Employee Relations Manager
Resume:
Lori L. Konopa Berbano, RN
Walnut Creek, CA ***** 727-***-**** ************@*****.***
RN Case Manager
Nursing & case management leader with 15+ years’ progressive experience including patient advocacy, care coordination, compliance, transition management, patient education, utilization management. RN Diploma, Iowa Methodist School of Nursing; pursuing BSN, (Re-enrolling in 2020); current candidate: Certificate, Clinical Documentation Specialist. Certified ACLS, BCLS, PALS.
Highlights:
Case Management Expertise: Adept at coordinating numerous elements of patient care, employing resources & services optimally; leverage fiscally-sound strategies—while maximizing patient care by working with multidisciplinary medical teams, patients, their families, insurance companies, other facilities / organizations.
Management Experience: Experience managing clinical facilities, addiction treatment, operating room, circulation, dialysis, endoscopy, hospice care settings.
Natural Leader: At Cigna, solved major non-compliance issue / liability for both clinic and Cigna by enhancing client (patient) relations—while enhancing clinic’s profitability within first 30 days, and improving resource efficiencies, employee relations.
Patient Advocacy: Skilled at knowing & anticipating patient needs, matching those needs with appropriate resources & services, encouraging teams to adopt patient’s point of view in meeting needs, responding to requests, resolving problems, initiating new services. Continually educate patients, families and caregivers on clinical conditions, proposed treatment plans.
Clinical Documentation Improvement: Work with providers & clinical staff to ensure accurate documentation of medical records; drive continual improvements in quality and completeness of medical documentation by following up to reconcile, adjust, continually enhance documentation.
Communications Leader: Superb interpersonal abilities; skilled at communicating, influencing, negotiating, facilitating, presenting—and getting others excited about implementing new ideas.
Signature Strengths:
Ensuring Quality of Care • Patient Health Assessments • Determining Level of Care • Identifying Barriers to Timely / Safe Discharge • Discharge Planning • Regulatory / Corporate Compliance • Thrive in Multicultural Environments • Cultivating Positive Cultures • Transition / Care Planning • Nursing / Case Management Code of Ethics • Medical Coding / ICD-9 / ICD-10 • Healthcare Leadership • Collaboration • Quality & Performance Improvement • Impeccable Attention to Detail • High Reliability • Medicare / Medicare Guidelines & Benefit Resources • ACOs, DRGs, Full Risk Coverage
Professional Experience
Clinical Documentation Improvement Specialist, Sutter Health; Concord, CA; Sept. 2019 – Dec. 2019
Teamed with providers and clinical staff to ensure accurate medical record documentation; employed expertise in ICD-9, ICD-10 at nonprofit healthcare provider serving 3M+ Californians. Learned new software, Nuance Clintegrity. Drove continual improvement in quality & completeness of medical documentation via analysis, refinement. Used Epic regularly.
Verified documentation, ensured appropriate services were rendered, and clinical data utilized in profiling & reporting patient outcomes was complete, accurate. Followed up to reconcile, adjust, and continually enhance documentation.
Used coding summary to accurately determine clarification-type, DRG impact.
Communicated with treating and consulting physicians, reported or referred assessment findings, obtained written, verbal or electronic clarification / action; authored queries as required.
Guaranteed compliance with CHOMP Coding Compliance Policy by partnering with staff to complete Documentation Clarification Forms.
Mentored and educated Coding staff on clinical and nursing best practices. Ensured points clarified with physician were recorded in patient record by educating staff on clinical documentation guidelines, performing follow-up reviews.
Adhered to all federal and state laws and regulations, AHIMA standards of practice.
Ensure accurate MS-DRG (Medicare Severity & Diagnosis-Related Group) and assignment by reviewing clinical issues with Coding staff.
Drove efficient, effective resolution / answering of post-discharge queries to physicians regarding clinical documentation.
