Workers and Medical Assistants that were imbedded in the Clinics to provide ongoing Care Coordination.

Provided leadership and guidance to a new staff of over 70

Managed both Complex and Integrated Care Managers

Oversight of Population Health Management as it relates to NCQA

Reorganized the entire Care Management department, responsibility included 13 clinics in Southern Colorado

Managed the duel eligible population regarding Medicare and Medicaid population

Designed and implemented the prevention programs across Colorado

KAISER PERMANENTE-COLORADO REGION, Denver, CO, (2015-2019)

Quality Review Coordinator, Quality, Risk and Patient Safety

Management of quality of care complaints as they relate to physician peer review and system opportunities, Oversight of NCQA standards as they relate to quality and Population Health. Coordinates quality, accreditation, and regulatory measures for the region. Educates physicians and staff regarding peer review, facility and physician credentialing.

Reviews and analyzes all quality of care complaints

Over sight of peer review assuring all regulatory compliance

Implementation and education of safety platform, Safety Connect

Manages and responds to all Medicare, (Kepro) complaints and appeals

Over sight of the Complex Case Management program, as relates to NCQA

Oversight of Population Health Management as it relates to NCQA

Credentialing for all contracted facilities with Kaiser

Over sight of Population Health as it relates to NCQA

PARKER ADVENTIST HOSPITAL/CENTURA HEALTH SYSTEM, Parker, CO, (2014-2015)

Medical Necessity Manager/Case Management

Administration and management of the Medicare and Medicaid RAC (Recovery Audit) appeal process and implementation. Developed and managed a robust denial process with increased fiscal return for the hospital Responds to level of care denials and medical necessity denials through formal written appeals. Provides education and ongoing training to physicians, and Case Management staff. Provides leadership to Case Management regarding fiscal management of Medicare/Medicaid reimbursement. Manages all denials to determine medical necessity and level of care.

Maintains rapport with physicians, and hospital staff to provide leadership and education

Utilize clinical skills in reviewing and interpreting clinical criteria

Develop and implement appeals process and procedures

Re-engineering of denial activities for implementation of best-practice techniques with variance analysis, to optimize key clinical and financial outcomes

Creates and maintains an environment that encourages personnel toward innovative, effective and efficient practices that enhance patient outcomes and positive fiscal outcomes for the hospital

UNIVERSITY OF COLORADO, Aurora, CO. (2012-2015)

Manager Case/Utilization Management

Administration of all phases of Case Management including the planning, organizing, coordinating and monitoring of the services and resources needed to respond to an individual’s health care needs, promoting quality, cost-effective outcomes. Manages the entire Care Coordination department daily which includes preadmission to discharge. Advocates for and allocates available resources to promote efficient, effective, oversight and execution of professional case management and utilization review. Manages a staff of 35 Case Managers and administrative support staff.

Manage and implement the care management process

Researches and suggest implementation of appropriate Care Coordination tools and techniques

Implemented a financial registry for long stay patients

Re-engineering of staff activities for implementation of best-practice techniques with variance analysis, to optimize key clinical and financial outcomes

Creates and maintains an environment that encourages personnel toward innovative, effective and efficient practices that enhance patient outcomes

Implemented change from InterQual to MCG clinical guidelines via Morrisey software

UNIVERSITY OF COLORADO, Aurora, CO. (2012-2013)

Case Manager, Cardiology Step-down Unit and Cardiac Critical Care

Collaborates with the health care team, patient, vendors and families to assess, plan, implement and evaluate opportunities and services to enable to the progression of clients across the continuum of care. Responsible and accountable for coordination of services through an interdisciplinary process that provides a clinical, financial, and psychosocial approach. Balances individually identified patient and family needs with the efficacious and cost-effective utilization of resources.

Manage and implement the care management process

Develop and implement length of stay and resource reduction strategies

Coordinate and plan the discharge planning process

Perform and implement the utilization review process

Provide education to clients, physicians, multidisciplinary team and the community

Provides coordination of care and services across the continuum

Acts as a leader in facilitation of effective cost and quality of patient outcomes

Coordinate with external regulatory agencies in all issues relating to utilization management

Second level review for utilization review

Co-chairman of Utilization Review Committee

VISTA EAST MEDICAL CENTER, Waukegan, IL. (2008-2012)

Case Manager for Critical Care and Interim Director

Collaborates with the health care team, patient, vendors and families to assess, plan, implement and evaluate opportunities and services to enable to the progression of clients across the continuum of care. Responsible and accountable for coordination of services through an interdisciplinary process that provides a clinical, financial, and psychosocial approach. Balances individually identified patient and family needs with the efficacious and cost-effective utilization of resources.

