Case Manager Health Care
Resume:
Lisa Trusler
************@*****.***
1. OBJECTIVE
To leverage my 30+ years of experience as a Registered Nurse, the majority as a Certified Case
Manager providing medical services coordination in a variety of settings and specialties, to
obtain an RN position in case management, research, utilization management, d/c planning,
InterQual reviews, care coordination, etc.
2. EXPERIENCE
Dec 2021 – Current – Molina Health Care – RN, Case Manager
Develops Care Plans for members to assure services and treatment plans meet patients' needs,
maintaining accurate daily documentation. Updates care plans every 6 months and as needed
utilizing CCA, Collective Medical, Member 360, QNXT, PEGA and Sales Force 360
Performs Health Risk Assessments (HRA) and various other assessments to determine
medical history and current status to assess care options including use of benefits and
community resources and access to services.
Acts as liaison and member advocate between member/family and providers and assists in
obtaining providers.
Assists in obtaining DME, coordinating outpatient or home health care, referring to rehab,
etc., as needed.
Sept 2015 – Mar 2016: Sentara Life Care – RN, Case Manager
Reviews clinical, financial and insurance information of patients in various Sentara
hospitals for appropriate level of care placement
Collaborates with medical team to coordinate transition of patients from hospital
setting to nursing centers for skilled nursing, rehabilitation, or long-term care
Jun 2015 – Aug 2015: St Luke’s Boise Medical Center – Travel Case Manager
Assists patients to reach optimal function in an environment appropriate for them.
Coordinates patient care from admission through discharge
Mar 2015 – May 2015: Naval Hospital Camp Pendleton, CA – Travel Case Manager
Provides case management services and extensive support to Wounded Warriors,
active-duty Navy and Marine Corps patients and their families
Advocates and facilitates extra coordination if required by providing nursing
psycho/social assessment and referrals within the military health care system
Nov 2014 – Feb 2015: Naval Medical Center San Diego – RN, Behavioral Health Care
Facilitator
Provides case management services to active-duty military and their dependents
with behavior health issues such as depression, anxiety, and PTSD
Assists the Internal Behavioral Health Consultant and the PCP daily as needed
Provides medication management by tracking medication adherence, side effects etc., and
follows up with these patients via in-person visits and weekly phone calls
Aug 2014 – Nov 2014: Christus St. Vincent Regional Medical Center, Santa Fe, NM - Travel
Nurse Case Manager
Performs clinical assessments of patients and provides d/c planning, coordination of
home care, rehabilitation, medical equipment, wound vacs, home 02, etc., prn
Participates in long term stay rounds to ensure patients have definitive d/c plans
Corroborates with MD's, SW's, PT's, etc., providing a team approach to pt care
Mar 2014 – May 2014: Atrium Medical Center, Corinth, Tx – Travel Case Manager
Coordinates, monitors, and ensures appropriate and timely primary, acute, and long-term care
services are provided to members across the continuum of care
Attend daily rounds to manage pt treatment plans, length of stay, and d/c planning
Provide daily clinical reviews to managed care insurance companies, Medicare, and
Medicaid utilizing Allscript’s Canopy for reimbursement purposes
Feb 2012 – Oct 2013: WellCare Health Plans, New York, NY – Nurse Case Manager
Develops Care Plan and interacts regularly with providers and member/family to assure
services meet patients' needs, maintaining accurate daily documentation.
Determine medical history and current status to assess care options including use of benefits
and community resources and access to services.
Acts as liaison and member advocate between member/family and providers.
Assists members in transitioning to and from nursing and residential facilities. Coordinates
hospital discharges with SW and hospital CM
Dec 2010 – June 2011: St Luke’s Hospital, New York, NY – Utilization Review RN
Perform assessments of patients, review patient charts, and collaborate with
physicians, floor nurses, physical therapists, and social workers
Provide daily clinical reviews to managed care insurance companies, Medicare, and
Medicaid utilizing Allscript’s Canopy for reimbursement purposes
July 2006 – Apr 2010: Lenox Hill Hospital, New York, NY – Nurse Case Manager
Managed in-patient cases rotating to every unit in the hospital including ICU's
Perform assessments of patients, provide discharge planning, refer patients for
home care, rehabilitation, durable medical equipment, wound vacs, home 02, etc.
Attend daily rounds with Residents, Social Workers, Home Care Consultants,
Physician Advisor, Physical Therapists, and dietitians to manage patient treatment
plans, length of stay, progress, and d/c planning needs
Provide daily clinical reviews to managed care insurance companies, Medicare, and
Medicaid utilizing Allscript’s Canopy for reimbursement purposes
Monitor patients diagnoses, progress and treatment response to procedures,
surgeries and lab results from admission through discharge. Discuss findings and
coordinate care daily with physicians and team to ensure timely quality care
Dec 2004 – June 2006: Option Care, NY, NY – Home Infusion Company RN Liaison
Coordinate definitive plan for infusion services prior to d/c to meet patient needs
Educate patients and caregivers regarding infusion policies and administration of
infusion therapies, initiating clinical consultation as necessary with physicians
Coordinate provision of various intravenous and enteral therapies
1.
May 2004 – Nov 2004: MedSource, Richmond, VA – Clinical Research Coordinator
Worked with pharmaceutical industry and principle investigator focusing on Phase I,
II, III, and IV clinical research studies.
Recruit and enroll study participants and perform procedures required by the
protocol. Schedule all study related visits and monitor compliance
Control and dispense study drugs to participants. Maintain drug accountability log
Ensure strict adherence to protocol, the accuracy of data collection and data
transcription to case report forms
Submits relevant data to the IRB re: initiation, progress, termination of the study,
adverse events, periodic and final reports, and changes to the research protocol
Oct 2003 - Apr 2004: Carolina Case Mgmt, Raleigh, NC - Nurse Case Manager
Medical services coordination for insurance companies, specializing in WC.
Traveled to hospitals, PT clinics and physicians’ offices to discuss medical cases,
length of recovery and secure recommendations for treatment programs.
Excellent rapport with MD specialists to gain information for claims adjusters.
Travel to claimants’ homes to conduct initial medical interview and monitor their
treatment plan and progress until return to work or MMI is achieved.
Met with employers at the job site to perform job analysis, obtain job descriptions
and develop strategies to expedite return to full or modified duty.
Coordinated FCE's, IME's, 2nd Surgical Opinions, Peer Reviews, Home Care, PT
Apr 2001 – Oct 2003: ROI, Genex Services and Independent Consultant, Virginia Beach,
VA – Nurse Case Manager
Same as above position. Consistently exceeded monthly production goals
Apr 1994 - Apr 2001: Crawford & Company, Virginia Beach - Nurse Case Manager
Same as above. Promoted to senior consultant after 1 yr, training new employees.
Sept 1993 – Mar 1994: EVMS Research Center, Hampton, VA – Research Nurse
Prozac/Weight Loss 6 month research study entailing great attention to detail,
patient assessments, documentation and excellent IV Therapy/Phlebotomy skills
May 1988-Aug 1993: Sentara Norfolk General and Leigh Hospital, Norfolk, VA-RN
Completed 6 month critical care internship. Alternated between ICU step-down
units: Tele/Cardiac, Neuro, Vent/Respiratory, Med/Surg, Burn/Trauma and Ortho
EDUCATION
Bachelor of Science in Nursing, West Virginia University 05/08/1988
Certified in Case Management, PRI’s, InterQual, Allscripts/Canopy, ECIN, Cerner
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