Manager Case

Kelly L. Blanks

***** ****** **, *** ***** CA ***44

Phone: 760-***-****/562-***-****

E-mail: *************@*****.***

SUMMARY

Possesses excellent communication skills, negotiating and listening skills. Knowledgeable in use of computers, nursing skills and ability to manage patients in the utilization and discharge planning process. Working independently through communication with others to accomplish tasks and projects for the benefit of the organization and the organization’s members. Able to adapt working solely or in a team setting and flexible to change for the benefit of all. Professional attitude, trust and networking assistance with keeping open communication lines to help with the information, decision-making and problem solving.

WORK HISTORY

5/15-Current Lead Afterhours Inpatient Case Manager, Regal Medical Group, Northridge CA

Worked as Afterhours Inpatient Case Manager nightshift, weekends/holidays to provide ongoing concurrent review, discharge planning. Arrange transfers, of members from non-contracted hospitals to in-patient hospitals or tertiary level of care. Lead role includes: act as a subject matter expert to the Afterhours Team, follow up on any urgent needs, assisting with coverage of case load as needed, audits, mentoring/coach Afterhours Case Manager on critical thinking skills in determining which patients are stable for transfer vs those who are not, identify and escalate performance issues to the Manager.

9/11-5/15 Ambulatory Case Manager, St. Mary High Desert Medical Group, Hesperia CA

Screen and open members for CCM/SNP CM Program. Develop and implement care plans, educate members on disease process, caregiver resources, etc. Monitor all transitions of care and coordinate all follow up care accordingly. Make daily calls to all members seen in ER, coordinate all follow up physician appointments. Monthly Healthplan reporting.

10/03-8/11 Supervisor of Inpatient Case Management, Prospect Medical Group, Santa Ana, CA

Responsible for oversight of staff of seven, Report directly to VP of Medical Management. On-call 24/7 for all CM issues. Carry daily inpatient caseload in addition to supervisor duties. Perform concurrent review, discharge planning and obtain retro review when indicated. Indentify ad report non-payable inpatient days due to hospital delay of ordered procedures, test and hospital staffing issues. Indentify Transition of Care cases and process as indicated according to company policy. Communicate directly with the Hospitalists and Specialists to expedite patient care and progression through continuum of care

6/99-6/02 Member Services Liaison Nurse, Cigna Healthcare, Glendale, CA

Research and presentation of second level member appeals to Medical Director. This included interpretation of benefits, review of relevant medical records and application of state mandates

EDUCATION

Tri-Cities Regional Occupation Program Licensed Vocational Nursing Program.

Graduated 9/86.

California Licensed Vocational Nursing-VN 138831

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