Case Manager Management
Resume:
Deborah K. Unversaw, RN, MBA, CCM
RN License #***13758A
Bloomington, IN 47408
Vision: I am looking for a company to provide my vast nursing experience and enhance my
continuing education. I enjoy challenges and helping to expand healthcare in its every evolving
dynamic structure.
QUALIFICATIONS
42 years as a Licensed Nurse
Certified Case Manager (Case Manager’s Society of America)
8 years Acute Care Utilization/Case Management
23 years in the Insurance Industry doing Utilization Review/Case Management
Implemented 3 Utilization/Case Management programs, acute settings
Implemented and Managed an Internal Medicine Physician Office and Family Practice
Work compensation and Mental Health /Substance Abuse UR/Case Management
WORK HISTORY
August 2,2021-Current: PayerCompass/ZELIS, RN Case Manager.
UM/CM for TPA’s.
Managing 60-70 cases per month.
Average cost savings of $354,761.46.
Turn around time for utilization less than 8 hours.
Audits at greater than 90%, goal at greater than 90%.
Assessments done in 30 days’ time frame consistently.
Bill time 182 hrs per month, with goal at greater than 100 hours.
Clinical Assessment of policies and procedures.
Milliman Care Guidelines, NCCN guidelines utilized.
Jan 16, 2018 -April 2021: Anthem Blue Cross, RN National Commercial Accounts Case Manager/SR
Case Management, Disease Management, Complex Case Management
Feb 25, 2019, IHM-FedEx: National IHM Atlanta
Milliman Care Guidelines/NCCN utilized.
July 7, 2014-January 1, 2018: SIHO Insurance Services, RN Case Manager/
RN Utilization Review Nurse (for TPA accounts with >35,000 lives)
2017 CASE MANAGER FOR THE TEAMSTERS ACCOUNT > 3000 LIVES
Preceptor for new employees
RN Medical Management for TPA accounts
WC City of Bloomington 700 lives
Psych Medical Management
Monthly Reports
Continuing Education
Milliman Care Guidelines/NCCN utilized.
December 12, 2011- June 30,2014: Dr. Kristina Morris, Family Eye Care, Billing, and Insurance Specialist
All aspects of physician billing and insurance coordination for Office Visits
Daily Chart Audits
Monthly billing and Collections
Credentialing
Compulink Resource for the office (EHR)
June 2011-December 28, 2011: IU Health Southern Indiana Physicians, Clinical Coordinator
Staff Scheduling
Ordering Supplies
Staff Training
Electronic Health Record Training
October 2010-July 2011: Indiana University School of Optometry, Bloomington, Billing Support Specialist
Filing of claims with Anthem, Medicare, and Medicaid
Customer Service Calls and Problem solving
Collected from Anthem with re-billing corrections thousands of dollars
Temporary/Hourly position
November 2009-September 2010: Visiting Nurse Service, Morgan County Branch, RN Case Manager
Home health care that involves teaching, PICC line care, IV care, wound care, wound vacs and disease management for teens through Senior’s.
Traveling over 5 counties, over 2,000 miles per month.
Branch closed in December 2010.
September 2007-November 2009:Golden Living Long Term Care Healthcare Center, Director of Clinical Education and Staff Development/MDS Coordinator
Aspects of job included duties in Human Resource development and clinical
education for the staff as Director of Clinical Education.
Training of CNAs for Electronic Medical Records
Nursing assessments for Medicaid and Medicare per MDS standards for billing
Purposes and care planning the individual resident’s needs.
Successful survey team member. Represented Education and Staff Development
Helped gain 2 x reimbursements as MDS coordinator for Medicare and Medicaid
Patient’s.
Successful State Board of Health Survey
Successful Chart Audits by State Board while under MDS Coordinator position
Instructor for CPR/AED/First Aid and clinical education for staff
April 2007-September 2007: Monroe Family Practice, RN Practice Manager
Started the Monroe Family Practice with two physicians. All aspects of office
management responsibility and start up including physician recruitment.
Position was dissolved when several contracted physicians decided not to re-locate
to Bloomington, IN.