Manage and implement the care management process

Coordinate and plan the discharge planning process

Perform and implement the utilization review process

Provide education to clients, physicians, multidisciplinary team and the community

Provides coordination of care and services across the continuum

Acts as a leader in facilitation of effective cost and quality of patient outcomes

Coordinate with external regulatory agencies in all issues relating to utilization management

Develop length of stay and resource reduction strategies

Interim Director for 12 months

ABBOTT LABORATORIES, Abbott Park, IL, HOSPIRA Inc. Lake Forest IL (1994-2006)

Infusion Therapy (Medication Management Systems and Critical Care) Senior National Sales Trainer/Manager (November 2001-2006)

Provided expertise and training to entire sales force on all Electronic Drug Delivery and Critical Care products.

Collaborated with Infusion Therapy Marketing teams to identify training needs within the sales force

Developed training materials to enhance Infusion Therapy representative’s product knowledge

Developed and implemented sales training programs and materials for new products launches within the Infusion Therapy Division

Educated new sales on Infusion Therapy and Critical Care product line

ABBOTT LABORATORIES, Abbott Park, IL (1994-2006)

Contract Marketing Solutions and Equipment and Electronic Drug Delivery Analyst (May 1999-November 2001)

Responsible for all contracts, pricing and representative support and coaching in 3 areas

Successfully implemented department goals by accomplishing HPD sales and goals via interaction with National Account Managers, Integrated Systems Executives, Divisional Managers, and field sales personnel

Contributor to key management decisions by providing analyses and support for Consorta $100 million in Solutions and Equipment and Electronic Drug Delivery business

Completed core management training courses

Training new Infusion Therapy representatives on interfacing with Contract Marketing and contract awareness

Peri-Operative Specialist, Sacramento, CA (October 1999- May 2000)

Provides expertise on a variety of anesthesia drugs, to physicians, nurses, and pharmacists in the Sutter hospitals. Responsible for management of business units, to meet and exceed all quotas. Advises sales and marketing regarding therapeutic trends impacting the product lines. Maintains good customer relationships, increasing sales and profits of the division.

Managed 24 accounts with a sales volume of $3 million

Finished in top 5% of sales force in 1999, at 30% above annual quota

Excellent rapport with physicians, pharmacists, and materials managers

Strengths include successful contract negotiation, financial skills and computer literacy

Project Manager, Sacramento, CA (July 99-October,19 99)

Assured successful conversions of 54 Consorta hospitals reporting to Area Sales Director.

Coordinated and assisted with product cross-references, IV assessments and staff requirements for all conversions.

Developed tracking form to monitor conversions reporting weekly to Area Sales Director.

Assisted with training for conversions at National meeting, participating in IV Conversion Simulation team.

Electronic Drug Delivery Specialist, Sacramento, CA (1996-1999)

Provided expertise and support to the sales team in promoting and selling Electronic Devices. Responsible for management of business unit, to meet and exceed all sales quotas.

Exceeded all sales quotas by 30% through maintenance of base and development of new business

Developed contractual agreements requiring a knowledge of cost analysis and creativity

Achieved impact goals by taking initiative to influence events to achieve goals

Managed multiple projects and accounts by determining priorities and evaluating progress

Developed Skills Lab Format for product education, which decreased district manpower hours for education and follow-up by 50% per project by increasing retention of information

Advised sales and marketing regarding therapeutic trends impacting the product line

Coordinate and implement all pump placements, providing education and follow-up

Clinical Nurse Consultant, Indianapolis, Indiana (1994-1996)

Provided consultative support of sales representatives and external customers throughout Indiana and Michigan on product choice and product implementation. Conducted clinical assessments for value analysis with financial implications. Managed activities in an environment challenged to “do more with less, in less time”.

Developed individualized clinical assessment goals and recommendations in conjunction with GPO contracts; resulting in customer satisfaction and greater contract compliance

Created workbooks for communication, clinical assessments, and product implementations which resulted in customer satisfaction and greater understanding of change process

Provided support in product placements/introductions where specific clinical expertise was essential to make the customer connection

Increased sales and profits of the division establishing and maintaining good customer relations

METHODIST HOSPITAL, Indianapolis Indiana (1991-1994)

Manager, Cardiovascular Critical Care Unit

Provided leadership and clinical support to staff in a 22-bed critical care unit. Position required interfacing with multiple disciplines, physicians, and external customers, requiring ability to simultaneously manage multiple clinical situations, and conflicts.

Developed scope of care, goals and objectives for Continuous Quality Improvement for JCAHO accreditation

Elected officer of Patient Care Managers

Developed tool for time management used for time study project as a part of Patient Care Manager task force

Provided care for Post-bypass, trauma, heart and lung transplant patients

Numerous years of critical care experience before 1991-available upon request

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