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Lori L. Konopa Berbano, RN
Clinical Documentation Improvement Specialist, CHOMP; Monterey, CA; Dec. 2017 – July 2019
At Community Hospital of Monterey Peninsula, partnered with providers and clinical staff to ensure accurate documentation of medical records; used knowledge of ICD-9, ICD-10 at nonprofit healthcare provider with 248 licensed hospital beds, 28 skilled-nursing beds. Drove continual improvement in quality & completeness of medical documentation by analyzing documentation, charts. Used Epic extensively. (Same responsibilities as position above.)
Utilization Case Manager, Physician’s Medical Group; Scotts Valley, CA; Feb. 2017 – Nov. 2017
Served full-time managing cases for all specialties, conducting utilization-management via telephone & computer, and participating in interdisciplinary team conferences by analyzing documentation, consulting with staff, reviewing care plans. Performed departmental quality improvement initiatives. Managed billing, claims, insurance.
Delivered optimal patient care across healthcare continuum by coordinating healthcare providers, patients, families.
Ensured compliance group-wide by actively participating in compliance program.
Determined appropriateness of care and staff compliance with documentation regulatory requirements (Medicare Conditions of Participation, JCAHO, Title 22) by conducting regular chart audits.
Case Manager, Clinic Manager, Health Coach, Cigna; City of Clearwater & Dunedin, FL; March 2016 – Feb. 2017
Managed all cases at standalone primary care clinic with (2) providers, (6) office staff seeing 30 patients / day. Ensured patients complied with recommended treatment by orchestrating triage on front, back ends. Drove HIPAA compliance with federal, state regulations, while ensuring staff adhered to all Cigna policies, procedures, standards.
Solved major non-compliance issue & liability for both Clinic and Cigna by enhancing client relations; clearing & adjusting patient expectations for pharmaceutical dispensing.
Enhanced clinic’s profitability within first 30 days—while improving resource efficiencies, increasing census.
Fixed lingering compliant billing and pharmacy approval processes.
Resolved previous Case Manager’s noncompliance, enhanced employee relations, performance within 30 days.
Boosted accuracy of mandated reports, archives.
Served on Cigna team to identify new locations and site inspections meeting needs of patients, staff.
RN Case Manager (Contract), US Army Reserve Case Management Center; Pinellas Park, FL; Aug. 2015 – Feb. 2016
Served in civilian government contract working with Army Reserve Surgeon General’s office tailoring processes to meet needs of specific USAR wounded and ill, including working with Wounded Warriors to coordinate care.
Educated, guided, assisted soldiers requiring referrals for medical treatment, care.
Adhered to regulations on managing soldiers with medical issues / readiness.
Led intake interviews; established communications with command; wrote biweekly case reports for Surgeon General.
Travel Nurse, (various); 1997 – July 2015
Served with distinction in numerous travel nurse roles in IA, CA, AZ, NV, NM, FL, across wide variety of specialties and facilities. Details available upon request.
Licenses & Accreditation
Registered Nurse Licensures: Florida; Feb. 2012; New Mexico; July 2011; Nevada; Nov. 2006; Arizona; March 2004; California; Sept. 2002; Iowa; June 1996.
Phlebotomy Certificate, Des Moines Area Community College
Certificate, Cardiopulmonary Resuscitation for Adults & Children
Certificates: Acute Cardiac Life Support (ACLS) + BCLS + PALS
Member, AORN
Education
Pursuit of BSN, (Re-enrolling in 2020)
Certificate, Clinical Documentation Specialist, (in progress)
RN Diploma, Iowa Methodist School of Nursing
Preceptor Program, RN Trainee (Specialty: Orthopedics)
Pre-Nursing, Emphasis: Health Sciences, Drake University
Pre-Nursing: Emphasis: Health Sciences, Des Moines Area Community College
Technology
Epic, ICD-9, ICD-10, Health Information Management Systems, InterQual, Hyperspace, Allscripts*, I-Notes, CDS, 3M-360. MODS / MEDCHART,MEBITT,
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