Cared for all age groups in this family practice
September 2006-April 2007:Monroe Hospital, Director of Utilization Review Coordinator/Case Manager
Started the UR/CM program for the new hospital in Bloomington, IN
Set up policies and did insurance review as well as quality indicators for quality
management and financial reports.
Also was the Interim Director of the Medical Surgical Unit and developed and
opened the Progressive care unit.
July 2001-September 2006: Bloomington Hospital and Healthcare System, Staff/Charge Nurse
Critical Care Unit/Cardiovascular Recovery Unit
Helped originate the Cath Lab pre/post op area on 3 NW.
October 1997-July 2001: Morgan County Memorial Hospital, Director of Utilization/Case Management Department.
Implemented and designed Utilization/Case Management Program at MCMH.
Instituted Clinical pathways for Medical/Nursing Staff, a designee on the Clinical
Performance Improvement Committee and instituted the Multi-disciplinary
Committee.
Infection Control Surveillance Officer and Mortality Review
Coordinator, Employee health and Infection control officer as needed.
Assisted with Social Service duties when needed and helped with Joint Commission
Survey.
Jan.1995-October 1997: Anthem Health of Indiana, Disease State Management Coordinator for Asthma
Developed and implemented the Asthma case management program for the state of
Indiana for Anthem Health for infant through senior’s age groups.
1995-1996: Heritage Indiana Medical Group, Director of Utilization/Case Management Department.
Implemented case management department and managed seven employees. Case
Management department savings of $200,000-500,000 per month.
Budget and Strategic planning for the department.
Utilized Milliman Care Guidelines and NCCN.
May 1995: Odyssey Health Consultants, RN Consultant, Development of a Managed Services
Organization in Johannesburg, South Africa
Speaker for the first meeting of The Case Manager Society of South Africa.
Instituted Case Management department in Johannesburg, SA
1994-1995: Hospice of Indianapolis, Provider Relations Coordinator
Interacted and influenced the referral patterns of healthcare professionals in
Hospitals, home health agencies, nursing homes and private practice of physicians.
Developed the Hospice program for several counties in Eastern Indiana.
1993-1994: Dialysis Institute of Indiana, Staff/Charge Nurse
Opened and managed a new facility at Northwest Indianapolis for dialysis patients. Charge
Nurse of 32 patients per 2 shifts and 11 technicians.
1992-1993: Sagamore Health Network, Utilization Review Coordinator
Utilization and case management coordination of psychiatric and medical patients.
Milliman Care Guidelines utilized. CMS and NCCN guidelines utilized.
1980-1986: 1990-1992: Wishard (Eskenazi)Memorial Hospital, Staff/Charge Nurse
Emergency Room. Level One Trauma Center.
Medical/Surgical Unit (1980-1982) that received many patients from the SICU
(1982-1985) Medical-Surgical unit, Post Anesthesia Care Unit, Staff Nurse.
EDUCATION
*Hospital Bill Review certification-1/31/23
*LNC, Legal Nurse Consultant certificate-2018
*MBA, Indiana Wesleyan University, December 1998
* BSN, Indiana Wesleyan University, May 1994
* ASN, Indiana University, May 1991
*LPN, Indiana Vocational Technical College, August 1981
CERTIFICATIONS
*CCM, # 4217766 December 2, 2015- November 30, 2025
*Certification for Care Guidelines Specialist April 18, 2016- April 18, 2018 (Milliman Guidelines)
*CPUR-1998 Certified Professional in Utilization Review
ORGANIZATIONS/ASSOCIATIONS
*American Association of Legal Nurse Consultants
*Ellettsville Mini 4-H, Co-Leader, 2007-2010
*American Nurses Association
*Member of American Association of Managed Care Nurses
*Unionville Hot-shots, Co-Leader for 4-H group
*Past Volunteer for 4-H community events
EHR SYSTEMS
Allscripts, McKesson, Compulink, New Crop, OAO, HSP, AS 400, Web-based programming, Avedon
Licensure
Indiana-compact license
New York
California
Colorado
Pennsylvania
District of Columbia
Michigan
Ohio
Nevada
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