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Nina Davis Dillard RN, BSN

Porter, TX 773**-***-***-

1979

ad4f8e@r.postjobfree.com

OBJECTIVE:

To work for a company that will offer stability and growth. WORK EXPERIENCE:

Legacy Community Health Services - Houston, TX

October 2023 to Role elimination Feb. 2024

Manager of Care Management

• Responsible for supervision of the population health team providing services to Medicare, Medicaid and self-pay.

• Ensured compliance to Value Based Contracts

• Provided supervision of the Transition of care team, Care coordination, high risk case management and chronic care case management.

• Developed training tools over EPIC system for the team.

• Developed workflows, policy & procedures for all programs & acts as a preceptor/mentor to new hires and employees

• Provided/coordinated ongoing educational programs and training. Performed quality audits.

• Assessed medical records documentation to meet coding compliance for billing.

• Audit charts and trained providers on correct billing process for care management programs.

• Utilized advanced conflict resolution skills as necessary to ensure timely resolution of issues.

• Collaborated with multidisciplinary teams to ensure care was of high quality, efficient & cost effective.

• Proactively identify and resolve delays/obstacles to improve outcomes.

• In charge of recruitment and hiring of departmental employees.

• Served as a liaison with community agencies and other organizations to assist patients with resources to improve in better health outcomes.

• Completed metrics reports monthly for upper management to show staff productivity.

• Analyze and interpret data to determine strategic needs related to targeted education\training.

• Leads weekly care coordination\care management rounds (team conferences).

• Great time management skills in working on multiple projects to completion in a timely manner. City of Houston Health Department - Houston, TX

Chief Nurse

November 2022 to November 2023

• Responsible for supervision of multiple offices servicing the community for DAWN centers.

• In charge of managing staff, Kronos, training and evaluations.

• Management of budgets and grant writing.

• Providing oversight and direction for the acute care specialty Clinic Case Management Department.

• Ensure monthly metrics reporting to city and upper management.

• In charge of outreach education and DPP, HTN and DSME classes.

• Create policies and procedures for the department.

• Collaborated with community partners to improve better outcomes.

• Ensures safe care to patients, staff and visitors; adheres to all policy, procedures and standards including time management, supply management, productivity and quality of service. Texas Children’s Health Plan - Houston, TX

Manager of Utilization Management

September 2019 to October 2022

• Responsible for supervision of inpatient department, appeals/denials department, NICU specialty, outpatient and discharge planning.

• Interviews for new hires and provide training to the team on an ongoing basis.

• Maintains and develops training tools. Ex. EPIC workflow, Quality tools etc.

• Demonstrated leadership skills. Strong analytical, data management and PC skills

• Attend MCO/State Fair hearings for service and waiver appeals.

• Responsible for inpatient and outgoing transfers from acute care.

• Experience working across multiple sectors within the healthcare industry including acute care, informatics, healthcare project management, High risk case management and utilization management, as well as clinical training.

• Create policies and procedures, job aids, and workflows.

• Maintain accountability for scheduling and staffing needs and budgetary guidelines.

• Applying highly technical principles, concepts and techniques central to the nursing profession in Care management and UM process.

• Assists in the establishment goals for performance standards.

• Approve employees time off and assignment of coverage for staff.

• Led weekly team conferences with interdisciplinary teams.

• Monitors the questions and complaints service line weekly.

• Utilized strong critical thinking and communications skills.

• Train staff on Epic usage, Interqual, and data entry to make sure we are providing the member with excellent service.

• Assess member to find out what services are needed and if denied finding out what was the reasoning for denial and inform members about appeals processing.

• Comprehensively assess members biophysical, psychosocial, environmental, discharge planning needs, clinical analysis, data report analysis and financial status. United Healthcare

Onsite Inpatient Care Manager

January 2011 to September 2019

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• Responsible for assessment, planning, implementation, coordination, monitoring and evaluation of case management services.

• Provide pertinent clinical to Medical Director to make informed decisions. Coordinated case management with interdisciplinary team members.

• Analyze member information through assessing Epic system at facilities.

• Identifies, assesses and manages medically catastrophic cases per Milliman criteria for commercial insurance members & Medicare.

• Spearheaded acute care discharge planning initiatives, coordinating seamless transitions for patients from hospital to acute care settings or home.

• Collaborates with Medical Director for coordination of care. Send out Denial letters to facilities and providers.

Harris County Hospital District

Manager of Health Services/Clinical Nurse Case Manager December 2008 to January 2011

• Responsible for the assessment, planning, implementation, coordination, monitoring and evaluation of case management services in EPIC system.

• Maintained acute regulatory compliance, staying current with guidelines specific to acute care settings and integrating them into case management practices.

• Ensured adherence to acute care standards and facilitated continuous improvement in alignment with regulatory requirements.

• Conducted comprehensive utilization reviews to assess the appropriateness and necessity of medical treatments, ensuring optimal resource utilization.

• Identifies, assesses & manages medically catastrophic cases per Interqual & Milliman criteria.

• Coordinates case management activities w/ the physicians, UM staff, hospital discharge planner, social workers, public agencies& public agencies as appropriate to ensure quality cost-effective care for the member.

• Informed interdisciplinary team and patients of denials and appeals processing.

• Regularly reviews & updates case management plans for continuity of care and facilities plan modifications including barriers to goals and interventions. PRN CHRISTAS VNA

Telemedicine Nurse/case Manager

July 2003 to August 2010

• Managed and Monitored the Telemedicine department.

• Worked with patients pending heart.

• transplants/ post transplants/oncology patients via computer network for vital signs report/ labs. Conducts chart audits and prepares reports.

• Make sure coding for ICD-9, DRG and CPT coding are accurate.

• Monitors staff and solve issues for staff in field with patient care.

• Assist staff with taking care of patients through assessment and plan of care.

• Collaborate care with the interdisciplinary team to coordinate care.

• Informed HMO/PPO, Medicare, Medicaid, workers compensation entities for patient care needs.

Houston Region Fresenius Health Plan

Manager of Case Management

January 2006 to August 2007

• Managed Houston Region Case management.

• Provided care of catastrophic case management for end-stage renal members for CMS/Medicare. Covered 25 ESRD clinics for Texas.

• Provided disease management for 187 members.

• Submitted weekly excel reports for analysis of hospital bed day improvement, cost savings, medical vaccinations, vascular access etc.

• Provided education to members with HTN, DM, Pending transplant and Asthma.

• Research and development of training modules.

XLHealth Corporation

October 2004 to January 2006

Manager of Care Management

• Managed the Central Region for disease management.

• Provided care of disease management for catastrophic diseases for CMS\Medicare.

• Provided Onsite Review at multiple facilities.

• Educated members and families on medical issues.

• Identified health risk factors.

• Coordinated outreach services.

• Exp. In research, development, implementation and management of systems training.

• Exp. In assessing all health needs of patients and making referrals.

• In charge of 3 licensed nursing staff. Provided clinical education to the team.

• Exp. in assessing pt’s psychosocial status, health needs and made appropriate referrals. United Healthcare

Clinical Care Manager-Telecommuter

January 2003 to December 2004

• Visited enrollees who required intensive medical and psychosocial support to assess healthcare needs.

• Provided onsite review of members in hospitals.

• Educated members on medical issues.

• Tile certified.

• MDS.

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HUMANA INC.

Personal Nurse\Case Manager

October 2001 to October 2003

• Onsite Review for Memorial hospital systems and Texas Children Hospital for monitoring/Overseeing the medical case management of neonates, OB\Gyn, ped’s and adults, worked closely with Medical Director, PCP’s, family and nurses to assist with d\c planning.

• Worked daily with InterQual and M/R guidelines.

• Managed complex acute care cases effectively, collaborating seamlessly with interdisciplinary teams to enhance patient outcomes.

Memorial Northwest Hospital

Case Manager

May 2000 to October 2001

• Maintained compliance with regulatory requirements related to case management, utilization review, and discharge planning, ensuring adherence to state and federal guidelines. Discharge planning, utilization management, case management, performance improvement, disease or population management, and managed care reimbursement were all effectively managed and executed. Monitored OB\NICU\Pediatrics for case management. Worked closely with interdisciplinary team. Discharge planning. Chart audits, Exp. ICD-9 coding & CPT codes. Monitored OB\NICU\Pediatrics for case management.

Worked closely with interdisciplinary team.

Discharge planning. Chart audits, Exp. ICD-9 coding & CPT codes. Columbia Healthcare Systems

Case Manager and Charge Nurse

July 1992 to May 2000

• Managed pt. hospital stays on a day-to-day basis, called clinical to providers. Worked in Case Management for pediatrics, neo and OB\GYN, Home Health, ICU, Rehab, Neuro, Workers comp., Med-Surg, OB, Pediatric, Oncology and Dialysis unit. EDUCATION:

BSN in Nursing

American Sentinel University May 2014 to August 2016 Associate degree in Registered nurse San Jacinto College May 1989 to May 1991

RN active license

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